RISK -New providers and their interactions with clients and also health workers.Bwiti – must be mentioned as there are risks around sustainability and the culture must be respected and honoured.
T & C - Personal issues not resolved creates reactionary transference. S.D - Using your own experience in empathy or to increase alliance, not in ‘war story’ or ego driven. S - Always be open to advice or critique and above all support and growth. N.B – Some clients want to wait but don’t know how, saying yes and potentially compromising protocol coz you want to ‘do good’ can ‘do harm’. R – will speak a bit further on that next and also assessment.
When I talk about the rescuer I am referring to the Karpman Drama Triangle. This involves a persecutor, rescuer and a victim. This is the triangle we want to work hard at staying out of !!
Unresolved issues can leave us in the drama triangle vulnerable to our clients persuasion. P ‘you remember what it was like’ V ‘if I don’t do this I just might die’ V ‘if this doesn’t happen next week I will lose my …..’ R ‘if anything goes wrong I will take all of the blame’
Working within the system (infiltration) increases progress. In my own training and self directed learning I have worked at the salvation army, moana house continuued care and currently at the local needle exchange as the free counsellor.
Respect for human dignity,Beneficence (doing good) and non-maleficence (avoiding harm),Confidentiality and privacy,Trust,Promotion of autonomy,Honesty & Integrity,Fairness,Skilfulness,Professionalism,Cultural praxis
The practitioner carries personal responsibility and accountability for his or her own ethical practiceMaintains competence by continual learning. ability to provide care is not compromised or brought into disrepute. keen awareness of crucial ethics principles and/or core values.2. promote an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected and upheld.3. determines and implements acceptable standards of ethical practice, management, research and education. Is active in developing a core of research-based professional knowledge. The practitioner, acting through an appropriate professional organisation, participates in creating and maintaining equitable social and economic working conditions.
Refer to Kamlet – assess, assess, assess
When working with one individual away from their environment you lose the capacity to heal whanau/family and social issues. In fact these can be further damaged by one using ibogaine due to lack of awareness around ibogaine.
We can look at 2mrw, ‘ok let’s make some $’ or we can look at 10 years time when solid and consistent practise protocols are well established. This ensures that ibogaine provision will be around for future generations to benefits from.
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What is the most important thing in the world? It is people! It is people! It is people! And what do people need to sustain life, the plants. We must keep this in mind when working with a sacrament such as iboga.
October 5 - Tanea Patterson
Ibogaine Aotearoa/NZ A Path to Integration withConsiderations on Assessment & Risk By Tanea PatersonDirector/Provider Ibogaine Aotearoa Charitable Trust I.ACT Applied Addictions Practitioner DAPAANZ Registered
"E nga mana, e nga reo, e nga waka, e taunei.”To all the chiefs, all the dialects, all thewaka that have gathered here.
Ko Tinana toku wakaKo Hereweka toku maukaKo Mata-Au toku awaKo Tanea Paterson toku ikoaNo Otepoti ahauNo reiraTena koutou, tena koutou, tena koutou katoa
Tanea Paterson• Born in Otepoti/Dunedin• Spanish, Scottish and English• Two Sons, Josef 13 and Salem 8• Solo Mum/Student for 13 years• Methadone program for 7 years, 6 years free• Qualified Addiction Practitioner
• 2008-09 Certificate in Health at Otago Polytechnic• 2009 Ibogaine Fora North & South Island• 2011 Set up Ibogaine Aotearoa Charitable Trust or I.ACT• 2011 Attended Cutting Edge National Addiction Conference & won award for my poster• 2011 Voluntary intern at Salvation Army ‘drop in centre’• 2011 Registered as an Addiction Practitioner with DAPAANZ• 2012 Completed Te Taketake Applied Addictions Practitioner Paper through Moana House• Current - Work at DIVO Dunedin IV Organisation• Comprehensive 1st aid and level 4 Resus Certification
Risk ManagementWhat Risk?• Provider• Client• Movement• West Africa – culture & resources
Addiction Training and the Importance of Personal Growth• Transference and Countertransference• Self Disclosure “who is benefitting from it?”• Supervision (not limited by geography)• Naïve Benevolence – doing goodwill without considering potential risks. When it is ok to say no or not yet• ‘Rescuing’ without proper assessment. (Karpman Drama Triangle, 1968)
Rescuers get caught up in enabling.Doing too much for someone else isrationalized because "I care so much."Rescuers are often unaware that pity anddisrespect are the fuel for this role. "Iknow whats best for you.” (thus movinginto the persecutor role)Backing up from the rescuer role meanslearning that indifference can be a usefultool.Wait and see if the person you’re trying torescue steps forward for themselves,increasing self efficacy on the way.
So next time you feel that brief flash of irritationat the start of a conversation or are left with anegative feeling after a conversation just stopand ask yourself “Was I just sucked into aDrama Triangle?” and then consider thequestion ”And to what extend was Iunconsciously colluding?”. The tactic to avoidthe Drama Triangle is to learn to recognise theemotional “hook” that signals the invitation toplay the Game; and to consciously deflectit before it embeds into your unconsciousmind and triggers an unconscious, habitual,reflex reaction. Anyone able to “press yourbutton” is hooking you into a game.
Priorities for Providers to Reduce Risk to Self and Others• Education, research and self growth‘having a baby does not make you amidwife’• Bwiti Tikanga, respect and knowledge of West Africa and source of the medicine we use• Negative thinking towards ‘the system’ slows progression
Ibogaine Therapy Integration NZ• The Feb 2010 scheduling of ibogaine as a non-approved prescription medication allows integration into health services• Prior to this ibogaine was ‘underground’ therefore often dismissed by healthcare providers• Exposing clients to risk -uninformed primary health workers = unsupported clients• Ibogaine is ONE part of a therapeutic plan
Developing and Maintaining Trust with Existing Health ServicesConsistency of• Provision• Protocol• ProfessionalismTransparency of practice
Code of Ethics DAPAANZ Example Drug and Alcohol Practitioners Association of Aotearoa/NZTHE DAPAANZ CODE – THE MAIN ETHICALPRINCIPLESIn the DAPAANZ Code there are 10 mainprinciples and/or core values.
Structural and Core Elements DAPAANZ1. Self responsibility and practitionerstatus2. Responding to clients and community3. Professional practice within agenciesand organisations
Assessment – Why Do It• Who is this person?• How can we best serve their needs?• How is their mind, body, spirit and social network.• Minimum of 6 assessment/counselling/preparation sessions pre ibo
The Importance of Assessment• Builds therapeutic alliance• A holistic picture of the client enables a more individualized therapy plan• Identifies strengths and build on these for increased sense of self worth & efficacy• Identifies history and extent of drug use and this also allows for opportunities to increase the clients’ awareness around substances• Can be therapeutic in itself, allows for reflection and communication with whanau
Western Model vs Eastern Orthodox/Maori Model Western - Humanity in Eastern - Humanity & control our relationship with the universe• Relationship to the issue • Relationship to each other• Scientific explanation • Spiritual explanation• Evidence based • Nature of breach intervention (imbalance)RealignmentScientia - Takes a Snapshot, Spirituality - Moving Model,Seeks Answers Seeks questions
Te Whare Tapa Wha (Durie, 1982)• A model of Maori health• Allowed Maori to reclaim a sense of ownership over health• Shifted away from a focus on disease and medical expertise• Recognised health as a balance between wairua, hinengaro, tinana, whanau, the four walls of a house• Used within areas of health, education and social services in Aotearoa/NZ
Balancing WellnessAs in Te Whare Tapa Wha all four areasmust be consideredIbogaine alone has the capacity to healphysically, spiritually and psychologicallyto an extent.It doesn’t change the person’ssocial/whanau interactions.
Taha Tinana - Body• Medical/physical exam• Exercise• Illness• Supplements• Diet• Physiological sensitivity to ibogaine• Mind body link• Overdose, using during tx or directly after‘Break up sex’
Taha Hinengaro - Mind• Psychiatric assessment/meds• Counsellor/therapist engagement• Fears listened to• Hopes listened to• Reassurance• Cognition and thoughts• Understanding and acceptance of process• Motivational Interviewing & Relapse Prevention Plan
Taha Whanau – Family/Social• Genogram/genetic predisposition• Who know’s? Who cares?• Work/education• Whanau inclusive practice = support, education & therapy• Communication• Relationships, respect. Reduce stigma• Aftercare & Social participation
Taha Wairua - Spirit• Beliefs and how they can be supported throughout therapy• Values• Rituals• Reassurance, Dignity and Respect• Cultural identity• Personal contentment• Spirituality• Stages of Change, Prochaska & DiClemete
Considerations on Assessment and Alliance• Surroundings, compliance more likely in a clinical setting – go for a walk• Senses, Cognition – does the person really understand. Have they had enough time to ask questions?• Negotiate access to substances during tx (inc cannabis, cigarettes, supplements)• Paradoxical effect of medications i.e benzodiazapine
Honouring Origins by Assessment “initiatory process in addiction therapy”• Spending the time with people prior to therapy not only builds trust and truth, it also allows greater respect for iboga/ibogaine (minimum 6 weeks)• I see assessment and therapy planning as a kind of initiatory process• This time spent prior to ibogaine increases long term efficacy thus lessens the amount of ibogaine used – sustainability
Importance and Benefits of Integrated Care• Assessment and Therapy Planning• Common language and synchronized therapy plans within sector• Insight and understanding into existing services for individual needs when planning• Legitimacy and availability of ibogaine therapy grows with awareness and commonality of care• Best Practice
Why Follow Best Practice? Cui Bono? To whose benefit? Who profits by it?
~50yrs on - Many ‘mistakes’ have been made, all with good intentions, tohonour those pioneers we should not be making the same mistakes. We, and future generations of providers and healers, therefore clients, all benefit from Best Practice.
Creative Commons Potential• Creative Commons for collective input from providers• “Our vision is nothing less than realizing the full potential of the Internet — universal access to research and education, full participation in culture — to drive a new era of development, growth, and productivity.”
He aha te mea nui o te ao?He tangata! He tangata! He tangata!
Further Reading….• DAPAANZ Code of Ethics• Karpman Drama Triangle• Te Whare Tapawha Maori Model, Durie• Relapse Prevention Planning, Marlett & Gordon• Motivational Interviewing, Miller & Rollnick• Stages of Change, Prochaska & DiClemente