1. The Power of Family Integration &
Natural Supports: Creating &
Educating Recovery Teams
North Carolina Recovery Conference
November 14, 2014
Ellen Howe, Chris Mulchay, Hillary Jones & Sharon Young
CooperRiis Healing Community

2. Background & Rationale
• CooperRiis began with bi-annual family ed
weekends & informal staff support
• Families loved it but asked for more
• One of our early social workers, Dorothy
Haner, presented research which
indicates that family ed improves the long
term outcomes of treatment

3. Background & Rationale
• Topics came from family feedback &
research
• A curriculum was developed that could be
delivered over the phone with co-learner
model
• This format was converted into current
experiential curriculum

4. Research Supporting Family
Education indicates:
• Markedly higher reduction in relapse and re-hospitalization
rates for individuals whose
families received psycho-education as opposed
to those who did not (differences ranging from
15-20% over 2 years)
• Improved well being of family members
• Increased participation in Voc Rehab
• Decreased cost of care
Evidence Based Practices for Services of People with Psychiatric
Disabilities, Dixon et al, PSYCHIATRIC SERVICES, July 2001 Vol. 52 No. 7

5. Schedule
• We begin each of the 2
days at 9:00 a.m. & finish
at 5 p.m.the first day and
4 the second day.
• We have lunch from 12
to 1 every day.
• We have breaks both in
the morning & the
afternoon.

6. Format
• 8 Sessions
• Session length: 1 ½ hrs
to 2 hrs
• Teaching modalities:
powerpoint presentations,
videos, small & large
group discussions, &
experiential activities
• All activities are voluntary
• Follow-up sheet provided

7. Topics Covered
• Introduction & Orientation
• Understanding Emotional Health
Conditions
• Effective Communication
• Common Reactions to Emotional Health
Conditions
• Family Systems
• Effective Family Problem Solving
• Navigating Times of Crisis
• Wrap Up

8. Session 1: Introduction &
Orientation
• Ice Breaker
• Background & Rationale for Program
• Logistics
• Creation of Ground Rules including
voluntary participation & the “T”
• Video about recovery movement
• Conspiracy of Hope Article
• Family Experiential Activity

9. Mix and Mingle!
• Where did you grow up?
• What is your favorite desert?
• What was your favorite childhood toy?
• What superpower would you have if you could?
• If you could be any animal, which would you be
& why?
• What is a favorite place you have visited?
• What place would you like to visit?
• What was your first pet?
• What would you do if you knew you could not
fail?

10. The Conspiracy of Hope by Pat
Deegan

11. Session 2: Understanding
Emotional Health Conditions
•Acknowledgement of the
complexity & mystery of this issue
•Advantages & disadvantages of
Diagnosis's
•Video: First person account
about Diagnoses
•Biopsychosocial Model with
scenario
•Exploration of Stigma with Video
•Recovery Language w/ role play &
exercise
•Small discussions &
experiential activity
Bricks and Rocks
Activity are used to
exemplify
overcoming stigma

12. Recovery Language Role Play
Scene
• You arrive early for a support group for loved ones with mental health
challenges. Before the meeting you run into a woman you have never met.
She introduces herself as Frances and casual conversation ensues. During
the conversation, Frances begins to describe her adult daughter:
• Role Play Scenario

13. Session 3: Strengthening
Communication
• Importance of good communication
• Assessing communication skills worksheet
• Elements of good communication
• Clear vs ambiguous communication w/ practice
• Impact of emotional health conditions on
communication
• Managing mis-understandings

14. Session 3: Strengthening
Communication
• Blindfolded mine-field
activitiy
• Non verbal
communication
• Attentive listening
(practice)
• Barriers to listening
• Supportive listening
(practice)
• I statements (practice)

15. Communication Scenarios Activity
Scenario:
Henry has been feeling quite depressed lately. He works for
the family business. Due to his depression, he has been
having a harder time getting out of bed and has been
missing more work. When he does make it to work he is
often late. When his mom asks what is going on, Henry
shrugs and just says, “I’ve been sick.” When she asks more
about what kind of sickness, he is rather vague, “just sick
with whatever had been going around.” She continues to try
to gather information, but just gets one or two word
answers.
What tips would you give to Henry’s mom about how to
respond?

16. Session 4: Common Reactions
to Emotional Health Conditions
• Review the stages of
recovery
• Emotional State of
Response Model for
family recovery
process
• 4 Stages of Care
Giving Experience
Model
• Video Glen Close:
Bring Change to Mind

17. Stage 4 of Care Giving Model
• Acceptance:
– I did not cause it.
– I cannot control it.
– I cannot cure it.
– All I can do is cope
with it.

18. What is Ambiguous Loss?
• A loss of previously
held beliefs and
expectations about
one’s life
• Is not defined by one
particular event
• Is vague, unclear, and
ongoing
• Is difficult to define
and, therefore,
recognized by others

19. How it often looks and feels
• Immobilized
• Feel helpless and hopeless
• Blocked coping
• Isolation
• Symptoms of depression
• Anxiety
• Physical exhaustion
• Emotional exhaustion
• Denial or selective attention to one aspect of the
situation
• Feelings of guilt and self blame
• Relationships change

20. How do I move forward ?
– Establish and maintain
some consistency/routine
– Educate yourself
– Identify the loss and
acknowledge ways that it
has impacted you and your
family
– Plenty of social and
emotional support
– Identify, accept, and
express your feelings and
thoughts
– Remember the 4 C’s (cause,
control, cure, cope)
– Both/And thinking, Not
Either/Or
– Set healthy boundaries
– Acknowledge changes and
believe in new possibilities
– Look for the meaning
– Spiritual connection
– Hope

21. Create a Self Care Plan
Using the paper and markers provided, create a
self-care plan with activities and intentions that:
– Can be realistically
incorporated into your
life.
– Are a consistent and
preventative practice,
not a last resort.

22. Session 5: Family Systems
• Activity to elicit different definitions of family
w/discussion
• Explanation of family as a system
• Family Sculpting Exercise
• Family Rules with Video
• Explanation of family roles & role changes
• Explain types of family boundaries with video
• Explain blame trap
• Honoring strengths with exercise

23. Family Sculpting Activity
• Narrative Story Presented t hat most families can connect
with
Cassie is an introverted girl who is bright and gets straight A’s in high
school. She has an amazing boyfriend and is close with her parents
and brother, who is away at collage. She is sensitive to her father’s on
going struggle with depression.
The summer before Cassie left for college, her boyfriend dies. When
Cassie begins college, she starts to disconnect from her friends. She
moves into her own place where she isolates and begins to make huge
darkly themed murals with spray paint.
Cassie gets suspended from college when she gets her grades and
discovers she has failed most of her classes.
• Explain and demonstrate how family sculpting works.
Set up the first scene then give the audience other
scenarios and have them help with the sculpting
process.

24. Session Six
Problem Solving:
Strengthening Skills for
New Solutions

25. New Solutions
• Common problems shared
• Styles of problem solving
• Tips for effective problem solving
• Teaching of a Structured Problem Solving
Approach
• Experiential Problem Solving activities
• Quick Sand experiential exercise

26. Experiential Problem Solving:
Group Line Up
Think of a number between 1 and 100.
• Without talking, arrange yourself in a line
from lowest number to highest number.
Once completed, signal to the facilitator by
giving a thumbs up.

27. Experiential Problem Solving:
Group Line Up
Think of an animal.
• Without using words, arrange yourself in
order from smallest to largest animal.
Once completed, signal to the facilitator by
giving a thumbs up.

28. A Structured Approach to Effective
Problem Solving
•Identify the Problem
•Brainstorm Ideas
•Evaluate Alternatives
•Decide on Optimal Solution
•Plan Steps to be Taken
•Implement Solution
•Review: Did the Solution Work?
•If Unsuccessful Try Another Solution or Revise
Plan and Try Again

29. Session 7: Navigating Crisis
• Centering activity (video)
• Definition and normalization of crisis
• Behavioral, emotional and cognitive aspect with
worksheet
• Managing Stress
• Triggers
• Ways to support during crisis
• WRAP
– (with Peer Support Specialist)
• Advance Care Directive
activity

30. Aspects of Crisis Worksheet

31. Session 8: Wrap Up
• Give a review of topics, allow for lingering questions to
be answered
• De-briefing; structured questions provided to help guide
this process
• Family Appreciation Activity with Sea Rose Cards
• Follow up calls
• Families ask to fill out post survey’s to help improve
quality of program

32. Data
Surveyed participants (59) indicated that they
moderately to strongly agreed that:
- the topics were relevant.
- helpful information was learned.
- the family emerged as a stronger
recovery team.
- they felt personally supported by the
experience.
- the format for the training was effective.

33. Data
• Pre/Post Knowledge survey data indicated
that participants on average, gained
significant knowledge about the topics
covered in the training
• On a 1-5 scale average rose from 2.7 to
3.9 (2 = a little knowledge, 3 = a lot of
knowledge, 4 = fully knowledgeable)

34. Data
• Participants rated the following topics as
most helpful:
The role of hope within recovery
Learning specific communication skills
such as “I statements”
Learning about the concept of
ambiguous loss
Learning about WRAP
Learning about stigma

35. Data
• Quotations from participants:
It was helpful to learn how a change in language used
has such an impact. . .
The section on ambiguous loss reminded me how
important this is for my son and how maybe more
attention should be place on this. .
I like the idea that when you help others you are giving
yourself a message of worthiness.
Family sculpting is a powerful visual to clarify family roles.

36. Data
• Quotations from Participants:
WRAP was so good. I like the thought of looking at
ourselves as our own detectives
Forgiveness and acceptance of what is and what has
already happened as a result of my illness feels more
possible now.
I feel more validated in my struggles and feelings through
the process and feel that my parents may feel more at
ease with their role and reactions.

37. Data
• Quotations from Participants:
Learned active listening. Learned I don’t
have to solve the problem or issue!
I think we’ll work together to better
communicate and notice the signs sooner,
and accept challenges when they arise.

38. Creative Commons License