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Are Your Clients a Pain?

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This presentation was given at CORE in Amelia Island, FL in 2016. Presentation objective:

Identify, 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

Published in: Healthcare
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Are Your Clients a Pain?

  1. 1. Are Your Clients a Pain ? MI , SFT, Brene’ Brown, Parallel Processes & Pain Recovery Strategies July 21, 2016 Core Conference
  2. 2. 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
  3. 3. Objectives Identify, 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
  4. 4. How Do Our Clients arrive ? Substance Abuse Mental Health Chronic Pain Legal Issues Money Problems Relationship Failures Sex, Shopping, Gambling Intergenerational Wounds
  5. 5. 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
  6. 6. Keeping The Status Quo SA. MH, CP etc . Organizing structure Unconscious and Consciously Gratification Strategies must be employed that change usual ways of relating, categorizing , and thinking
  7. 7. Family and Confabulations
  8. 8. Before Treatment CONFUSED BEWILDERED CONFABULATORS- DENIAL MINIMIZE FEAR DRIVEN FRAZZLED SHAME and GUILT

  9. 9. What Kind Of Families do You Meet AGREEABLE ANALYSIS INVISIBLE QUESTIONER KNOW IT ALL COMPLAINER TALKER WORRIER MICO-MANAGER BOOMERRANG
  10. 10. HAVE YOU EARNED THE RIGHT TO HEAR ANOTHER’S STORY ?
  11. 11. 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
  12. 12. BRAVING - Brown Am 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 ?
  13. 13. 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
  14. 14. START WHERE YOUR CLIENT IS
  15. 15. 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

  16. 16. SOLUTION FOCUSED InSoon Young & Peter Berg HERE & NOW NOT NECESSARY TTO KNOW DEEPER CAUSE COUNSELOR EXPERTISE CALL SMALL CHANGE Can Lead To Big Change
  17. 17. SFT STRATEGIES PROBLEM TALK SEPARATE THE PERSON FROM THE PROBLEM MIRACLE QUESTION EXCEPTIONS SCALING QUESTIONS -CONFIDENCE GOALS -FEEDBACK COMPLIMENTS TASK SETTING 
 
 

  18. 18. The DARING WAY SHAME-GUILT - HUMILIATION COURAGE -asking what you need, seeking support, owning your story , setting boundaries Vulnerability THESE AE NOT THERAPUTIC STRATEGIES
  19. 19. STORY
  20. 20. INDIGENOUS TO ALL OF THIS IS GRIEF LOSS INTERGENERATIONAL TRAUMA WORK
  21. 21. 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
  22. 22. INTERVENTION- BAR RELATIONAL ATTACHMENT
  23. 23. The TEAM 3 Sisters 2 Attorneys Family Friends Relatives Security
  24. 24. 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
  25. 25. Paradigm Shift Moving From Passive :Cure me Doctor to Being an ACTIVE PARTICIPANT
  26. 26. Meet Harriet - 62 y.o Female
  27. 27. How Harriet’s Lights Went Out Small 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
  28. 28. Losses Lost Family Business Lost Insurance Lost Family Money Lost Self Esteem Lost Ability to Walk Lost Her Smile
  29. 29. Strategies 15 day detox- Pain still 20% due to Hyperalgesia Education Cognitive Behavioral Therapy Mindfulness Mediation Yoga etc Peer Support
  30. 30. OutComes REDUCED PAIN 45 days later lightly jogging 3 miles SMILE REMADE BUSINESS BACK ON TRACK MARRIAGE BACK ON TRACK GRANDMOTHER DUTY
  31. 31. MEET KING BABY and His Parents MULTIPLE TREATMENT EPISODES ANXIOUS PARENTS NO BOUNDARIES 2 years of work with one 9 months with another
  32. 32. Meet JAVIER Car Accident- 8 years ago Previous Experience with AA Intergenerational Stylist for Major Stars
  33. 33. Meet Jack 50 yo male Previous TreatmentPrevious Treatments Laminectomy L3/L4, L4/L5 Outcome – increased pain, radiculopathy Lumbar fusion and Lysis of adhesions Outcome – failed fusion, pain continued Physical therapy Outcome – moderate but temporary
  34. 34. 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
  35. 35. Goals May not be the Abolition of pain but adaptation to Pain ACCEPTANCE CAN BE KEY
  36. 36. Treatment Plan Biofeedback and relaxation therapy Psychophysiological education CBT , MI, Group Therapy Postpone implantable drug delivery
  37. 37. QUEEN BABY and her MOM Intergenerational Change Agreements Treatment for Whole Family
  38. 38. Resources The 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
  39. 39. Pain Resources Center 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
  40. 40. An Intervention Guidebook for Loved Ones and Their Families Learn Thrive:to LOUISE STANGER ED.D., L.C.S.W., BRI II, CIP

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