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Trauma, Invitations To Change and Family Mapping


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Identify, Describe How Clients and Families Come to your Practice

Identify, Describe and Discuss Addiction, Mental Health , Chronic P ain and Process Disorders

Identify how Trauma, Shame ,Guilt, Humiliation, Embarrassment, Grief and Loss Effect Ones Story about Themselves

Identify how we as clinicians, behavioral health care professionals identify our clients

Published in: Health & Medicine
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Trauma, Invitations To Change and Family Mapping

  1. 1. Trauma , Invitations To Change and Family Mapping Louise A. Stanger Ed.D, LCSW, CDWF, CIP
  2. 2. Meet Dr. Louise Clinician-Social Worker Author-Blogger Educator- Trainer Wife, Parent, Widow ,Grandparent
  3. 3. What Is your Philosophy of Treatment? Take a few minutes and write down 3 or 4 words that describes your philosophy of treatment.
  4. 4. Objectives Identify, Describe How Clients and Families Come to your Practice Identify , Describe and Discuss Addiction, Mental Heath , Chronic Pain and Process Disorders Identify how Trauma, Shame ,Guilt, Humiliation, Embarrassment , Grief and Loss Effect Ones Story about Themselves Identify how we as clinicians, behavioral health care professionals identify our clients
  5. 5. Objectives Identify , Describe Invitations to Change Inside and Outside of The Treatment Mileu-Current intervention Models and Practices To develop an invitational vocabulary as we work with clients and loved ones to share their story
  6. 6. Objectives At the end of this workshop Describe and discuss Portraiture as a qualitative method of inquiry Describe and discuss Rising Strong as a qualitative method of inquiry Discuss the efficacy of using qualitative methods of inquiry while doing Family Mapping
  7. 7. Create Possibility Aspiration that a better life is possible
  8. 8. Substance Abuse- Addiction Mental Health- Depression/Anxiety Chronic Pain-Physical Maladies Relationship failures - Legal But-how do our clients arrive?
  9. 9. ASAM March, 2011 A Primary Chronic Disease of the brain reward, motivation, memory and related circusy Dysfunction leads to Biological, psychological, social and spiritual manifestations Individual pathologically pursing reward or relief thru substances
  10. 10. Chronic Pain 133 million People Experience Chronic Pain 1 in 5 globally 65% of all people experience chronic pain once in their life 75 % of all heron users started with a prescription 96 people die daily
  11. 11. Trauma
  12. 12. Definitions of TraumaOverwhelming experiencing that cannot be integrated and elicit animal defensive mechanisms and dysregulated arousal “A stress that causes physical or emotional harm that you cannot remove yourself from” Larke Huang , Director of Health Care Equity at SAMSHA
  13. 13. Trauma is objective What happened ( My father killed himself, My baby dies of SIDS, I was date raped , humiliated etc
  14. 14. Trauma is subjective : How do I perceive the situation ? Relationship to early child- hood experiences - and Alcoholism Adverse Childhood Experience- 17,000 patients -Kaiser- effects of trauma are cumulative and one of most destructive forms is recurrent calling and humiliation
  15. 15. What do your Clients Say about Trauma ???? Verbal abuse Physical abuse Witnessing a tragedy Not being told about something Accidents Divorce Death
  16. 16. Getting Emotionally Hooked
  17. 17. Training Evidenced Based Graduate Education Post Graduate Education
  18. 18. Shame Shame is that intensely painful feeling of believing we are flawed and therefore unworthy of love and belonging. I am not good enough Brene Brown
  19. 19. Guilt Have you ever stolen anything ? Had guilty thoughts ? Have you ever lied? Made up a confabulation?
  20. 20. Humiliation The Act of Making Someone Inferior or Foolish
  21. 21. Loss and Grieving Loss -Something of Value is gone Grief = Total response to an emotional experience related to loss Breavement- Subjective response by loved one Mourning -behavioral response
  22. 22. My Philosophy Of Treatment
  23. 23. Sheldon Kopp The therapist can interpret, advise, provide the emotional acceptance and support that futures personal growth , and above all can listen…actively and purposefully, responding with the instrument of his trade, that is with his personal vulnerability of his own tumbling self. This listening is that which facilitates the patients telling of his tale that can set him free.”
  24. 24. Sara Lawrence-Lightfoot
  25. 25. About Sarah Lawrence Lightfoot Prize Winning Sociologist-McArthur Award George Leider Prize for research Harvard 27 Honorary degrees from colleges and universities- novelists -9 award winning books The Emily Hargrove's Endowed Chair which upon her retirement becomes Sara Lawrence Lightfoot chair making her the first African American in Harvard's history to obtain that. Full of grace and compassion
  26. 26. Philosophy Strength based-it begins by looking for what is good and healthy and assumes the expression of goodness will always be laced with imperfections. Collaborative qualitative inquiry- The researcher becomes part of the conversation -Become witness to the conversation The Context -where the interview takes place becomes part of the portrait -Human experience is framed shaped by the setting. Discovering the tension between life, loss and liberation.
  27. 27. Who Am I ? I am the mirror who reflects back their pain, their fears their voices. I am the inquirer who asks difficult questions, who searches for evidence and patterns. I am the companion on the journey bringing my own story to the encounter, making possible an interpretive collaboration, I am the audience who listens , laughs , weeps an applauds. I am the spider women spinning their tales.. I am the therapist who offers cathaersis support and challenge… I am also the stage manager coordinating the intersection of three plays-the story teller, the narrator and the readers inviting your voice to the drama”
  28. 28. Lifting The Veil of Widowhood Tell me about yourself. Tell your experience of being married How you felt about your spouse or partner How did your spouse or partner die ? How if at all did your life change after the death of your spouse ( Family, Friends, Economically, Emotionally etc. What would you like the world to know about this experience
  29. 29. Raising Strong Brene Brown
  30. 30. Invitation is to Wholehearted living Strength based Cultivates Curiosity Owning Your Story ( Falling down and Rising UP) To look at our SFD and Confabulations
  31. 31. The Reckoning Look at your Fall Down Moments What Emotionally Hooks you -Giving Permission to Reckon - Mindfulness as a Way in How have I been Off loading Hurt? Am I willing to get Curious ?
  32. 32. The Rumble Unleashing Curiosity Rumble with Vulnerability -uncertainty, risk and emotional response (what does it look like, feel like , show up etc) Rumble with Shame ( How does shame show up in your story (perfectionism,comparison ) SFD Rumble with Boundaries (choosing courage over comfort right over what is fun , generosity Rumble with living big, anxiety, criticism
  33. 33. Rumbling With Forgiveness The belief you come out the other side… abetter person not consumed by anger or hatred… no longer chained in victimhood and dependent on the perpetrator”
  34. 34. The Revolution Story is our way home “We are the authors of our own lives We write our own daring endings We craft love from heartbreak Compassion from shame Grace from disappointment Courage from failure Showing Up is our Power
  35. 35. Take Aways
  36. 36. Strength based Collaborative Realistic Inclusive Looking for Goodness Listening to Strangers Client Centered Qualitative Inquiry- Open Ended Questions
  37. 37. To Articulate Your Philosophy
  38. 38. Invitations to Change
  39. 39. –Louise A. Stanger An Intervention is an invitation to seek and accept care
  40. 40. In Your Office
  41. 41. Professional Interventionists are Called when Families are Fearful ,Angry &Confused Attached to the Problem Cognitively and emotionally Dis- regulated Attempts have failed
  42. 42. Folks have unconsciously colluded with the problem
  43. 43. Accountability Teams Sad-Disgusted Boundary less Loving -Worried Frustrated-Shocked Embarrassed- Shamed Terrified-Controlling At Wits End
  44. 44. Interventions Include a Village of Potential Change Agents Participants are experts Value Driven Solution Focused Evidenced Based Interventionists job is to bring people together for the common good and to identify SA, MH and other issues
  45. 45. Intervention Models
  46. 46. Traditional Surprise Vern Johnson-I’ll Quit Tomorrow Frank Pickard- Family Intervention Ken Seeley- John Southworth- Intervention Show
  47. 47. Traditional Made Modern The Storti Model Est. 1973 Heart to Heart: The Honorable Approach to Motivational Intervention, 1995
  48. 48. Jeff and Debra Jay Love First , A Families Guide to Intervention 2000 Aging & Addiction , Colleran and Jay 2010 It Takes A Family, 2014
  49. 49. Action Intervention Model Jean Campell LCSW, Dr. Jim Tracey and Bill Maher Psychodrama , sociometry and other action oriented strategies for families
  50. 50. Thought Leaders in Invitational Models Spaere & Raitner - Systemic Arise -Garret and Landau Breakfree- Lamm
  51. 51. Interventions are an Invitational Process An 11 step process for a 12 step solution 2016
  52. 52. Theoretical Underpinnings Salvador Minuchin Virginia Satir. TFT Bowen , Family Systems Bowlby, Attachment Monica McGoldrick- Family Systems Therapy
  53. 53. Start where your Client is !
  54. 54. Phase 1 : Intervention Agreement & Initiative Step 1: Engagement Step 2: Determine Key Stakeholders Step 3 Define Client Guidelines,Confidentiality
  55. 55. Phase 2 : Information Gathering, Objectives & Assessment Step 4- Family Mapping Step 5- Assess ILO and key stakeholders (Portraiture - Retrospective Analysis) Step 6- Teach & Survey Accountability Teams (Triangulation of data) Step 7:Develop Measurable Action Plan
  56. 56. Phase 3 : Implement . Review & Follow Up Step 8 : Coaching , Delivering the Invitation Step 9 : Pre Intervention Meeting The Invitational Meeting Intervention Progress Review and Solution Focused Family recovery Coaching
  57. 57. Other Types of Invitational Interventions(Stanger) Clinical Interventions ( Stanger & Storti ) Reverse Interventions
  58. 58. A Way Into Story
  59. 59. Conversations will be non- linear
  60. 60. The Conversation will take you many places Open ended
  61. 61. Always Start With
  62. 62. Qualitative Questions Tell Me about ……….. Tell me about your Family.. Tell me about your children, family, Grandparents etc
  63. 63. Meet Christine 32 yo music executive Opioids and disorder eating Mother and Father Brother Cooper
  64. 64. What Stands out?
  65. 65. Family Mapping Startedafter first placement
  66. 66. Meet Jack and his family 54 yo old retired executive lives with 29 yo son Two previous treatment episodes 3 children 19, 22, 29 Wife in process of divorce Being asked to leave treatment center as wrong placement Had to get him from A -B
  67. 67. Families Readiness to Change In 2 months 3 out of 5 family members were ready to change In 7 months 3 out of 5 family members had engaged in treatment which lasted more then 60 days. 1 family member went for a 2 week intensive, 2 Private therapists 1 family member refused treatment
  68. 68. Meet Rock Refered by Producer 37 foster homes legal problems sexually assaulted Gang leader Chronic Relapser Multiple marriages and children Poet
  69. 69. Sometimes the First Story is SFD Great Treatment center CorrectFamily Map Wrong Placement How did I react ?
  70. 70. Rock is Raquelle
  71. 71. Rock is one of the Most Courageous Gentleman Walked Into His Story Got Curious Felt Safe to End the SFD - Confabulations And asked for Help And After I got Over being Uncomfortable, I was of service
  72. 72. Meet Erik 20 years old Only son of high wealth family 92 sisters) Legal issues Substance Abuse Anxiety & Depression ADHD
  73. 73. Eriks Family Sisters-Bullying and Depression Mom -Family History of SA Mom in Recovery Dad Family History of SA and then Mom said I have something to share ……
  74. 74. Erik’s mom My brother died at age 38 he had HIV
  75. 75. You are Ready?
  76. 76. Take Aways Family Mapping is a way into story You need about 90 minutes Paper and Colored pens Life is messy Qualitative inquiry works to illuminate
  77. 77. Be Curious
  78. 78. Wounded Hearts
  79. 79. Resources Brown, Brene- Rising Strong . Speiegel & Grau International 2015 NYC NY Brown, Brene, DaringGreatly. Gothom Books 2012 Lawrence Lightfoot,Sarah & Hoffman Jessica .The Art and Science of Portraiture. Joey Bass. 1997 LawrenceLightfoot, S. Respect , 1998. Press Books, Mass. Lawrence, Lightfoot,S. I’ve Known Rivers , Penguin Publishing. Ny 1995 Lawrence, Lightfoot, S Growing Each Other Up, University of Chicago Press. 2016
  80. 80. Resources Kopp, Sheldon- If You Meet The Buddah on the Road , Kill Him, 1982. Penguin House Random House, NY, NY Stanger, Louise. Falling Up- A Memoir of Renewal 2015, WZY Press Stanger, addiction-you_us_592f0f7ee4b0d80e3a8a329e Stanger differences-between-trauma- addiction_us_58f4e7aee4b048372700da27
  81. 81. Resources Stanger Systemic Model Arise Jays Lamm Seeley
  82. 82. Resources Mintz www.reallifeis Tap 35 www.motivational