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The Uninvited Guests
Mental Health
ADDICTION
Chronic Pain
Trauma
Stanger 2019
About Dr. Louise Stanger
• Clinician-Educator
• Interventionist of the Year -2019
DB Resources and McLean
Hospital-An Affil...
How did you arrive ?
Mindful: or Mindfull
Objectives
Identify, Describe How Clients and Families Come to
your Practice
Identify , Describe and DiscussAddiction, Men...
Objectives
• Articulate your philosophy of
practice
• Identify, Describe and
Demonstrate CIS and Family
Mapping as a way i...
To Articulate Your Philosophy
What Is your Philosophy of
Treatment?
Take a few minutes and
write down 3 or 4 words
that describes your
philosophy of tre...
My Philosophy Of Treatment
Sheldon Kopp.
Existential
Strength Based
Gift of the Buddah
Philosophy
Strength based-it begins by looking for what is good and healthy
and assumes the expression of goodness will al...
Who Am I ?
“I am the mirror who reflects back their pain, their fears their
voices. I am the inquirer who asks difficult ques...
Create Possibility
SubstanceAbuse-
Mental Health-Depression/
Anxiety
Chronic Pain-Physical Maladies
Digital and other Process
Disorders
Relat...
ASAM March, 2011
A Primary Chronic Disease of
the brain reward, motivation,
memory and related circusy
Dysfunction leads t...
Chronic Pain
133 million People Experience Chronic
Pain
1 in 5 globally
153 Billion was spent on adolescent chronic
pain
6...
Mental Health Issues
Anxiety
Depression
Narcissism
PTSD
Bi-Polar
Personality
Psychosis
Phobias
Trauma
Definitions of Trauma
Overwhelming experiencing that
cannot be integrated and elicit
animal defensive mechanisms and
dysreg...
Trauma is objective
What happened ( My
father killed himself, My
baby dies of SIDS, I was
date raped , humiliated etc
Trauma is subjective :
How do I perceive the situation ?
Relationship to early child-
hood experiences -and
Alcoholism
Adv...
Trauma
What do your Clients Say about
Trauma ????
Verbal abuse
Physical abuse
Witnessing a tragedy
Not being told about something...
The Brain & Memory
Amygdala -Alarm circuit
Prefrontal cortex
(Conscious thinking)
Walking down the Street
and think you se...
Trauma and Memory
Memories
Explicit- Thought
Containing Memories in an
18 year old (my dog is good
Procedural Or Impicit
Memory ( instinctua...
Getting Emotionally Hooked
When I Experience X
I Feel- Body Sensation
I Think -Whats my go-to
thought process
Behavior-Wha...
Folks Are More Then Their Trauma
Questions about life role
Your place in life
Coupled with a sense of loss
Perhaps we have...
Shame
Shame is that intensely painful
feeling of believing we are
flawed and therefore
unworthy of love and
belonging.
I am...
Guilt
Have you ever stolen
anything ?
Had guilty thoughts ?
Have you ever lied?
Made up a confabulation?
Humiliation
The Act of Making
Someone Inferior or
Foolish
Loss and Grieving
Loss -Something of Value is
gone
Grief = Total response to an
emotional experience related to
loss
Breav...
Addiction -Attachment Disorder
Values are lost as we attach to substances and other unhealthy behaviors
Brene Brown
Invitation is to
Wholehearted living
Strength based
Cultivates Curiosity
Owning Your Story
( Falling down and Rising
UP)
T...
Family Mapping Is the Way In
Story is our way home
“We are the authors of our own
lives
We write our own daring endings
We...
Take Aways
Strength based
Collaborative
Realistic
Inclusive
Looking for Goodness
Listening to Strangers
Client Centered
Qualitative I...
Invitations to Change
–LouiseA. Stanger
An Intervention is an invitation to seek
and accept care
Collective Intervention Strategies
Louise Stanger Ed.D, LCSW, CDWF, CIP
Why CIS?
• Collective - In that to be successful there must be a
team of Families, Friend, Collegues, Associates,
business...
• Strength Based
• Solution Focused
• People are Teachable
• Change is Possible
• The Present is Important
• We can rise t...
Theoretical Underpinnings
Salvador Minuchin
Virginia Satir. TFT
Bowen , Family Systems
Bowlby,Attachment
Monica McGoldrick...
Theoretical Strategies
• Motivational Interviewing
• Cognitive Behavioral
• Acceptance & Commitment
• Values Clarification
...
Counseling Skills Used
•Listening- Empathy
•Genuine
•Unconditional Positive Regard
•Concreteness
•Reflecting- Echoing Key w...
Interventions Include a Village of
Potential Change Agents
Participants are experts
Value Driven
Solution Focused
Evidence...
Accountability Teams
Sad-Disgusted
Boundary less
Loving -Worried
Frustrated-Shocked
Embarrassed- Shamed
Terrified-Controlli...
Families are taught
• The nature of substance
abuse process and mental
health disorders. If
appropriate about chronic
pain...
Dr. Louise Stanger
“An Intervention requires Crucial
Conversations”
War of The Roses
Case Study
Clinical & Reverse
Interventions
Demonstrate CIS -Case Studies
Clinical & Reverse Interventions
Clinical Intervention
Reverse Intervention
Interventions Include a Village of
Potential Change Agents
Participants are experts
Value Driven
Solution Focused
Evidence...
Clinician Interventionsist
Must Be able to :
• Develop a Team
• Do a Family Map that engages everyone
• Do a Retrospective...
Beliefs an individual or
group makes about
what constitutes proper
behavior
Standard of Conduct
Make sure you know
Collective
Perspectives
Bringing Folks
Together
For The
Common Good
Basic Anatomy
• Intervention Agreement &
Initiative
• Education, Information
Gathering & Assessment
• Implement , Review, ...
Start where your Client is !
Family Mapping
A Way into Story
Folks have unconsciously
colluded with the problem
Dr. Louise Stanger
“A Successful Intervention has the Potential To
Transform not just the Identified Client but the
Entire ...
The Conversation will take you many places
Open ended
Conversations will be non-linear
Always Start
With
Identified Love One
Qualitative Questions
Tell Me about ………..
Tell me about your Family..
Tell me about your
children, family,
Grandparents etc
20
The Wounded Hearts
Secrets & Lies
I LO
Substance Abuse
Legal
Jack
Learning disability
SallySusie
Laura John
MikeJim Sr ...
Meet Christine
32 yo music executive
Opioids and disorder eating
Mother and Father
Brother Cooper
Meet Sally
Mental Health- Sucicidality- Disordered Eating -Substance Abuse
About Sally
• Mother -Father South American, Jewish
descent
• Father Hx of Depression
• Family has 4 children- Sally is th...
Family Mapping Started
after first placement
Meet Jack and his family
54 yo old retired executive lives
with 29 yo son
Two previous treatment episodes
3 children 19, 2...
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 memb...
Meet Maddi
10 operations - 6 treatment centers
First major accident age 14
Family History of SA , MH and Molestation
Pain Body, SexualAssault Trainer
For past 9 years ha...
Maddi gains trust with primary clinician
Maddi gains trust with exercises
Maddi Starts to talk to therapist
Family is conf...
Accepted to premed
Meet Erik
20 years old
Only son of high wealth
family 92 sisters)
Legal issues
SubstanceAbuse
Anxiety & Depression
ADHD
Eriks Family
Sisters-Bullying and
Depression
Mom -Family History of SA
Mom in Recovery
Dad Family History of SA
and then M...
Erik’s mom
My brother died at age 38 he had HIV
Be Curious
We can all 

Fall Up!
Contact Dr.Louise
DrStanger@allaboutInterventions.co
m
www.allaboutinterventions.com
619-507-1699
Learn To Thrive
Falling ...
Resources
https://acestoohigh.com/got-your-ace-
score/ Test
Resources
Brown, Brene- Rising Strong . Speiegel & Grau International 2015 NYC NY
Brown, Brene, DaringGreatly. Gothom Book...
Resources
Kopp, Sheldon- If You Meet The Buddah on the Road , Kill Him,
1982. Penguin House Random House, NY, NY
Stanger, ...
Resources
Stanger www.allaboutinterventions.com
Systemic Model www.systemicintervention.com
Arise www.linkingsystems.com
J...
Resources
storti-www.stortimodel.com
Mintz www.reallifeis
Tap 35
www.motivational interviewing.org
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
Virginia 2019 - The Uninvited Guests
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Virginia 2019 - The Uninvited Guests

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OBJECTIVES:
Identify, Describe How Clients and Families Come to your Practice
Identify , Describe and Discuss Addiction, Mental Heath , Trauma , Chronic Pain and Process Disorders
Identify how Trauma, Shame ,Guilt, Humiliation, Embarrassment , Grief and Loss Effect Ones Story about Themselves

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Virginia 2019 - The Uninvited Guests

  1. 1. The Uninvited Guests Mental Health ADDICTION Chronic Pain Trauma Stanger 2019
  2. 2. About Dr. Louise Stanger • Clinician-Educator • Interventionist of the Year -2019 DB Resources and McLean Hospital-An Affiliate of Harvard • Author-Falling Up A Memoir of Renewal- Amazon • The Clinicians Guide to Addiction Interventions-In press Routhledge • Widow, Wife, Mother, Grandmother • Adventurer
  3. 3. How did you arrive ? Mindful: or Mindfull
  4. 4. Objectives Identify, Describe How Clients and Families Come to your Practice Identify , Describe and DiscussAddiction, Mental Heath , Trauma , Chronic Pain and Process Disorders Identify how Trauma, Shame ,Guilt, Humiliation, Embarrassment , Grief and Loss Effect Ones Story about Themselves
  5. 5. Objectives • Articulate your philosophy of practice • Identify, Describe and Demonstrate CIS and Family Mapping as a way into story • Share invitational vocabulary
  6. 6. To Articulate Your Philosophy
  7. 7. What Is your Philosophy of Treatment? Take a few minutes and write down 3 or 4 words that describes your philosophy of treatment.
  8. 8. My Philosophy Of Treatment Sheldon Kopp. Existential Strength Based Gift of the Buddah
  9. 9. 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.
  10. 10. 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”
  11. 11. Create Possibility
  12. 12. SubstanceAbuse- Mental Health-Depression/ Anxiety Chronic Pain-Physical Maladies Digital and other Process Disorders Relationship failures -Legal But-how do our clients arrive?
  13. 13. 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
  14. 14. Chronic Pain 133 million People Experience Chronic Pain 1 in 5 globally 153 Billion was spent on adolescent chronic pain 65% of all people experience chronic pain once in their life 75 % of all heron users started with a prescription 155 people die daily
  15. 15. Mental Health Issues Anxiety Depression Narcissism PTSD Bi-Polar Personality Psychosis Phobias
  16. 16. Trauma
  17. 17. Definitions of Trauma Overwhelming 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
  18. 18. Trauma is objective What happened ( My father killed himself, My baby dies of SIDS, I was date raped , humiliated etc
  19. 19. 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
  20. 20. Trauma
  21. 21. What do your Clients Say about Trauma ???? Verbal abuse Physical abuse Witnessing a tragedy Not being told about something Accidents Divorce Death
  22. 22. The Brain & Memory Amygdala -Alarm circuit Prefrontal cortex (Conscious thinking) Walking down the Street and think you see a snake
  23. 23. Trauma and Memory
  24. 24. Memories Explicit- Thought Containing Memories in an 18 year old (my dog is good Procedural Or Impicit Memory ( instinctual or conditioned responses associated with Doggy
  25. 25. Getting Emotionally Hooked When I Experience X I Feel- Body Sensation I Think -Whats my go-to thought process Behavior-What do I do?
  26. 26. Folks Are More Then Their Trauma Questions about life role Your place in life Coupled with a sense of loss Perhaps we have lost a core part of ourselves Sometimes we become still and quiet
  27. 27. 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
  28. 28. Guilt Have you ever stolen anything ? Had guilty thoughts ? Have you ever lied? Made up a confabulation?
  29. 29. Humiliation The Act of Making Someone Inferior or Foolish
  30. 30. 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
  31. 31. Addiction -Attachment Disorder Values are lost as we attach to substances and other unhealthy behaviors
  32. 32. Brene Brown
  33. 33. Invitation is to Wholehearted living Strength based Cultivates Curiosity Owning Your Story ( Falling down and Rising UP) To look at our SFD and Confabulations
  34. 34. Family Mapping Is the Way In 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. Invitations to Change
  38. 38. –LouiseA. Stanger An Intervention is an invitation to seek and accept care
  39. 39. Collective Intervention Strategies Louise Stanger Ed.D, LCSW, CDWF, CIP
  40. 40. Why CIS? • Collective - In that to be successful there must be a team of Families, Friend, Collegues, Associates, business partners , managers or co-workers assembled to bring about change • Intervention- In that we seek to move (i.e/ motivate a person to a place of change) • Strategy, in that nothing is set in stone ; we may adapt the process as needed
  41. 41. • Strength Based • Solution Focused • People are Teachable • Change is Possible • The Present is Important • We can rise to our best possible self Philosophical Underpinnings
  42. 42. Theoretical Underpinnings Salvador Minuchin Virginia Satir. TFT Bowen , Family Systems Bowlby,Attachment Monica McGoldrick- Family Systems Therapy
  43. 43. Theoretical Strategies • Motivational Interviewing • Cognitive Behavioral • Acceptance & Commitment • Values Clarification • Solution Focused • 12 Step or other Self help • Mindfulness • Breathing
  44. 44. Counseling Skills Used •Listening- Empathy •Genuine •Unconditional Positive Regard •Concreteness •Reflecting- Echoing Key words •Body Language •Open Ended Questions •Paraphrasing- Summarizing •Counselor Self Disclosure •To Do Not Harm
  45. 45. 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
  46. 46. Accountability Teams Sad-Disgusted Boundary less Loving -Worried Frustrated-Shocked Embarrassed- Shamed Terrified-Controlling At Wits End
  47. 47. Families are taught • The nature of substance abuse process and mental health disorders. If appropriate about chronic pain syndrome or other medical legal problems • The way an intervention is conducted • The active and instrumental part they have in moving someone to change
  48. 48. Dr. Louise Stanger “An Intervention requires Crucial Conversations”
  49. 49. War of The Roses Case Study
  50. 50. Clinical & Reverse Interventions
  51. 51. Demonstrate CIS -Case Studies Clinical & Reverse Interventions
  52. 52. Clinical Intervention
  53. 53. Reverse Intervention
  54. 54. 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
  55. 55. Clinician Interventionsist Must Be able to : • Develop a Team • Do a Family Map that engages everyone • Do a Retrospective -bio-psycho-social • Develop case strategy • Create Treatment Plan & Placement • Case Management • Follow with Aftercare • Facilitate Family Engagement in the healing process • Have Concierge Capabilities • ETHICS are Paramount
  56. 56. Beliefs an individual or group makes about what constitutes proper behavior Standard of Conduct Make sure you know
  57. 57. Collective Perspectives Bringing Folks Together For The Common Good
  58. 58. Basic Anatomy • Intervention Agreement & Initiative • Education, Information Gathering & Assessment • Implement , Review, Followup
  59. 59. Start where your Client is !
  60. 60. Family Mapping A Way into Story
  61. 61. Folks have unconsciously colluded with the problem
  62. 62. Dr. Louise Stanger “A Successful Intervention has the Potential To Transform not just the Identified Client but the Entire Family”
  63. 63. The Conversation will take you many places Open ended
  64. 64. Conversations will be non-linear
  65. 65. Always Start With Identified Love One
  66. 66. Qualitative Questions Tell Me about ……….. Tell me about your Family.. Tell me about your children, family, Grandparents etc
  67. 67. 20 The Wounded Hearts Secrets & Lies I LO Substance Abuse Legal Jack Learning disability SallySusie Laura John MikeJim Sr Mary Jack Susan Jena Jim Anxiety & depression Medical Bullying Work RAGE Religiosity Perfectionism - everythinglooks good Secrets T T T TT T T T T= Trauma = Money Issues Sample Family Map 18 = Affair Sally T died age 38 1614
  68. 68. Meet Christine 32 yo music executive Opioids and disorder eating Mother and Father Brother Cooper
  69. 69. Meet Sally Mental Health- Sucicidality- Disordered Eating -Substance Abuse
  70. 70. About Sally • Mother -Father South American, Jewish descent • Father Hx of Depression • Family has 4 children- Sally is the Subsequent child of an infant death - Brother died of brain tumor at 9 months, older brother age 5 dx with autism- PTS • Bullying, Isolation , No Friends • Trauma Riding , at School Sexual Assault • 4 Suicide Attempts-Disorded Eating- • Pills & Marijuana • No Formal Inpatient Treatment
  71. 71. Family Mapping Started after first placement
  72. 72. 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 fromA -B
  73. 73. 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
  74. 74. Meet Maddi 10 operations - 6 treatment centers
  75. 75. First major accident age 14 Family History of SA , MH and Molestation Pain Body, SexualAssault Trainer For past 9 years has been in and out of treatment centers Walking on crutches or not walking at all
  76. 76. Maddi gains trust with primary clinician Maddi gains trust with exercises Maddi Starts to talk to therapist Family is confronted with their substance abuse and their need to detach Maddi experiences a difference in family Maddi experiences a Community IntegrationApproach Maddi could be your next client
  77. 77. Accepted to premed
  78. 78. Meet Erik 20 years old Only son of high wealth family 92 sisters) Legal issues SubstanceAbuse Anxiety & Depression ADHD
  79. 79. 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 …………..
  80. 80. Erik’s mom My brother died at age 38 he had HIV
  81. 81. Be Curious
  82. 82. We can all 
 Fall Up!
  83. 83. Contact Dr.Louise DrStanger@allaboutInterventions.co m www.allaboutinterventions.com 619-507-1699 Learn To Thrive Falling Up-Amazon The Definitive GuideAddiction Interventions-Collective Strategies- Stanger & Weber .2018 Routhledge
  84. 84. Resources https://acestoohigh.com/got-your-ace- score/ Test
  85. 85. Resources Brown, Brene- Rising Strong . Speiegel & Grau International 2015 NYC NY Brown, Brene, DaringGreatly. Gothom Books 2012 Lawrence Lightfoot,Sarah & Hoffman Jessica .TheArt 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
  86. 86. 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,http://www.huffingtonpost.com/entry/tricksters-addiction- you_us_592f0f7ee4b0d80e3a8a329e Stanger http://www.huffingtonpost.com/entry/what-are-the- differences-between-trauma-addiction_us_58f4e7aee4b048372700da27 www.allaboutinterventions.com
  87. 87. Resources Stanger www.allaboutinterventions.com Systemic Model www.systemicintervention.com Arise www.linkingsystems.com Jays www.lovefirst.net Lamm www.bradlamm.com Seeley www.intervention911.com
  88. 88. Resources storti-www.stortimodel.com Mintz www.reallifeis Tap 35 www.motivational interviewing.org

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