Dialectical leadership for winter symposium 2020 a
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Co-Presented with Dr. Annie Peters on how to apply DBT and Servant Leadership together to empower staff to feel more valued and engaged in the mission of the organization.
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Dialectical leadership for winter symposium 2020 a
- 1. Dialectical Leadership in Behavioral Health Gina de Peralta Thorne, MS Annie Peters, PhD, LP January 27, 2020
- 2. RECOVERY IN THE ROCKIES 1.27.20 Objectives • Discuss the core values of trauma-informed care and DBT, and how these can be applied to leadership practice • Learn DBT skills that can be used in administrative and clinical supervision • Learn how specific leadership practices increase transparency, accountability, and communication with staff 9
- 3. RECOVERY IN THE ROCKIES 1.27.20 Workplace Challenges in Behavioral Health • High stress • Limited resources • Secondary traumatization • Compassion fatigue • Burnout • Turnover 9
- 4. RECOVERY IN THE ROCKIES 1.27.20 Empathy + Powerlessn ess Converted into anxiety, depression, fatigue, overeating, health issues _____________________ Projected onto clients, co- workers, leadership, etc. • Gossip • Blaming • Taking it home Externalize d Internalized
- 5. Principles of quality client care can be applied to leadership and supervision to create an environment of awareness, trust, accountability, distress tolerance, self-care, and work relationships based on shared values
- 6. RECOVERY IN THE ROCKIES 5.16.17 Trauma-Informed Care Core Values Leadership Practices Safety Safe supervision environment; clear feedback and expectations; culture of accountability Choice Empower staff to make decisions regardless of the outcome. Collaboration Include staff in committees; obtain input on big decisions; solicit feedback from staff about leadership Trustworthiness Compassion; interest in staff; share your “why;” provide honest and direct feedback; transparency, consistency, and fairness in performance evaluation Empowerment Engage staff in solutions when problems are identified; provide professional development opportunities, staff feels valued to do well, re- recuitment Diversity Demonstrate respect; value differences; promote inclusivity
- 7. RECOVERY IN THE ROCKIES 1.27.20 Dialectical Leadership Japanese management practices – building harmony and taking the “middle way” Focus on shared values, trust, transparent communication, and unity among diverse staff to generate new knowledge and change in an organization Examples in behavioral health settings 9
- 8. RECOVERY IN THE ROCKIES 1.27.20 Dialectical Behavior Therapy (DBT) 9 • Targets – reducing crisis, decreasing quality of life interfering behaviors, increasing effective behaviors, learning skills to manage distress • Goals – living in the moment, coping with stress, regulating emotions, and improving relationships • Key dialectics: REASON EMOTIO N ACCEPTANC E CHANG E
- 9. RECOVERY IN THE ROCKIES 1.27.20 Feel Valued • Support • Recognition • Validation • Engagement • Empowermen t • Professional development Perform Well • Coaching • Modeling • Expectation setting • Performance evaluation • Accountability Finding Balance in Supervision: Help Employees To…
- 10. RECOVERY IN THE ROCKIES 1.27.20 Using DBT Skills as Leaders Distress Tolerance: distraction, self-soothing, finding meaning Emotion Regulation: awareness of emotions, letting go, taking opposite action Interpersonal Effectiveness: empathy and kindness; honesty and fairness; validation of emotions; assertiveness Mindfulness… 9
- 11. RECOVERY IN THE ROCKIES 1.27.20 Put on your SPECS Safe Present Effective Calm Spiritually connected
- 12. RECOVERY IN THE ROCKIES 5.16.17
- 13. RECOVERY IN THE ROCKIES 1.27.20 Professional Development
- 14. RECOVERY IN THE ROCKIES 1.27.20 What is Servant Leadership? Servant leadership is both a leadership philosophy and set of leadership practices. The servant-leader shares power, puts the needs of others first and helps people develop and perform at their best. Direct Patient Line Staff Middle Management Senior Leadership Patients & Families 7
- 15. RECOVERY IN THE ROCKIES 1.27.20 Servant Leadership Values Servant Leadership involves values and behaviors that include: • Listening • Empathy • Healing • Humility • Acts of Service (Giving oneself freely) - this promotes growth in others, nurtures human potential and builds community. Tom Hill White Paper Interview by William White 9
- 16. RECOVERY IN THE ROCKIES 5.16.17
- 17. RECOVERY IN THE ROCKIES 1.27.20 The Supervisory Relationship Responsibilities Include: • Aligning individual performance expectations with org goals • Develop performance goals collaboratively with staff • Ensure performance goals are clearly communicated and current. • Provide fair, constructive, and timely feedback toward performance expectations and goals • Provide assistance, guidance and coaching support as needed. • Ensure staff have professional development plans in place • Conduct performance evaluations
- 18. RECOVERY IN THE ROCKIES Expectation Setting New Staff Orientation Setting annual goals Creating professional development plans Reviewing and revising work plans Delegating Assigning projects Reviewing and revising job description Performance Review Quarterly and/or biannual performance reviews Annual performance reviews Setting annual goals Creating Professional Development plans Regular Communications Discussing current projects, workload, and deadlines Identify and solve problems Give timely appreciative and development feedback Coaching and supporting Supervision Framework
- 19. RECOVERY IN THE ROCKIES Supervisor Expectations Professional • Arrive to work and all meetings on time, adhere to dress code, use appropriate language, what else? Respectful • Greet people in the hallways, treat colleagues as internal customers, be mindful of campus and clean up after yourself. Accountable • Meet all deadlines, come to meetings prepared, follow through on projects, respond to requests in a timely fashion
- 20. RECOVERY IN THE ROCKIES Measuring Your Performance• Fosters ongoing two-way communication between employees and managers. • Supports the development of clear, consistent, and measurable goals linked to Harmony core values and competencies. • Helps to articulate and support training needs and career development • Establishes the criteria for making reward and recognition decisions.
- 21. RECOVERY IN THE ROCKIES 1.27.20 Effective Performance Management Begins… • Respect for one another and ends with excellence in performance. • It is the responsibility of supervisors to communicate on an ongoing basis with their employees. • These conversations should be grounded in honest communication. • Provide staff with clear role expectations, feedback, identify performance improvement, development opportunities, and career possibilities.
- 22. RECOVERY IN THE ROCKIES 1.27.20 Radical Transparency "Radical transparency" is creating a culture that is direct and honest in communication and sharing of company strategies so that all people are trusting and loyal to the continuous evolution of the organization. For leaders, radical transparency is a way to build trust with their employees.
- 23. RECOVERY IN THE ROCKIES 1.27.20 Performance Feedback Our Brains go one of two ways: 1. Proving Mode - When we have someone tell us something we did badly, our ego steps in and we start to feel bad, angry. • This is the primal emotional reaction, the lower level you. 2. Improving Mode – this is our inner Olympic athlete • Improving Mode recognizes you are always a work in progress. •
- 24. RECOVERY IN THE ROCKIES 1.27.20 Feedback Spectrum Obnoxious AggressionRadical Transparency
- 25. RECOVERY IN THE ROCKIES 1.27.20 Giving Feedback • Needs to be authentic • Non-Judgmental • Constructive Process • Eliminate the phrase “Don’t take it personally.” • Radical Candor – Caring personally about the person while at the same time challenging them to be better. • Ok for someone to get upset; it’s normal • React with compassion – Emotional Novocaine • Feedback Sandwich – Praise. Criticism. Praise. (No)
- 26. RECOVERY IN THE ROCKIES 1.27.20 The Coworker Relationship • What are the consequences of: • Gossip, complaining, rumors, venting, sarcasm? • When people go to peers with concerns/complaints instead of supervisors, what happens? • Solutions • Talk about others only if you’d say the same thing in front of them • Save concerns for rounding and supervision • Start meetings with mindfulness and “wins” • Look at positive engagement or “positive gossip”
- 27. RECOVERY IN THE ROCKIES 1.27.20 Feedback & Radical Transparency • Go in and be humble – you may be wrong • Most important thing you can do is state your intention to be helpful. • Easier to take feedback when you know it’s meant to help you. • If you know it’s healthy and you experience the positive benefits of it, you will keep seeking it out.. (i.e., know sometimes it hurts working out, but know it’s good for my overall well being) • Radical acceptance (DBT) – Accepting whatever is in the moment. “Accepting the moment and being okay with it”
- 28. RECOVERY IN THE ROCKIES 1.27.20 Final Thoughts • Leadership in behavioral health presents unique challenges. • Embedding clinical principles into leadership has benefits for the leader and the staff, ultimately the clients. • When faced with a leadership crisis think dialectically. • Remember that the relationship between you and staff is a partnership, not a transactional power differential. • Whether you’re a leader or staff, feedback is data that allows for improvement and a sense of personal mastery. • Leadership is evolving, mindful of our style, open to change helps us model to staff agility, innovation and self-care.
- 29. RECOVERY IN THE ROCKIES 1.27.20
Editor's Notes
- Really should be Dialectical Behavioral Leadership
- Client trauma staff trauma/burnout/secondary traumatization organizational trauma Internalized - (depression, anxiety, stress, physical illness, overeating) Externalized - (projected onto clients, coworkers, leadership) – gossip, blaming; Take it home (impacts family dynamics or no communication) Venting leads to more venting and increased negativity Venting and self-reflection cannot exist in the same mindset WE NEED A TRAUMA-INFORMED APPROACH TO LEADERSHIP WE NEED TO APPLY WHAT WE KNOW WORKS WITH CLIENTS TO WORK RELATIONSHIPS AND SELF-CARE
- enhancing employee capabilities; improving employee motivation; reducing dysfunctional behaviors; enhancing leader/staff capabilities and motivation; structuring the environment to not reinforce problematic behavior
- Why should leadership practices be trauma-informed? Compassion fatigue Secondary traumatization Burnout Organizational trauma Turnover SAFETY - Emotional and physical safety for all – staff and service recipients. Fostering safety in all interactions. Consistency and fairness. Honest and compassionate communication CHOICE - offer choices and options. COLLABORATION – input is taken seriously, inclusive approach instead of top-down TRUSTWORTHINESS - Clear and consistent policies, transparent communication, honest service delivery with program- appropriate boundaries. EMPOWERMENT - Hopeful, positive, flexible, resilient. Recognize and build on strengths. DIVERSITY – recognize and respect culture and gender differences Safe sup environ – how do you know? (employee survey) Culture of accountability – how does this create safety? Promote inclusivity – diversity committee What’s going well, and where is there an opportunity for improvement?
- Vs. dualistic concepts like leader/follower, transactional/transformational, hero/villain, directive or forceful or commanding vs. servant leader Finding our “why” – sharing this in meetings – why do we do this? Finding balance (cost/quality care; change/tradition) Sharing knowledge among staff, by leaders and front line staff, to guide change, decision making Leaders and staff implement new strategies as a science (analysis of what works and doesn’t) and as a craft/art (creativity) No either/or attitudes – rather it’s both/and. Helping staff see the need to balance quality and cost which also innovating. All staff should have a balance of self-assertion and modesty/respect – become aware that we all make errors and talking about these openly moves things forward Moving away from rigid thinking and behaving – and fostering that in the culture infuses flexibility, healthiness, openness to change and new ideas EXAMPLES: One we all probably face – wanting to give excellent care and needing to keep costs down, helping staff understand that there can be a lot of heart but it’s also a business (TCP). Talk about change at Harmony and how we’ve rolled it out – brand new executive team, board, mental health focus, MAT… Change to update but keep 12 step focus. “Family approach no longer feasible” – needed to innovate fast and some weren’t innovating, would react negatively to feedback. Change “family” to accountability. Coaching staff to innovate rather than just support staying the same.
- Decreasing or eliminating therapy-interfering behaviors (missing sessions, not doing homework, behaving so that others burn out”. using hospitalization as a way handling crisis. ). •Reducing or eliminating hospitalization as a way handling crisis. •Decreasing Quality of life interfering behaviors (eating disorders, not going to work or school, addiction, schronic unemployment). •Increasing behaviors that will enable the person to have a life worth living. •Increasing behavioral skills that help to build relationships, manage emotions and deal effectively with various life problems. These skills are: Mindfulness, Interpersonal Relationships, Emotion Regulation, Distress Tolerance, and Self-Management. Emotions and reason Acceptance and change Validating their own views of their difficulties vs learning new skills that will help them emerge from their suffering From DBT-12 “being able to identify wo opposing ideas or concepts (dialectics) and learning how to find and ‘walk the middle path.’ You’ll need to avoid black-and-white thinking, not speak in extremes and absolutes, and remember to balance acceptance and change.” Feeling bad about term’g an employee and knowing it was the right thing to do Self-centeredness and selflessness Change and staying the same Asking for help and wanting to do things alone Wanting to look perfect and feeling flawed 5 functions of comprehsnive DBT treatment (or leadership) – enhancing capabilities; improving motivation; reducing dysfunctional behaviors; enhancing therapist/leader capabilities and motivation; structuring the envir onment to not reinforce problematic behavior
- Values – rounding, AIDET, thank you notes Care about the person but challenge them to be better. Giving constructive feedback IS trauma informed because it helps us improve and do our jobs better. Best response is like an athlete getting pointers from a coach. Understand your supervisor is not trying to criticize you but help you improve. Take feedback as DATA not criticism. Ask supervisor “What am I not doing well?” Studer tools – AIDET, rounding, thank you notes, High/Solid/Low Understand people will make mistakes – we know we’re not doing it perfectly yet Finding our “why” – sharing this in meetings – why do we do this? Sharing knowledge among staff, by leaders and front line staff, to guide change, decision making Leaders and staff implement new strategies as a science (analysis of what works and doesn’t) and as a craft/art (creativity) No either/or attitudes – rather it’s both/and. Helping staff see the need to balance quality and cost which also innovating. All staff should have a balance of self-assertion and modesty/respect – become aware that we all make errors and talking about these openly moves things forward Moving away from rigid thinking and behaving – and fostering that in the cluture infuses flexibility, healthiness, openness to change and new ideas Talk about change at Harmony and how we’ve rolled it out – brand new executive team, board, mental health focus, MAT, accountability vs. “family”
- When people receive critique, it activates NS and stress response. Understand how you respond – avoidant, argumentative, shut down?
- Note – being more mindful – culture of support and health means we stop and think about what we say around people and not being reactive. Open staff meetings with mindfulness. Ask if anyone has anything to share that is a “win” or shows our mission, shows our “why” we work here
- Supervision is a workplace activity in which a manager oversees the activities and responsibilities of employees he manages. It is an important job function for managers at all levels throughout your company. Coaching, training and employee development are among the common responsibilities assumed by a supervisor.
- Research says bad – 1. If you lead with praise, waiting for other shoe to drop and seems insincere, and people often tune out what’s in the middle and that;s the part you want them to know
- Gradual decline of trust and morale. Work productivity goes down because people are emotionally caught up Anxiety and tension are high as rumors circulate and people walk on eggshells without knowing what is and isn't fact. Divisiveness as people take sides. Unexpected turnover and loss of good talent who left due to the toxic work environment Go to peers – it doesn’t get resolved, it upsets the listener Venting leads to more venting and increased negativity Venting and self-reflection cannot exist in the same mindset