“I believe that the most important aspects of any professional intervention is: 1) to be comfortable with your counselor or professional, and 2) whether your counselor believes in your ability to change. I believe that each person is fully capable of making their own best decisions and - sometimes with a bit of help – is competent to discover or uncover what healthier living means for them. Working with people, in any format, is a privilege. It also helps me to be a better professional and consultant.”
Dee-Dee Stout holds a Special Major Master’s degree in Health Counseling for Special Populations from San Francisco State University. She is also a California Certified Alcohol and Drug Counselor level II (CADC-II) with international reciprocity. She is a member of the Motivational Interviewing Network of Trainers (MINT; see www.motivationalinterview.org). Dee-Dee has done extensive training in the field of substance abuse and behavior change with such experts as Drs. William Miller & Stephen Rollnick (Motivational Interviewing), Drs. Scott D. Miller & Barry Duncan (The Heroic Client: Becoming Client-Centered and Outcome-Oriented; The Heart and Soul of Change), Jane Peller, LCSW & John Walter, LCSW (Recreating Brief Therapy); (Dr, Patt Denning and Jeannie Little, LCSW (Harm Reduction Psychotherapy), among others.
Dee-Dee is a faculty member at City College of San Francisco and former adjunct faculty at San Francisco State University; she has developed curriculum for the Northern California Training Academy at UC Davis as well as in other settings. Dee-Dee spent the past year as the Clinical Program Manager for Project Pride in Oakland, CA, a California Community Prisoner Mother Program (CPMP) that includes community-based pregnant and perinatal women. There, she and staff worked to break new ground, bringing trauma-informed, gender-responsive treatment to these moms and dismantling the often re-traumatizing traditional prison therapeutic community (TC) model of substance abuse treatment. Dee-Dee has also worked in other treatment settings: other therapeutic communities (TC), social model, and medical-model settings. Her past accomplishments in treatment include developing exercise programs; forming a relapse prevention treatment program for a large HMO; starting family programs for residential social-model treatment programs in the Bay Area, and now, bringing trauma-informed treatment to female prisoners and other moms.
Dee-Dee has conducted some 450 presentations, talks, and trainings to date on such subjects as: Anger Management, Families of Substance Users and Abusers, Motivational Interviewing, the Stages of Change, Human Sexuality, Nutrition, and more. She is a frequent Bay Area speaker and trainer and has presented at numerous conferences including the International EAP Conference in Vancouver, several Harm Reduction Conferences, the Annual Federal Bureau of Prisons Conference, CAADAC Conferences, and the 2009 International Institute on Violence, Abuse, and Trauma conference. She has spoken to groups as diverse as EAGALA (equine-assisted therapy) to Cornell University (3-day MI training) to the recent Annual Voice Conference (through UCSF Department of Otolaryngology) in San Francisco. She was even filmed by the Emmy-award winning Showtime series “Penn & Teller’s Bullshit!” and is often interviewed for comments for radio and in press on treatment. She also contributed to the book “Over the Influence” by Patt Denning, Jeannie Little, and Alina Glickman (Guilford Publishing) as well as David Rosengren’s new book, “Building Motivational Interviewing Skills” (2009, Guilford Publications).
Dee-Dee has spent time volunteering with the Department of Public Health/Community Behavioral Health Services (CBHS) and the Volunteer Legal Services Program (VLSP) here in San Francisco as well as with various organizations promoting human rights, including queer rights, women’s health, and drug user’s rights. Previously, she has worked in such areas as marketing & advertising, radio, and taught Suzuki piano for a decade.
Dee-Dee’s new book, Coming to Harm Reduction Kicking and Screaming: Looking for Harm Reduction in a 12-Step World,” is available through the publisher (www.AuthorHouse.com) as well as major book retailers.
(rev Sept 2009)
Responsible Recovery™ (RR) was founded in order to offer more than one choice of treatment to those seeking help with addictions and other health behaviors. While I happily support those who find 12-Step helpful to their lives, I also do not require that one attend any self-help group. Treatment is a very personal decision and group work is not right for everyone. RR believes the job of a clinician is to help guide you to the decision that works best in your life, not to a predetermined decision made by someone else. Harm Reduction Recovery™ is a concept developed to better bridge the 12-Step world to the harm reduction world. It simply means that if you define yourself as being mindful in your life, feel connected to yourself and others, and are doing something – anything – to grow (mostly, we’re human after all!), you are in recovery. This may even include people who are current drug users (and always includes those on prescribed medications of any kind, using them as prescribed) though would likely not include those who are having trouble with their drug use or other less-than-healthy behaviors. Make sense?
RR is also a consultation agency for treatment providers: as an on-site consultant to help develop curriculum; as a trainer and coach source in client-centered skills especially Motivational Interviewing, Solution Focus Brief Therapy, and Harm Reduction; and as a resource for other client/person-centered, solution-focused strategies to assist the individual or family to discover their own solutions. In addition, RR works with outcomes using client-centered, outcome-informed work principles and forms developed by Scott Miller and Barry Duncan <a href="http://www.getontrack.org" target="_blank">www.scottdmiller.com</a>. These interventions and strategies are the ways to avoid burn-out for the clinician/worker and agency, and to encourage empowerment in the client/person.
RR is also pleased to be affiliated with other like-minded providers and agencies and I invite you to look at my “links” section. There you will find others that believe in these basic harm-reducing tenets:
• People should be held responsible - for their actions not simply for what they put in their bodies
• There are as many different ways to recover from life as there are people
• All lives are worth saving
If you believe in these ideals as well, please send me a note. Tell me what you think of the drug laws of this country, of the fact that currently there is more funding for incarceration than treatment, and of any current treatment experiences you have (workers and clients). Please let me know if you have been hurt or helped by professionals in my field. Thanks for stopping by and may your dreams become your reality!
is a concept that brings together 2 seemingly polar- opposite ideas – 1) that people can be ‘in recovery’ and 2) they can continue to
use substances and other behaviors. What, you say? Are we mad?! This is insane…blasphemy!
Well, we don’t think so. Actually, we know that people can and do use
chemicals both responsibly (most people) and irresponsibly (some of us). And
we also know that recovery is about much more than abstinence. HRR is simply
suggesting that not one way fits all and that there are an infinite number
of ways to recover. This does not mean that everyone can use responsibly.
If you are interested, though, please look into Substance Use Management (SUM),
a copy of which can be viewed at the Chicago Recovery Alliance website, www.anypositivechange.org. There you will find a thorough discussion of SUM and be able to decide for
yourself if it is a possible approach for you. Some people who use chemicals
are genetically programmed differently and they will probably not be able
to use responsibly. However, often they CAN learn to reduce some of the harmful
effects of their use (both to themselves and others) while working towards
complete abstinence (think warm turkey instead of cold turkey).
In spite of what the name seems to imply, HRR, like traditional harm reduction,
does include abstinence…and 12-Step, and SMART recovery, and psychotherapy
and acupuncture and anything else you can think of. See, that’s the
whole point - HRR includes EVERYTHING! It simply brings recovery decisions
back to where they belong – to the client. HRR believes it is up to
the individual, with assistance from professionals, to determine what course
of recovery and/or treatment THEY would like to begin, from occasional chemical/behavioral
use to regular but moderate use, to abstinence. Changing behaviors isn’t
easy but it can be done. The key is to begin to form rituals of behavior that
are aligned with your own personal values. And that’s how recovery begins.
After all, recovery really just means three things:
Mindfulness + Connectedness + Inner Growth
And these 3 things can begin at any point, like right now. You can decide
right now to be more mindful of what you’re doing, right? You can learn
to notice more often, to be really aware of what you’re doing and maybe
why. You can certainly be more connected to others and yourself especially
while practicing- ritualizing - the beginning stages of HRR. One suggestion
in HRR is to begin to ask friends about how they have changed their own undesired
behaviors. And, by asking for suggestions about change from others, you are
connecting with them, right? Then, there’s inner growth. Well, that
can be as simple as picking up a book on change (a great one is “Changing
for Good” by James Prochaska and others) to learn more about it. Remember:
it’s ANY POSITIVE CHANGE made through ritualized behaviors that are
practiced. And practice never makes perfect but it does make progress!
So again, recovery is NOT abstinence and abstinence is NOT recovery. Nor is
it required for someone to begin to recover from other conditions so why should
it be different for chemical dependency, misuse, or other compulsive behaviors?
Responsible Recovery believes in helping clients determine their own unique
recovery by being respectful of people and their unique circumstances. We
believe that recovery is an inside job which means inside the client, not
the professional. We also believe that people often need some help to recover;
and with Responsible Recovery, that help comes with unconditional support
from our professionals.
|So Why This Focus on Trauma? Trauma and interpersonal violence have more recently come to be seen as catalysts for substance abuse disorders (SUDs) especially among women. According to Harvard researcher Lisa Najavits, most women who come to treatment have a history of at least one traumatic event, typically sexual (for men the rates are lower but probably due to under-reporting, not necessarily for less trauma) (Najavits, 2001). This greatly impacts the type of milieu and treatment modality these trauma-surviving women should receive for best results. Motivational Interviewing (MI) was developed as a way to elicit the internal motivations of problem drinkers in an effort to engage them in treatment services. Since that original 1983 article by Dr. William R. Miller, MI has transformed, becoming a way to communicate in a variety of settings beyond addictions, one of the latest being with victims of trauma and interpersonal violence (Wahab, Stout, et al, in press; Miller & Rose, 2009; Miller & Rollnick, 2008).
So what is the connection between MI and IPV? As a humanistic model of being with people, MI is the perfect vehicle to help transform a typically stressful first meeting with a newly ‘wounded warrior of trauma’ into one of hope, listening and witnessing, and potential assistance with available services. MI is the perfect fit for those types of potentially transformative meetings. It allows – no, encourages – workers to take a step back in favor of allowing the safety and space for the client to come forward. It is within that sacred safe space that a glimpse of the world of the client can peek through, leading to a better understanding by the worker of the types of services from which this client might benefit, knowing that not all services will be appropriate for everyone (another belief espoused by MI).
We are speaking here about a population who have often had so much trauma and violence in their lives - as have their children - that frequently violence has come to be seen as a natural and normal part of life by all involved. Their chemical use and other less-than-healthy behaviors are also due, in large part, to the need to cope or soothe the psychological, physical, and emotional effects of a violent life. And these less-than-healthy behaviors and chemicals work - to alleviate the pain and anxiety, and simply to allow folks to leave their surroundings for even a brief moment. This can sadly lead to some professionals to label these drug/behavior users as being “in denial” rather than fully appreciate what these behaviors are doing for their client. Moreover, as workers see these client behaviors as “being in denial” and “addict” behavior, they do not “join with” these clients, and may even respond themselves with control (a type of violence) and punishment (abuse). This hurts not only the client but also the worker. Our behavior and treatment now mimics the role of the controlling former partner/person and we become the controller/abuser, a role understood and perhaps even expected by this population. But is this who we really want to be?
This hurtful role of our may also be part of the explanation for why this population fails to often seek treatment. After all, why leave one abuser for another? One that is unknown (us) and requires that clients give up the only coping skill they may have - one that works every time, all the time? We must engage and encourage these ‘wounded warriors’ to treatment - not with lofty promises but with real promises of real treatment, including a sensible menu of options appropriate to the individual, not to us.
The principles of MI are a good place to begin to understand its potential impact on especially these initial meetings with our clients with IPV. MI has four (4) basic principles: 1) Expressing Empathy, 2) Avoiding Arguments by Rolling with Resistance, 3) Developing Discrepancy, and 4) Supporting Self-Efficacy. These principles are especially helpful in framing the first stages of trauma recovery - safety, according to Judith Herman (Herman, 1992). Often our female clients are mothers who are already marginalized, facing stigma and prejudice especially if their lives have intersected with the criminal justice system. MI can assist workers in providing the safety needed for these client-moms to begin their healing process simply through the use of these MI principles in this client-centered communication. It is a small but important step toward building rapport with a client, and the effect of building this rapport into a true partnership is the largest of all change effects (this “therapist alliance” can account for as much as 60% of change effects. For more, see Scott Miller & Barry Duncan’s work at www.talkingcure.com).
With GRTI, we are advocating for a complete shift in traditional SUD’s treatment, using MI as the model. With its competence world view versus deficit world view, MI sees these clients as able to make change in their lives, able to make healthier decisions for themselves, their children, their families, and able to partner with workers to make these changes. This is in opposition to the current models of SUD’s treatment who see all drug users and drug use in a negative light, sometimes even as addiction even when no criteria for dependence is seen (i.e., “you use because you’re an addict, and you’re an addict because you use”). In a traditional deficit model, clients’ problems are the focus of treatment and there is typically a singular way to recover (usually 12-Step based which may also be a trigger for some women and others with trauma histories). Also, trauma is seen as a “one-to-one” event: one trauma leads to a singular experience and a singular symptom. The idea that all persons with a similar problem will have the same symptoms and that they can be successfully treated in the same way is also part of this traditional model. MI helps us to move away from this ‘singular service’ model through its basic principles. With MI, we are better able to express empathy and appreciation for the behaviors and lives of these heroic clients; help clients develop discrepancy between the life they would like to have and their current circumstances; roll with the natural resistance of making change through avoiding arguments with clients; and help build a clients’ confidence to make these changes through supporting their self-efficacy and fostering autonomy. If I’m doing my job well, I’m always working myself out of a job with a client. My goal is for them to recover their lives and leave me behind as soon as possible!
I hope this has helped to describe GRTI treatment and especially as it intersects with Motivational Interviewing. If you would like assistance in your program with either training or revamping/developing a policies & procedures (P&P) manual utilizing GRTI principles, please contact me. It is possible that your agency would be eligible for free training and/or consultation through one of the State grants. And if you have any comments or questions, please email me. I’d love to hear from you! Finally, I know none of us got into this field to purposefully injure anyone. I also know that we mistakenly injured many early in my career when we didn’t know better. Well, we know better now. No more excuses. Let’s revolutionize treatment and, who knows - maybe clients would even want to come!
(rev Sept 2009)
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