Back in the saddle again!

Hello world.  Just trying to catch up after a medical problem that put me in the hospital for over a week.  I am grateful to be alive and healthy.

I have been doing a great deal of coding for several research projects, as well as feedback/coaching for practitioners in healthcare, probation and mental health.  I begin teaching in the Marriage/Family Therapy program at Northwestern University, and the Family Institute has been so gracious to me.  Many thanks to Doug Breunlin and Bill Russell for continuing to be my cheerleaders.  I also begin teaching a similar course in the Community Counseling masters program at Argosy University in Schaumburg, IL and a big shout out to Dale S., my chairperson there.  And Dan Beach, Chair of the Psychology Department at Dominican University, you are the bomb, dude.  I truly am grateful for all of your support during this very trying last 18 months of my life.  I know that I am not only in writing (typing) that you all have continued to see something in me that has provided the optimism much needed, as well as the part time work.

Teaching these courses allows me to continue my own research in teaching Motivational Interviewing, as every student provides a baseline session of MI, receives feedback/coaching and then provides another session at the end of the course.  This has allowed me to see what differences, if any, we can see with or without Feedback/Coaching vs. just numeric feedback.  It is a tremendous amount of work on the part of the students, and I know what courage it takes to let someone hear and code one's own clinical work.  Bravery of this type is in short supply among practitioners and they are to be commended.

I love my students.

Jacque

Guided Imagery Audio to relax to by Jacque Elder and Scott Hughes

Here is a lovely relaxation audio that Scott Hughes and I created so please help yourself and feel free to share with anyone.  Here is the link and I believe you can download it for your own use.  Scott was feeling a wee bit tired so I said "Let's go do some meditation for you to help you rest."

This is the result, and Scott did the beautiful music.  My dog, Laura, is snoring in the background yet I don' t know that you can hear her little doggie sleeping sounds.

A College Education for Free? I love it!

I was reading The Economist Magazine when an article titled "How to make college cheaper" caught my eye, of course.  Having just read that tuition in the UK just skyrocketed and yet Germany decided to not make students pay any tuition in some parts of the country, this article was something I knew I had to read.

The University of the People is a free online university and the link is noted above.  It looks great.  I have applied to be volunteer faculty yet they already have 2,000 volunteers and only 1,000 students.  It is a global university, using the internet to offer free (minus a small admissions fee and some $ for teachers grading exams, etc) yet all in all, you can get a Bachelor's degree in Business, Economics or General Studies.

I hope they pick me.  I love people who do stuff like this.

Jacque

"Can't Get a Break"

This is a standard patient roleplaying the struggles of "trying to do the right thing" with a felony conviction blocking his way of becoming employed.

I hope you enjoy it.  The standard patient ( a good buddy of mine, paid and signed release) did a wonderful job, I thought.  He made the session so easy....

Jacque

Reading "Being Wrong" book

Last week, I finally finished the book Being Wrong,  which I highly recommend.  The book focuses on the "good" vs "not so good" things about how we make mistakes (assumptions) and how transparency about talking about our mistakes actually has the opposite effect that most people think.

For instance, the author has a chapter on all the lives that are lost in hospitals, due the medical error and the "thin blue(green) line" that is evoked when any practitioner makes a mistake because of the fear of legal liability.  She states that doctors and hospitals that acknowledge their mistake, and especially apologize to the patient and their family are sued 80% less than those who don't!  What a novel idea!  There is a beauty in transparency, as it speaks to our core values of honesty and integrity.  It is amazing what a simple apology can do in terms of impact upon the person to whom the harm has been done.

She also writes about using the language of uncertainty, which in MI is "asking permission" or using what a student of mine called "wiggle room".  "What, if any, ideas do you have about making this change if you decided to?"  "You will know if you are ready, and that is if you decide to do it at all."  "You are making a decision to not make a decision, and you know yourself best."  I have found that adding the "if any" is powerful.  For instance, "What are the not so good things about smoking cigarettes, if any?"  "What things have you done in the past to change this behavior, if any?"  That removal of certainty (expertness) opens up for collaboration and autonomy.  And we just cannot assume that they have done this things, or experience "not so good" things.

This is especially true in "Looking Backwards".  I cannot assume that folks have a positive experience that they can resource, and as a result, using the "if any" gives me my wiggle room.  As an Ericksonian hpnotherapist, Erickson was know for his strategic use of language, making sure that we start with the hypothesis that we do not have a crystal ball and cannot make assumptions about the patient's inner world or life experiences.  This is especially true with working with poor people.  They live in neighborhoods where it is not safe to go out and take a walk so pressing them to do so can be offensive.  They don't have money for fresh foods, and there has been a great deal of media attention on "food deserts", which are always located in disadvantaged neighborhoods.  I don't think they have a Whole Foods or Traders Joe's on the West Side or the Englewood neighborhoods of Chicago.  I haven't seen one so if someone knows of one, let me know.  And Oak Park does not count as the west side of Chicago.

Great book, easy to read and I learned a great deal about my willingness to "f**k up" as the author so succinctly puts it.  She wants it to be OK to do that, rather than hiding it and creating the constant "imposter anxiety" we all may experience either all the time or just some times.

Many thanks.  Jacque

Starting to use the MISC 1.1

I am finally taking the leap and trying out Lisa Hagen and Terri Moyer's MISC 1.1, which Lisa assures me is very easy to use!  I will be finding out today as I practice with it for the first time.  The MISC 1.1 codes for Change Talk and Sustain Talk, using full pass coding, only one has to code the entire session instead of a random 20 minute segment.
I am looking forward to using this, as the MITI only codes the practitioner, and the MISC 1.1 tracks the presence and absence of what is going on with the client.  This fits in well with Scott Miller's Feedback Informed Treatment, though his feedback (SRS: Session Rating Scale) gives much more specific feedback to the practitioner and is easy peasy.Registration for Advanced MITI 3.1 and MISC 1.1 Online Coding Training.

Harm Reduction in the Brickyard of Chicago - Greg Scott and Jacque Elder

click here to listen to show

This was a show on NPR that my friend, Greg Scott, a sociologist from De Paul, asked me to join in as the "addictions expert".  I know the host was expecting a Treatment As Usual (TAU) practioner yet that ain't gonna happen.  I met Greg through Chicago Recovery Alliance, the US's largest mobile needle exchange where I am a volunteer and Captain of their Chicago AIDS Foundation Team.

Never thought I would get to see the inside of WBEZ, and it was beautiful.  I loved our "experts", one woman and two men who lived in the Brickyard, a illegal homeless shantytown in Chicago.  It has since been bulldozed.

Greg has some great videos on You Tube so search for Sawbuck Productions and Greg Scott.  It is very graphic video of folks shooting up heroin yet the Change Talk as he talks to them is lovely.

Brickyard Residents and Drug Counselors Address Treatment Options

Brickyard Residents and Drug Counselors Address Treatment Options

Helping folks learn MI

It took me several years to find out what the mystery was about in learning MI.  I wish I could write that I do perfect or even really good work often yet I don't.  I like being in kindergarten, getting cookies and milk, and naps and recess!  So, I don't mind letting other people hear and code my work as I learn something every time I allow my work out there.

When I was at The Family Institute, we used to have to do "live sessions" and those are more vulnerable than taping an audio session with a client.  I made mistakes yet I watched my peers make mistakes as well, and it level the playing field.

I think Change Talk is becoming increasingly important, and I introduce early on in my trainings.  Learning what is sounds like, learning what Sustain Talk is and what to do with it.  If Change Talk is the jewel in the crown, I need to be polishing that jewel every chance I get.  Change Talk is language that indicates Desire, Ability, Reason or Need to change.  "I like my drinking and I ain't giving it up but those hangovers are killing me!"  Ding, ding, ding! "Tell me more about those hangovers. They don't sound fun at all."  First there is Identifying Change Talk, Eliciting it if need be, Reinforcing it with directive questions or a reflection (I tend to use questions), and then taking it some where.

I was telling my students at Argosy that we do want to create cognitive dissonance if they are in our office for some reason, and yet doing it gently and carefully is an acquired skill.  My own agenda sneaks out at times to this day, as (here is some Freud here), I have counter-transference.  With them all!  And some I like more than others.  Yet, I have this willingness to approach each one with an open mind, and what a lovely thing when they allow us to enter their word.  I am becoming more curious and adventurous in my personal life, and it is seeping into my clinical world, affecting my empathy so that I am listening more (duct tape over my mouth).

I am working with a couple that is considering splitting up, and I am grateful  for having experience with being both the dumper and dumpee.  The dumper has all the power and so extra loving-kindness is what I give to the dumpee.  There is just something about getting dumped that taps into every abandonment issue you have had since you popped out of your mom's uterus.  It taps into "Who will be my mommy?" or "My Daddy" or as Pema Chodron puts it "There is no babysitter."  What, no babysitter?  That sure burst my bubble, and working from that awareness now means I have a different perspective than I used to.  Things don't get better very quickly.  Getting sober is hard work and takes a long time.  Getting fit through exercise - long time, hard work!  If behavior change were easy, I wouldn't have a job.

So, Change Talk is the word for the day, and we have an advanced coding course coming up  this week and next where we are also going to try out the MISC 1.1, which codes...Change Talk!  I am excited about checking out the perspective of the client, especially with my training I am doing with Scott Miller on Feedback Outcome Treatment.  The MISC coding results may give us an idea of what the client is thinking about the session.  What a novel idea.

Does learning the MITI 3.1 Coding system increase practitioner skills?

Using Motivational Interviewing with Feedback Informed Treatment (FIT)

In February 2011, I went through Scott Miller's Advanced Training in the use of Feedback Informed Treatment.  If you are not familiar with Scott's work, he wrote many articles and books when he was doing Family Therapy, in the development of Solution-Focused Therapy.  His book, The Heroic Client, describes his departure from the use of any one "model" or "technique" to focus on what actually works from the viewpoint of the client, rather than the practitioner's opinion on how well the client has done with them.

I have begun using his Outcome Rating Scale, in which the client is asked about the level of distress re: their presenting problem using a Likert scale of 0 to 10, with 0 being "very bad" and 10 representing "very good".  This data is then entered into a database to follow how the client is assessing their problem per session. 

At the end of the session, the clients are asked to fill out the SRS, Session Rating Scale, whereupon they rate the practitioner, their satisfaction with the session including the content of the session, whether or not they experienced being heard and understood, whether the practitioner missed anything and can/should include logistical matters such as being on time, chewing gum, etc.

My first client did not want to fill out the questions at all, and when I asked the second session, she still did not want to.  I started getting worried that this might become a problem, so I began telling my clients while on the phone making the appointment that I would be using these tools.  I explained that I could not become a better practitioner without their brutally honest feedback, and that their progress on their "problem" would guide both of us as to whether what I was doing or whether I was a good fit for the client.  One client told me (on the phone) that she saw a therapist for 7 years almost weekly, and felt she made very little progress.  She was reluctant to terminate with her (though she liked her) because she (the client) thought that it was something she rather than the therapist had done wrong.  It was only through a good friend urging her to try someone else that she did. 

I have found that the approach of getting honest feedback from the client is easier than I would have thought.  By explaining it as an issue of them being an "educated consumer" as well as assisting me in becoming a better therapist was very helpful.  One client said "I feel like I am grading you!"  "You are!", I responded.  I encouraged them to be very honest, as I was interested in what would bring a number up.  I have found that I get some 7's out of 10 in some sessions, and I ask them "What would bring it up to an 8?"  I get very specific feedback:  I don't want writing assignments, I would need help accessing and using a computer for a website you recommended, I don't like to read, etc.

All of this data is then put into a database, which then allows me to plot if they are getting "better" (according to them) as well as their experience of me as being helpful.  If by session 6, their level of distress has gotten worse rather than better, we have already discussed on the phone and first session that it is time to discuss other options.  Using me to be "their paid best friend" is not effective therapy, if they are feeling worse instead of better.  It could be finding out what would be more useful to them (we always cover that) will also reveal that they need a practitioner with a different skill base than my own.  Perhaps a healthcare practitioner would be the person to see or perhaps going to a Buddhist temple might be the answer!  People solve their dilemmas with different pathways and they do not all involved psychotherapy. 

This August, I am going through Scott's Training of Trainers, and I am looking forward to learning more about how to interpret the data of Evidenced Based Practices more accurately, as well as hone my skills in FIT.  I can use any tool in my toolbox, anything I feel competent in, whether it is MI, hypnotherapy, Cognitive Behavior Therapy, helping them develop a resume, couple/family therapy, anything I feel competent in.  If they needed help with Anxiety, I would find a good referral for them as I don't have enough background for in vivo work, which is the CBT method I like best. 

I have not had my feelings hurt by getting scores of less than 10.  I thank my clients when they give me a 6 or 7, as they can then share what they need and want.  This approach increases the sense of collaboration that I love about Motivational Interviewing.  I am a MITI 3.1 coder and coding trainer, and I am always thinking about how the client would have rated the practitioner in the session.  Here I am, rating them and why is not the "expert", the client, rating them?  It is an acquired skill to present the desire for honesty about me, and yet so far, I think they have been quite honest.  I tell them most clients (most people) overrate everything on surveys such as this, whether in a restaurant or online.  What good does it do any provider to get no feedback from their "customer"?

I am digging it!

Jacque