HARM REDUCTION SUMMER SCHOOL

2019 (HRSS19)The Art of Possibility

June 28-30 Emeryville, CA

GENERAL AGENDA

• FRIDAY 6-9PM • 6-7pm MEET & GREET w/finger food • 7-8 The Founders of HRP: Patt Denning &

Jeannie Little • 8-9 INTRO FACULTY & OVERVIEW/Q&A

• SATURDAY • 9-12 Jenn: HRP Basics plus • 12-1 Lunch on your own • 1- 2 More with Jenn • 2-4 Dee-Dee: MI3

• SUNDAY • 9-12 Jeremy: SUM Groups • 12-1 Lunch on your own • 1-3:30 Dee-Dee: Using LOVE to Listen - HR,

MI & Families • 3:30-4 Closing Remarks

Harm Reduction,

Motivational Interviewing,

& Families

• In response to Codependency movement of 1980’s

• Sources: Harm Reduction Psychotherapy (Patt Denning, 2000) + article (2010); CRAFT/Get Your Loved One Sober (Bob Meyers); Motivational Interviewing (Bill Miller & Steve Rollnick); Beyond Addiction (Jeff Foote, et al); Family Drug Support (Tony Trimingham, AUS)

• Much written for parents re MI especially (obesity; maltreatment); re: hoarding behaviors

• MI & HR both strength-based

• MI & HR both not agenda-laden but flexible • Helping families make their own decisions

based on their values, time frames, resources, etc not on a clinician’s values or societal pressures

Sources

• Motivational Interviewing, 3rd edition. (2012) Miller, W. & Rollnick, S. Guilford Press. NY, NY.

• Beyond Addiction. (2014). Foote, J, et al. Simon&Schuster. NY, NY.

• Listening Well: The Art of Empathic Understanding. (2017). Miller, W. Wipf & Stock. Eugene, OR

• The 20 Minute Guide – for Parents/Partners, 2nd edition. (CMC) https//:the20minuteguide.com.

• Motivating Substance Abusers to Enter Treatment. (2004) Smith, J. & Meyers, R. Guilford Press. NY, NY

• Get Your Love One Sober. (2004) Meyers, R. & Wolfe, B. Hazelden. MN.

• Over the Influence, 2nd edition. (2017) Denning, P. & Little, J. Guilford Press. NY, NY.

• Practicing Harm Reduction Psychotherapy, 2nd edition. (2012) Denning, P. & Little, J. Guilford Press. NY, NY.

• Harm Reduction Psychotherapy. (2007). Tatarsky, A. Jason Aronson.

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“In my early professional years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?”

---carl Rogers (circa 1965)

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COME AS YOU ARE

• Sometimes easier for us to believe where our own family members are concerned

• Sometimes easier for some of us to believe this with folks who have problem behaviors

• ALL DESERVE THIS MOTTO • Kurt Cobain (on the song of the same name):

• Lyrics of "Come as You Are" are contradictory, the song was about "people and what they're expected to act like".[2] 

•  Allmusic's Mark Deming suggests that the line “and I swear that I don't have a gun” is Cobain's "attempt to reassure listeners that ... his target is the world at large rather than the individuals in it, and that there was still room in this damaged world for everyone".[13]

“Pathological

Listening” (Bill Miller)

OARS for Families (Listening Well)

Open Questions, Affirmations, Reflections, Summaries

LOVE (Beyond Addiction & The 20 Minute Guides)

The Superpower called LOVE

Excerpt from conversation with Gabor Mate in “Dead Set on Living” (2018)

by Chris Grosso and Alice Peck 

Value Cards Sort

• In groups of 2-3, please share your chosen 3 value cards with one another

• Answer this question: • “How do you know that this

is of value to you?”

LOVEListening, Offering,

Validating, Empathizing

Listening without Words: An Exercise

• Listener, Speaker (Observer?) • Speaker: Be prepared to talk about something

(a monologue) for a few minutes. Possible topics include: where you grew up & something about it; an experience you had once that’s hard to explain; your favorite/dream vacation

• Listener: Try to show the Speaker that you’re listening without using words

• Return to large group to debriefThis Photo by Unknown Author is licensed under CC BY-NC-ND

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“Be curious not judgmental“Open-Ended Questions Exercise

1. (Demographics) Where do you live? How many times have you sought services? Are you sober now?

2. How many times are we going to have to go through this? 3. Don’t you feel bad that you may lose your job? 4. Don’t you think you’ve had enough? Aren't you

embarrassed at what you did? 5. Why didn’t you use your tools?++ Do you want to

wind up in the hospital?

12This Photo by Unknown Author is licensed under CC BY-NC-ND

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Affirmations

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Affirming/ Positive

Comments

John Gottman’s research shows 5 positive comments needed to cancel 1 negative

• Accentuate the positive • Acknowledge efforts • State your appreciation • Catch them doing something right

(remember our ratio is 7:1-5:1) • Give a compliment • Express hope, support, caring:

encourage less harmful behaviors!

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Affirmations - Examples

• You’re not a quitter. You’ve tried medications, different treatments, and you’re here. People who are quitters don’t do all that.

• You worked really hard this week in spite of things not turning out how you’d hoped.

• You’ve been through several detoxes and tried a few treatments. You’re really motivated to make this change.

• It’s obvious you’re trying hard

• I appreciate your openness today • Thanks for helping me with the dishes tonite • I like the way you said that to your friends. You

know, you’re really good with people • I hope this weekend goes well for you

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REFLECTIONS: 2 BASIC TYPES

• Simple Reflection: lets the person know that you understand what they said

• Complex Reflection: adds more substantial meaning - oomph; reflect the emotion & the content of what the person has been describing

When you’re unsure what to do/say next, try simply reflecting

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Reflections:

Examples

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Them: You never listen to me!

You: Seems like I don’t understand

what you’re saying

You: I’m not hearing you

Them: I don’t want to stop

drinking

You: Drinking helps you cope

with things

You: Alcohol is really important

to you

You: You:

Reflections: My Fave Clinical

Example

• Them: I used last night. • Me: How many other times this week did

you use? • Them: Just last night. I really didn’t want

to but…damn I’m tired of screwing up! • Me: Let me see if I understand: you went

out last night with no intention of using and yet wound up doing so for the night. You stopped after the one night and have been abstinent since. Is that right?

• Them: Yeah • Me: So how did you manage to stop?

That’s pretty impressive

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Thinking Reflectively

• In groups of 3: Speaker, Listener, Observer

• Speakers: Be prepared to share on “One thing I like about myself is…” Be sure it’s an abstract characteristic (not how tall I am for example)

• Listeners: You may only respond with “You mean that…”

• Speakers: May only respond to Listener with “Yes” or “No”. No other elaboration please

• Observers: What did you notice about this exercise?

• Each member of the group may get a chance to be each role

• Debrief in large group

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Using Reflections

Building Trust – The Penny Game

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Building a Trust Bank • In pairs: 1 Speaker & 1 Listener

• Speaker begins by talking about something real though not too tender (i.e., how you came to the work you do)

• Each time the Listener reflects appropriately, the Speaker moves 1 penny or more from their pile to the Listener’s “bank.” (How many is up to the Speaker)

• The goal is for the Listener to get as many of the Speaker’s pennies in front of them

• And remember, to ask a question (even open ones), Listeners must PAY the Speaker a quarter! Ouch!

• Return to debrief in big group

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Summaries

• A collection of reflections used to connect, to clarify or “check our assumptions”

• Shows we can move on to the next part of the conversation

• Summarizing shows we’ve been paying attention/listening

• You can’t reflect or summarize everything someone says so it’s up to you to decide what to reflect & how

Offering: the Oreo

• Ask Permission • Would it be OK if I shared a concern I have? • Could I make a suggestion? • Can I ask a question?

• Provide Information • Provide options • Offer don’t mandate • Allow for disagreement

• Check Back • Does that make sense to you? • What do you think of that idea? • I’m not sure I said that right…

This Photo by Unknown Author is licensed under CC BY-SA

“Never miss a good chance to shut up.”

---Will Rogers

Validating

• Confirm someone’s experience/Support someone’s POV • Affirming reflections which include knowledge of

past events you know or comments: “You’re really mad.” “This is really hard to do.” “You’re wondering how you’re going to make friends if you’re not smoking.” “Having to take care of the kids as well as the yard seems really unfair.” “I know some people have treated you badly in the past so it makes sense that you’d be angry at your friend; and yet threatening to harm them just now has really hurt you too.” ”These changes are taking too long.” “You’re having a hard time right now,.”

• Your friend has been divorced for 3 years. He feels uncomfortable doing activities with other couples because he is the only single person in the group. You say, “It’s normal; most single people feel this way around couples.” 

Thanks to www.dbtselfhelp.com for some examples

Empathy: “The Express Lane”

(aka the Backstory)

A Story about Coming to Understand Better

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Reframing Resistance• Thinking • Opportunity • Natural phenomena in change • Discord • Something we all can improve/

worsen • Relational • Rolling with Resistance

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Dance more, wrestle less!

Talking about LOVE:OARS Scrabble Exercise

• In groups of 3: Speaker, Listener & Observer • Using the Scrabble tiles, have a convo re a

real change, a client scenario, family situation, etc, using ONLY the tiles you have

• Observers may move the tiles for the Listener if desired. Observers also please take notes re what happens in the conversation: what helps/what reduces conversational ease, builds trust, & more

• Debrief in large group

“People don’t resist change…they resist being changed.”

…..Peter Senge, PhD; MIT

THANK YOU ALL FOR COMING!!!

•drjenniferfernandez@poweroveraddiction.com •https://jenniferfernandezphd.com

•jprillwitz@sfaf.org •https://www.sfaf.org

•deedeestoutconsulting@gmail.com •www.deedeestoutconsulting.com