just talk sparks webinar slides

https://heartandsoulofchange.com 9/20/2014

[email protected] 1

Something like this Barry ?Just Talk

PCOMS As Political Action

Jacqueline Sparks, Ph.D.Heart and Soul of Change:

Evidence Based Practice One Client at a TimeSaskatoon, Saskatchewan

June 5, 2014

Jacqueline Sparks, Ph.D.Heart and Soul of Change:

Evidence Based Practice One Client at a TimeSaskatoon, Saskatchewan

June 5, 2014

Great doubt: great awakening.Little doubt: little awakening.No doubt: no awakening.

Zen koan


[email protected] 2

Why Do We Do What We Do?Why Do We Do What We Do?

The work we do provides benefit for many people. The average “treated” person is better off than 80% of those not “treated.”


[email protected] 3

• Many from non-dominant groups (ethnically/culturally diverse, diverse sexual orientations, economically disadvantaged, diverse religious/spiritual backgrounds, . . .) either stay away or, when mandated, do not engage.

• Many clients do not find what they are looking for and drop out.

Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists – A merican Psychological AssociationApproved as APA Policy by the APA Council of Representatives, August, 2002

• The typical dyad in psychotherapy historically was a White middle-class woman treated by a White middleclass therapist.

• Eurocentric models may not be effective in working with diverse populations and may do harm by mislabeling and using inappropriate treatments.

Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists – A merican Psychological AssociationApproved as APA Policy by the APA Council of Representatives, August, 2002


[email protected] 4

“Mental Health” is entrenched in a monolithic, Eurocentric paradigm based on a coded ritual: Diagnosis + Prescriptive Treatment = Cure.

Sue, D. W., & Sue, D. (1999). Counseling the culturally different: Theory and practice(3rd ed.). New York: Wiley.

y

• Lack of cultural sensitivity of therapists

• Distrust of services by racial/ethnic clients

p )

• Therapy “can be used as an oppressive instrument by those in power to…mistreat large groups of people” (Sue & Sue, 1999, p. 7)


[email protected] 5

http://lastrealindians.com/sexual-trauma-one-legacy-of-the-boarding-school-era-ruth-hopkins/

North America’s First Peoples – A Stolen Identity

In the name of benevolence. . .

• In the 1940s, U.S. physicians performed an estimated 18,000 lobotomies

• Applied to "difficult" patients; became a way to control behavior rather than to relieve symptoms

• Moniz received the 1949 Nobel Prize for Medicine and Physiology for pioneering the procedure

http://www.minddisorders.com/Ob-Ps/Psychosurgery.html


[email protected] 6

“Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient….” Ernest Hemingway

In the name of benevolence. . .

The TalkTo be effective, the diagnosis and treatment of mental illness must be tailored to all characteristics that shape a person’s image and identity. The consequences of not understanding these influences can be profoundly deleterious.

(US Surgeon General 2010 Mental Health Report, p. 22)


[email protected] 7

Recovery: Mental Health Care Is Consumer and Family Driven

“After a year of study, and after reviewing research and testimony, the Commission finds that recovery from mental illness is now a real possibility. The promise of the New Freedom Initiative—a life in the community for everyone—can be realized “(The President’s New Freedom Commission on Mental Health, 2003).

More Talk

Evidence-based practice is the integration of the best available research with clinical expertise in the context of client characteristics, culture, and preferences (American Psychologist, May 2006).


[email protected] 8

Clinical Expertise

• The clinician fits the approach to the client and make changes as needed

• Clinical judgment is always in play

• Therapist autonomy is valued

• Individualized treatment decisions are valued

In the Context of Patient Characteristics, Culture, and Preferences

• Research informs the options

• Client preferences determine the approach

“Psychotherapy is a collaborative enterprise in which patients and clinicians negotiate ways of working together . . . Thus, patient values and preferences (e.g., goals, beliefs, preferred modes of treatment) are a central component of EBPP (APA, 2006, p. 280).


[email protected] 9

Diagnosis+

PrescriptiveTreatment

= Cure or Symptom

Amelioration

The Walk: Everyday Practice


[email protected] 10

Clinicians are. . . • Technicians—treatment delivery

systems.

• Manuals and consistency produce the best outcomes.

Assessment is. . .

Click-by-Numbers



. . . “cardboard cutouts” upon which clinicians pin their diagnoses and empirically -supported treatment prescriptions.

Clients are. . .

Treatment is. . .

. . . a drop-down menu option.



“Treatment” promotes adjustment…

• …to power and economic disparities

• … to gender, sexuality, & family norms.

• …to problematic societal institutions.

… to the label.

• Conditions of poverty, discrimination, and injustice that produce “unacceptable” or “deviant” behaviors.

“Treatment” obscures . . .



• We become susceptible to media touted interventions

The therapy relationship. . .• Diagnosis constrains

and contains; we become separated from our clients and from their stories.

• We become disconnected from clients’ cultural healing resources



Psycho-Medicalization• Combat veterans post-

combat experience

• Childhood

• Diverse expressions of sexuality and sexual identity



"I'm not mental. You can see that. I don't understand why my son left. I want my boy back. I'm not incompetent. Life can make you incompetent If there's no roof over your heard, it can make you depressed.”

Gondolf, E. W. (l998). Assessing woman battering in mental health services. Thousand Oaks, CA.: Sage. (p. 50).

“Treatment” for the Poor

Differential Psychiatric Tx for Poor Children

• Use of antipsychotics in children with Medicaid coverage is four times that of children in the private sector and for less serious conditions (Zito & Burcu, 2013).



In Their Own Words – Eduardowww.childrensrights.org

“It kept me from doing my work. I was always falling asleep. I couldn’t stay up for a little bit or even to finish a test, so I kept on getting held back in school.”

Injustice – Economic Mobility• Less likely to succeed academically and socially

• Less likely to move out of the under class into middle class jobs

• The cycle is perpetuated



Treatment of the “Severely and Persistently Mentally Ill”

• Perpetual prescription

• Forced drugging

• Inhumane hospital treatment

• Hopelessness

• Dependency

• Isolation

• Stigmatization

Just Talk: Enacting Our Values



Psychotherapy’s Evolution

• Psychoanalysis

• Behaviorism

• Humanism

Comas-Diaz (2012). Humanism and multiculturalism: An Evolutionary Alliance. Psychotherapy, 49(4), 437-441.

Multicultural theory is now the dominant view in counseling psychology, indeed, it has been called the field’s core identity (McCutcheon & Imel, 2009).

MULTICULTURALISM

Comas-Diaz (2012). Humanism and multiculturalism: An Evolutionary Alliance. Psychotherapy, 49(4), 437-441.



• Reflective training and critical consciousness may not translate into behaviors with clients.

• “There does not appear to be a single study examining the relationship of MCC with clinical outcomes” (McCutcheon & Imel, 2009).

• Standard views of multiculturalism do not address key dimensions of social justice.

• Altering conditions that maintain psychological distress may not be viewed as part of the therapist’s role.



Psychoanalysis Behaviorism

MulticulturalismHumanism

MEDICAL

MODEL

POLICIES

PROCEDURES

PAPERWORK

The Basis for a New Paradigm: Client Voice and Choice

• Multicultural psychotherapy is embedded in humanism. . . [it] fosters people’s capacity for choice, freedom, and transformation (Comas-Diaz, 2012).



• Social justice "involves the promotion of the values of self-development and self-determination for everyone“ (Vera & Speight, 2003, p. 111)

Client Self-Determinism

Psychotherapy and Social Activism

• Changing “social institutions, political and economic systems, and government structures that perpetuate unfair practices, structures, and policies in terms of accessibility, resources distribution, and human rights.”



Social Activism: What Does It Mean for Psychotherapists?

Sometimes it does mean going shoulder to shoulder to protest the conditions that produce much of the distress we see on a daily basis.

We see the distress; to be silent is to be complicit in hiding its real sources.

Social Activism & Psychotherapy: The Personal Is the Political

• Psychotherapy itself is a political act.

• What we do in our daily practice, within the sphere of psychotherapy talk or within the confines of our work setting, either supports or undermines systems of injustice and oppression.



Transforming mental health policies, procedures, and paperwork to give clients the loudest voice in determining goals and methods for therapy is political action.

PCOMS as Just Talk

• PCOMS systematically includes clients’ voices to guide all treatment decisions

• Clients teach clinicians their desired ways of working and preferred outcomes



PCOMS As Just TalkPCOMS provides a safety net for ensuring we do not replicate oppressive practices of the past (and present), especially when clients differ from their therapists along lines of culture, ethnicity, race, gender, social location, and other aspects of identity.

PCOMS As Just Talk

• Clients’ worldviews and beliefs are integrated into treatment decisions and serve as catalysts for change.

• A continuous process of exploration of client meanings and stories allows a contextual view of the strengths and barriers inherent in the social and physical conditions of clients’ lives.



Just Talk: A Blueprint for Political Action

• Examination and re-valuation of all paperwork to bring in line with systematic collection of client feedback

• Incorporation of client feedback into all supervision and staff meetings.

Just Talk as Political Action

• Advocacy and education at larger policy levels to transform payment systems based on diagnosis to payment systems that utilize client feedback.



Just Talk as Political Action

• Advocacy for the creation of flexible services (e.g., home, community, school-based) to be able to more fully honor client requests for non-traditional forms of help.

Actions Small and Large• Speak up in staffings and supervision to bring in

client voice or advocate for adopting PCOMS

• Instead of diagnosis, use client scores on scales to change the conversation and center client voices

• Create community—together we have the most power to affect change in our agencies and worksites



“You can’t be neutral on a moving train.”

Howard Zinn

We must never adjust ourselves to racial discrimination and racial segregation. We must never adjust ourselves to religious bigotry. We must never adjust ourselves to economic conditions that take necessities from the many to give luxuries to the few. We must never adjust ourselves to the madness of militarism, and the self-defeating effects of physical violence.

– Martin Luther King, Jr., APA, September 1967



References

• American Psychological Association Presidential Task Force on Evidence-Based Practice (2006). Evidence-based practice in psychology. American Psychologist, 61, 271–285. doi:10.1037/0003-066X.61.4.271.

• Comas-Diaz (2012). Humanism and multiculturalism: An Evolutionary Alliance. Psychotherapy, 49(4), 437-441.

• Gondolf, E. W. (l998). Assessing woman battering in mental health services. Thousand Oaks, CA.: Sage.

References• McCutcheon, S. R., & Imel, Z. E. (2009).

Valuing diversity: Implementing our best intentions. Counseling Psychologist, 37(5). 760-771.

• Sue, D. W., & Sue, D. (1999). Counseling the culturally different: Theory and practice(3rd ed.). New York: Wiley.

• Vera, E. M., & Speight, S. L. (2003). Multicultural competence, social justice, and counseling psychology: Expanding our roles. The Counseling Psychologist, 31, 253-272.



References

• Zito, J. M., Burcu, M., Ibe, A., Safer, D. J., Magder, L. S. (2013). Antipsychotic use by Medicaid-insured youths: Impact of eligibility and psychiatric diagnosis across a decade. Psychiatric Services, 64(3), 223-229.

just talk sparks webinar slides

Education

preferences research

apa policy

bestavailable research

prescriptive treatment

mental health care isconsumer

apa council ofrepresentatives

treatment ofmental illness

preferred modesof treatment