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An electronic circular of the Coalition's Center for Rehabilitation and Recovery
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No. 72, June 2011
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The Center for Rehabilitation and Recovery provides assistance
to the New York City mental health provider community through
expert trainings, focused technical assistance, evaluation,
information dissemination and special projects.
THE DIRECTOR’S NEW YORK MINUTE Why Is It So Hard to Believe in Recovery? Part 1 By Courtenay M. Harding, Ph.D. A long time ago in a galaxy far away, I was a nurse in the neurosurgical unit at Boston’s famous Children’s Hospital. One afternoon, we received a patient named Charlie in our ICU, who was semi-comatose. He was 15, apparently a really good kid from a terrible neighborhood in Roxbury, a section of Boston next door to us. He and his best friend had found a gun in a trash can and thought they had checked the barrel for bullets and proceeded to play Russian Roulette. The friend put the gun between his own eyebrows and pulled the trigger! The gun just clicked and nothing happened. Charlie did the same thing but there was one last bullet and it shot through his head and out the back side! He arrived from Beth Israel Hospital nearby having had the surgeons debride his wounds (meaning they had removed the damaged tissue along the bullet’s path so the wound could heal). He was sent to us because many deaths occur as the brain would swell against the hard skull and make further injuries. However, our neurosurgeons had figured out a way to take the top half of the skull off and put it in the freezer. Then, they would sew up the scalp over the jiggly brain and let the swelling occur and then subside. When it returned to a normal size, they would put the skull cap back on. (Something similar was recently done for Rep. Gabriel Gifford (1).) For Charlie, the most amazing thing happened! He walked out of our hospital 6 weeks later needing only a little outpatient physical therapy for one hand and a little speech therapy. I could hardly believe my eyes. Imagine putting a gun between your eyes and walking away with your life! Astonishing! We had all assumed that it would be a sad story to tell. For the past 30 years, I have been teaching members of the caring professions about recovery, especially from schizophrenia (2-3). There have been 10 contemporary long-term follow-up studies (now 11) of 20 to 30 years in length which all showed that one half to two thirds of each group studied, significant improvement and even recovery had occurred over time (4). Even in the shorter-term studies, people were getting better as early as 3 to 5 years (5). Early on, clinicians of all stripes yelled at me about how ridiculous such a thought could be. After all, for the past 120 years, their training curricula had pronounced that downward course or at best marginal levels of functioning were all that a person could hope for with these significant psychiatric problems. In addition, they kept seeing profoundly disabled people day after day and no one appeared to be getting much better. Therefore, the old predictors must be true. What the staff had forgotten were all the people they didn’t see anymore. Even if they thought about a certain person who had left their care, the assumption was made that the person was in someone else’s caseload across town. The clinicians did not realize that another scenario might have taken place - one in which the clinicians were systematically deprived of hearing! After all, Joe or Mary never called them up to give a report about outcome saying such things as “Hello. This is Joe, and I am calling to say I am married, have three children, and a fulltime job and thank you very much for all the work you did to help me seven years ago.” We, clinicians, hardly ever hear such stories and as a result, we keep thinking that this scenario hardly ever or never happens. But the long-term studies tell a different story. This is because the researchers followed intact groups of people, no matter if they left the system or not. Usually investigators assess only people still in the system of care because it is much more convenient to so. Finding people, who have left the system, is much more difficult but still possible. When a study does that, an important rebalancing of our understanding occurs. That is when we hear more tales from Joe and Mary. Our understanding of what is possible has shifted and we now provide hopeful messages to those with whom we work. References 1. Childs, D.: “Gifford’s Brain Surgery Safe, but not Risk Free, Surgeons Say.” ABC News Medical Unit, May 18,2011 http://abcnews.go.com/Health/rep-gabrielle-giffords-brain-surgery/story?id=13631297
Please Don’t Scrub the Toilet With My Toothbrush: By Susan Blayer, LMSW, MDiv The joke goes like this: “A husband says to his wife, I don’t know how you do it. Every time I get angry at you, you never fight back. Tell me how you do it! The wife responds, It’s really very simple. I go clean the toilet…. with your toothbrush.” For a clinician, anger is a fascinating emotion, one which is manifested in myriad ways. It seems one can’t live with it, or without it. The negative aspects of expressing anger seem obvious: when we lose control and “fly off the handle,” the likelihood of abuse and violence towards others increases. Untempered anger requires much emotional energy, deflects us from dealing with core issues, and detracts from working towards life goals. Outbursts of rage and hostility escalate conflict within relationships,(both personal and professional), and often lead to unwanted consequences. Yet anger is such a natural human emotion that it is demonstrated by every culture on the planet. It sends the signal that something needs to be addressed-- perhaps injustice, or unresolved hurt, or needs which have gone unmet and become increasingly frustrating. Anger can be a cathartic response to loss, betrayal and disappointment, often uncovering deep-rooted depression. On global, community, and family levels, justified anger is necessary for opposing cruelty and what many would consider evil behaviors. We have seen, time and again, that for some people, if stifled, anger can destroy relationships as much as if conveyed inappropriately, as well as contribute to somatic distress and mental health challenges. So how do we manage our anger and help others to do the same? One model, heightened by the self-awareness movement and Primal Therapy in the 70s, stressed that venting raw, unadulterated anger was the key to resolving it. This notion was challenged in the early 80’s by social psychologist Carol Tavris, author of “Anger: The Misunderstood Emotion,”(1) in which she references hundreds of studies to support her contentions. In a New York Times article, Dr Tavris stated, “Talking out an emotion doesn’t reduce it, it rehearses it…People who are most prone to give vent to their rage get angrier, not less angry.” (2) Thus, there seems to be a distinction made between repressing and suppressing – the former being detrimental due to its unconscious influence on behaviors, while the latter,(intentional suppression of certain instances of anger), may actually help a person handle the emotion more effectively. At about the same time (1984), the Anger Control Training (ACT) program was first developed to help aggressive and violent adolescents aged 12 to 17 who were incarcerated in juvenile institutions. (3) It has subsequently been adapted for adult mental health settings. ACT sessions are designed to address the behavioral, affective, and cognitive aspects of aggressive and violent behavior through cognitive restructuring combined with social skills and moral reasoning training. In 2002, SAMHSA released both a manual and participant workbook entitled, “Anger Management for Substance Abuse and Mental Health Clients.” Designed to be used by qualified mental health providers, it is a 12-week curriculum for cognitive behavioral anger management groups, utilizing the principles of social learning theory and a combination of CBT interventions: practicing relaxation techniques, targeting cognitive processes and communication skills building. NAMI-New York State distributes a helpful brochure entitled, “How to Express Anger (Without Hurting Yourself or Others,” which outlines ways of expressing anger appropriately, including strategies for how to “Talk to the person directly (when it’s safe),” and “When you can’t express your anger directly.” Similarly, the Mayo Clinic’s website offers the article, “Anger Management Tips: 10 Ways to Tame Your Temper.” One of the suggestions on the list, “Get some exercise,” has actually been backed by research which demonstrated that even a single session of exercise can have a “robust prophylactic effect against the buildup of anger.” (4) Times are tough, people are frustrated, and anger is nothing new. Yet we can choose to use often overwhelming emotions as a constructive, creative force towards positive change. To that end, I leave you with this quote from Tibetan Buddhist and author, Pema Chodron: Feelings like disappointment, embarrassment, irritation, resentment, anger, jealousy, and fear, instead of being bad news, are actually very clear moments that teach us where it is that we're holding back. They teach us to perk up and lean in when we feel we'd rather collapse and back away. They're like messengers that show us, with terrifying clarity, exactly where we're stuck. This very moment is the perfect teacher, and, lucky for us, it's with us wherever we are. Resources
Center Co-Sponsors Economic Self-Sufficiency Forum II The Center is pleased to announce that we are co-sponsoring the Economic Self-Sufficiency Forum II with the NYC Department of Health and Mental Hygiene and other advocacy groups. Following the success of the first Economic Self-Sufficiency Forum, we have decided to partner with our colleagues to organize a second event. The new forum will focus closely on the tools consumers can use to increase their economic power. Specifically, presenters will offer practical information and strategies that enable consumers to earn and save money without losing their benefits. We encourage you to download the event flyer below and circulate it widely among consumers in your programs. The event is FREE, though participants must register by July 6, 2011. Event: Economic Self-Sufficiency Forum II May’s multi-agency training at the Center was “Inspiring Stories of Recovery,” facilitated by our Director. Participants had an opportunity to explore their thoughts about recovery and learn from eleven long-term studies of serious and persistent psychiatric problems which revealed that most people can significantly improve, and many even recover, over time. Here, Dr. Harding chats with participants, Celina Pinto and Bojun Hu >> CALL TO PROVIDERS--Post Your Open Peer Position on our Peer Job Board: http://www.coalitionny.org/the_center/jobs/ Note: If you are typing the URL in your browser, the space between “the” and “center” is in reality an underscore symbol “_”.
20 Ways to Overcome Barriers to Recovery In this half-day workshop, Dr. Harding will provide a window into at least 20 obstacles which may stand in the way and how to resolve many of them. You will receive a clear set of questions to ask, new ways to rethink problems and some solutions to remove the roadblocks. Facilitators: Courtenay Harding, PhD Recovering Together: Introduction to Group Work This full-day training is designed for mental health practitioners who seek to harness the power of groups to support individuals in their recovery. The training may be of particular interest to providers of Personalized Recovery Oriented Services (PROS) since group work is the main service modality in PROS programs. Participants will be introduced to theoretical concepts and fundamental skills essential for leading various types of groups, including knowledge-based, skills-based and therapy groups. The focus will be on developing group dynamics that engage and empower group members, motivate them to achieve personal goals and help the group as a whole recover. Through didactic and experiential learning, participants will acquire the skills they need to plan and lead groups that are meaningful and alive. Facilitators: Aaron Vieira, LMSW Guiding the Group: Advanced Methods Prerequisite: The Center strongly recommends that participants complete our training, "Recovering Together: Introduction to Group Work", before taking this training. This full-day training is designed for experienced group leaders in mental health programs who are interested in learning cognitive behavioral techniques that help group members change their patterns of thinking, feeling and acting. The training may be of particular interest to providers of Personalized Recovery Oriented Services (PROS) since group work is the main service modality in PROS programs. Facilitator: Aaron Vieira, LMSW Opening the Toolbox of Rehabilitation Resources: How to Find A Date- A New Way to Teach Social Skills Participants in PROS programs lead very complex lives as they strive to get their equilibrium back and pursue a life of purpose and meaning. Clinicians in PROS programs lead very complex lives as well. This workshop will provide concrete and practical tools and strategies for the clinician to help people move forward in reclaiming their lives. Each clinician needs a “little black bag” with tools of the trade stuffed inside to pull out when needed as the person with whom they are working wants to have a clearer head, a healthier body, “a home, a job, friends, and a date for the weekend!” This workshop will be interactive and fun. Facilitator: Courtenay Harding, PH.D Center Training Schedule Available on Website Now you can plan ahead to attend upcoming Center trainings. Our calendar is now available for you to view and print from our website. Please go to: http://www.coalitionny.org/the_center/training/ and click on link to the right entitled, “Winter/Spring Schedule, 2011” to see what we have to offer. Note: If you are typing the URL in your browser, the space between “the” and “center” is in reality an underscore symbol “_”.
The Coalition’s Professional Learning Center Training: While the public health model for smoking cessation sensitizes and legitimizes the goal, behavior change for many individuals with co-existing psychiatric conditions may require a clinical intervention. Through a proven and easily incorporated program of manualized step-wise behavioral interventions, this approach supports clients who would like to quit but feel they can't. Clinicians learn how to effectively with work client's fears of changing a deeply ingrained behaviors and irrational beliefs about smoking and quitting. They learn how to build their clients confidence to quit through a series of carefully designed exercises. To address client physiological dependence, clinicians learn how to incorporate the aggressive use of combining two forms of nicotine replacement therapy (NRT). Date: June 15, 2011 Cognitive Remediation Conference This Columbia University Medical Center conference, led by Alice Medalia, Ph.D., is designed for Mental Health Professionals involved in the research and treatment of people with psychiatric conditions who have cognitive deficits. Course participants will acquire knowledge about different approaches to treating cognitive deficits, how cognitive deficits can impact everyday functioning, the factors that influence a positive response to cognitive remediation, how medications affect cognition, and how to provide cognitive remediation to different psychiatric populations. Participants will be able to attend all plenary presentations and to choose among a research symposium and several small group workshops led by the faculty members. The early registration fee of $135 has been extended for all agencies with PROS programs.(Please refer to this offer) Pre-registration is required. Date: June 10, 2011 Free Webinar: Work Initiatives for People Living with Mental Illness and Disabilities “Putting People Back to Work: Work Initiatives for People Living with Mental Illness and Disabilities” is a webinar will discuss NYS Office of Mental Health's (OMH) Work Initiatives that are meant to increase employment opportunities for individuals living with mental illness and/or disability. Michael Seereiter of the OMH, Office of Consumer Affairs will inform participants of employment initiatives.
To reserve your Webinar seat: https://www1.gotomeeting.com/register/758606281 The Fifth Annual Peer Specialist Conference During this free, full day conference, Peer Specialists, Bridgers, Counselors, Facilitators and Advocates will have the opportunity to network and be inspired by keynote speaker, Patricia Deegan, PH.D. This year’s theme is radical change, innovation and creativity. Date: June 21, 2011 Mental Health Association of NYC Webinar: PTSD and Older Adults MHA-NYC’s Geriatric Mental Health Alliance of NY is offering a webinar addressing the impact of post-traumatic stress disorder on older adults. Participants will learn about how trauma affects elders, how those experiences interact with co-morbid psychiatric conditions, and the impact of secondary trauma. Participants will also learn to use assessment strategies and other best practices to treat elders suffering from this condition. The cost of the webinar is $25 per participant. CEUs are available at no additional cost. Date: June 15, 2011
The full-day, 11th Annual New York State Supportive Housing Conference is the largest supportive housing conference in the nation, to be held again at the New York Marriott Marquis. This comprehensive day includes relevant workshops for all levels of staff, a select group of exhibitors with information about their products and services, a networking lunch and post-conference reception. A keynote address will be given by Dr. Cornell West. Date: June 9th, 2011
This OMH Bureau of Cultural Competence webinar will build on the existing best practices in self-help / peer support / mutual support. Specific staff competencies will enhance the ability to incorporate the principles of “Olmstead” to help individuals to truly become part of their communities. In order to assist individual members with community integration, a key function of Recovery Centers will be to assist individuals in identifying, remembering or discovering their own passions in life. This webinar is free, but seating is limited, so please register asap.
To reserve your Webinar seat: https://www1.gotomeeting.com/register/565560392 Physical Screenings in NY State Mental Health Clinics Last year, The New York State Office of Mental Health mandated that all adult mental health clinics regularly monitor three health indicators—body mass index, blood pressure, and smoking status. This was in response to the study which revealed that on average, mental health consumers dies 25 years earlier than the general population. To read more about this OMH initiative, as well as the variety of wellness programs which were implemented, go to: http://ps.psychiatryonline.org/cgi/content/full/61/4/346 A Meta- Analysis of Cognitive Remediation for Schizophrenia This overview of Cognitive Remediation from the May 2011 American Journal of Psychiatry explores the effect of treatment and whether study method of potential moderators influence the outcome. Til Wykes, Ph.D et al concluded that Cognitive Remediation benefits those with schizophrenia, and when combined with psychiatric rehabilitation, increases positive functioning more than rehabilitation alone. To download the article in pdf go to: http://ajp.psychiatryonline.org/cgi/reprint/164/12/1791 Which One Do You Want First—The Good News or the Bad? Dr. Lloyd Sederer, NYS OMH Medical Director, gives you both in his most recent blog post, “The Good News and the Bad News About Mental Health Care in America.” He also shares what are, in his opinion, the two main reasons why people do not receive effective treatment. Find the full post here: http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_862051.html Best Practices for Improving Engagement of Clients Providers are increasingly interested in ways to build trusting relationships between staff and consumers, which is the focus of the article, “Best Practices for Improving Engagement of Clients in Clinic Care.” Here is an excerpt: “Surveys suggest that engagement is facilitated when treatment providers are committed and dedicated, listen and encourage, and use a partnership model involving problem solving and shared decision making.” To read more, visit: http://psychservices.psychiatryonline.org/cgi/content/full/61/4/343 |
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