Tips and Topics
Vol. 10, No. 1April, 2012
This April edition of Tips and Topics (TNT) is the beginning of our tenth year. Welcome to all and the many new readers this month too.

Senior Vice President
of The Change Companies®

SAVVY

In March 2012’s TNT, we focused on spirituality and religion which had never really been written about since commencing TNT in April 2003. In SAVVY we’ll complete this topic for now by addressing two of many comments received about the topic.

Reader 1
Why did you not include references to the work of pastors or priests?

“First, I welcomed your article on spirituality and religion. As you said, long overdue. However, I was interested in your references. Although I am sure your persons referenced are sterling and very knowledgeable, I found it interesting there was nothing from a pastor, priest, etc. Such as from the writing of Father Martin, or the philosophy of Father Leo Booth and many others.

How could you not include men and women of the faith when writing on spirituality and religion. As an example, Fr. Leo Booth has lectured for years on that very subject.

Excellent article, but…..

Regardless, keep up the good work for another year. I have been with you almost from the very start.”

Ray Wilson, Interested reader and community member (I am now retired and volunteer with local alcohol and drug organizations).

My Response

Thank-you, Ray, for being a long-time reader and for your comments. In this edition on spirituality and religion, I could only touch on the subject inspired by these two very recent articles written in February and March, 2012. As you know, Tips and Topics can only be rather brief as few have time to read long newsletters, so I cannot include a broad range of references.

Comprehensive review papers that are meant to include an extensive literature search would hopefully include references to Fathers Martin and Leo Booth, both of whom I have met and listened to. Tom Peltz is a man of faith, though not by profession. I know what you mean though, and I too appreciate the wisdom of pioneers like Father Martin and Father Leo Booth.

David

Reader 2

Respect for all of faith and non-faith; and how about pastoral counselors?

“Thanks for this piece but I am having a couple of personal concerns:

1. I work in a city that is dripping with Christianity, even at my agency, where a Baptist minister is always asked to perform a benediction for large staff events. I don’t have trouble talking about faith with a client but I wish my agency would have more respect for the albeit minority Muslims and Jews in their midst.

2. Many of our clients have had little to no religious experiences or are very angry with G-d and thus are hostile to any religious references – they deserve respect too.

3. Many more have a theological education that is just as poor or poorer than their secular one – attributing things/actions to G-d that simply aren’t true.

4. Therefore, I think if we are going to incorporate more faith-based actions within the work with this population, we should consult with or encourage participation in treatment of pastoral counselors.

Just a few thoughts.

Peace.”
Psychologist

My Response

Thank-you for all those good points. Yes, including religion and spirituality in the assessment and treatment should have the same sensitivity as we expect with cultural competence and other areas we are all learning to be aware -like trauma informed, recovery-oriented systems of care or gender-specific work. The client is at the center of this process. Focus on spirituality is about making sure we don’t exclude this important area for a person. It may well be a trigger area for that individual, like past trauma could be. Let’s not overlook the strength and resource that spirituality and religion may be for someone. This has too often been ignored by clinicians.

It should never be about putting our issues first- like praying with a client who doesn’t want that; or disrespecting a person’s beliefs because they may be in a minority position (like Muslims and Jews in your area.) Of course, in some areas of the country they are not in a minority position.

Anyway, I’d like to forward your questions to Tom Peltz to get his response.

Thanks for raising these concerns.

David

Tom Peltz’s Response

The reader’s points reminded me of the sign in Tony’s barber shop where I went as a boy. The sign read “No talking about religion or politics.” Perhaps this advice is still followed by people in this field, but your reader raised four really great concerns.

* Some parts of the country and some programs have a pastoral counseling staff, yet many do not. Thus, it is important for clinicians to discuss the topic of spirituality and religion within each of their clinical settings. I suggest that just as such spiritual and religious communication is wise to have with a client, so also it needs to occur with our supervisors, management and staff in our agency departments and organizations.

* Such open conversation needs to be included and addressed in examining the mission statement and purpose statement, as well as current program expectations, clinical approaches, and future goals for agency growth; and such examination needs to occur regularly at least every few years or so. This renewal of the process allows for better understanding of the common agency beliefs with such issues occurring as new staff are hired, or staff turnover, and as there are changes in the program’s direction over time. I would wonder how many agencies even mention spirituality in their mission or purpose statement?

* Obviously, this conversation does not fit into a normal staff meeting agenda, as it requires more time and input from each staff member. Such a conversation invites input from everyone – including the very religious to the very secular, or atheist, and all voices in between. The whole program team will become strengthened by such a process, and the members of the team will know to whom to refer which clients for more specialized treatment – even if a Pastoral Counselor is not there on staff.

Imagine how the reader must feel as a staff member if he/she does not agree with the agency’s lack of addressing the minority involvement, and how much more complicated this becomes for the client who comes in for treatment and does not know the staff’s or the program’s agenda? Phew.

* The reader’s point about ‘respect for differences’ is absolutely critical and is needed by all staff in this field. Clinically we need to offer a safe place to all people who come to us requesting our clinical services for growth and change. Like our clients, so too, we go through changes and growths in life, and need the safety to professionally be able to share our growth in our skills, belief, and practice. I wonder if the Baptist minister knows of the reader’s opinion of their performing benediction for large staff events, and what that minister might say if a conversation between the two of them were to occur?

Some people choose Alcoholics Anonymous (AA) or SMART Recovery (Self Help for Substance Abuse and Addiction), or no meetings at all, because of differing thoughts and feeling about spirituality and sobriety. So also it is important to keep in mind that different staff will take different points of view on this topic of spirituality. No one system of beliefs is right for all and that is probably why such national diversity in treatment and care exists to choose from. So too, there are still some people in this field, like my childhood barber, who just pointed to his sign to ‘not talk.’ I certainly did learn to keep my mouth shut as a child, but at what cost do we do this now in addiction treatment?

I am glad to chat further with people and learn their opinions, feelings and thoughts.

Tom

Thomas A. Peltz, M.Ed.
978-927-6763
PO 5554
Beverly Farms, MA 01915-0520

www.tompeltz.com

SKILLS

Not many readers have been with us from Day 1. So in SKILLS this month, I thought it useful to do a little “back to the future”. In my training and consulting work, a number of topics repeatedly come up. I refer people back to past issues of TNT to review. So take a trip back to 2003 and 2007 for some still relevant topics and skills as we highlight these enduring concerns.

TIP 1

Check how to do individualized treatment and document it.

An ever-recurring frustration for clinicians is documentation – individualized treatment plans and progress notes. Take a look at the July 2003 edition of TNT and read in SAVVY about treatment plans often sound all the same and how you can check if that happens where you work and document.

July 2003 | Tips & Topics

Next take a look at SKILLS in July 2003. See how you can “walk the talk” about individualized treatment in your next individual or group session. Also see how to help clients to collaborate on a meaningful treatment plan.

Read about “What Made Me Say That?” too. It will help you write more specific and person-centered Problem or Need Statements in the Treatment Plan.

TIP 2

Put Assessment, Diagnosis, Evidence-based Practices, Stages of Change and Documentation in Perspective with Therapeutic relationship and Outcomes

There is increasing pressure to deliver Evidence-Based Practices (EBPs), comprehensive assessments, diagnoses and individualized stage-matched documentation. But what outcomes research tells us about what works to achieve positive results is significantly influenced by the quality of the therapeutic alliance. Only as we use EBPs, documentation and assessment of stage of change to strengthen to alliance with the client and then track outcomes in real time, will our work be “peoplework” rather than just paperwork.

Read more about this in SAVVY and SKILLS in the August/September 2003 and edition of TNT. August/September 2003 | Tips & Topics

P.S. The Institute for Therapeutic Change mentioned in SAVVY has been replaced by The International Center for Clinical Excellence.

http://www.centerforclinicalexcellence.com/site.php?page=leadership.php

TIP 3

Conflict is normal. Not resolving conflict is the problem.

No matter who you are and where you live and work, there will always be interpersonal conflict – between staff team members; between clients and patients; between you and clients (not to mention at home). In the February 2007 TNT, I discuss this in more detail. I offer a Conflict Resolution Policy and Procedure which I encourage you to try out if your policy and procedure is non-existent or not effective.

February 2007 | Tips & Topics

Then in SKILLS, you will find excellent wisdom of Marshall Rosenberg, Ph.D. in Nonviolent Communication (NVC). This provides a simple, yet effective structure to tune into others’ feelings and needs. Empathy defuses anger, violence and conflict. However it is not easy to do without some tips that NVC’s four step process outlines.

SOUL
There are a number of President Obama’s Cabinet members leaving at the end of the President’s term of office -(His first term if you are a determined Democrat; and his first and last term if you are an avid Republican). I was listening to a back and forth on National Public Radio about what each departing member’s legacy will be. What will they be remembered for having achieved in their tenure at the highest levels of influence and power?It got me thinking about Tips and Topics as we start Year Ten. I am very gratified by the many expressions of appreciation I receive in-person and by e-mail regarding what works about Tips and Topics. Of course subscribers who never open or read their copy, or who may think TNT “sucks”, never write me about their feelings/opinions; they’re even less likely to say that to my face. So admittedly it is a selected sample of readers who give me the impression it’s worth writing TNT every month.

Whatever your vocation or avocation, it has worth too. Do you ever ponder the impact of your efforts on the people you serve, on the lives you touch, on the people and places you go?

When I left the Boston area Addiction Treatment Unit I had established and directed for four years in the 1980’s, the staff held a farewell party.  People said the usual nice things. However a comment from the team chaplain caught my attention, disturbed me and stayed with me. Here’s what he said: When a person leaves, it is like a hand in a bucket of water being pulled back out of the bucket.  The water flows right back as if the hand wasn’t even there.

Wow…that’s how much I’ll be missed?

That’s how enduring my impact on the Unit will be…just like the hand was never there?  What I think the chaplain meant was to reassure the team lamenting my departure, that the Unit will keep functioning well as other leaders flow in to fill the space and carry on the good work. The place will continue to be effective, it won’t fall apart. But a wounded self-esteem might well take that comment the wrong way.

Yet in a sense it is so true.

If you do what you do to prop up a shaky need for attention, adoration and adulation, rather than out of the proactive power of choice to achieve your personal mission, meaning and purpose, you may well be disillusioned. If you think the waters will part ways like the Biblical Red Sea when you enter or leave the room, you may actually be drowned.

I have trouble remembering who won Best Actor and Best Actress at the Academy Awards, and that was just in February this year. How many Nobel Prize winners can you name? You can play this game with winners of the World Series, Davis Cup, US Open etc. You get my point.

It’s like pulling a hand out of a bucket of water. Why do I do what I do? Why do you?

STUMP the SHRINK

A question from November 2009 provided a good opportunity to explain more about TIP 2 in SKILLS above. Think about how you use Stages of Change – to label and categorize a person? Or as a new way to say “denial”? Or to guide you in developing a better therapeutic alliance? Take a look.

Tips & Topics | November 2009

Until next time


See you late in May. Thanks for reading.

David