Vol. 11, No. 1

Welcome to the 10th anniversary of Tips and Topics (TNT). Perhaps this is your first edition as a new reader or your 100 edition as a longtime reader. Either way, enjoy this anniversary edition……and my party hat!

Senior Vice President

of The Change Companies®

SAVVY

When I turned 30 years old, my wife threw me a surprise birthday party.  It was very thoughtful of her, but I enjoy_ other_ people’s birthday parties. It’s not so comfortable when I’m the center of attention, especially when it’s a surprise.  Now, I’ve gotten a little more comfortable with attention (doing fulltime training and consulting for decades gives you lots of practice.)This month, for our 10-year anniversary of Tips and Topics, I actually _asked_ for readers’ attention!I thought it would be fun (and informative to me) to hear what you appreciate about Tips and Topics.  So here are some of your “appreciation gifts” to me to celebrate 10 years together.  I excerpted from your “gifts” so as not to be too voluminously boring.

Welcome to our Tips and Topics birthday party! (and check out SHARING SOLUTIONS for a special anniversary deal)

TIP 1

See if you resonate with any of the themes of these “anniversary gifts.”

I grouped readers’ comments in like categories….sort of……

Challenging our thinking and sharing TNT with others

What an honor to be asked to share how your efforts with Tips and Topics have impacted us over the years as an anniversary gift to you.

Since first becoming aware of your work and meeting you 6 years ago, I have been a faithful reader of Tips and Topics…….Over the years, I have used Tips and Topics to share with the clinical staff a deeper understanding of how they could assess a caller…  Your ability to bring so many different service delivery providers together and weave the experiences in a meaningful way that makes one stop, think and yes, sometimes even challenge how we think of providing services continued to contribute not only to our development as professionals but also to the benefit of the clients.

I have no doubt that I contributed to adding to your email list because I often encouraged people to make sure they took advantage of having such a powerful resource at their finger tips; especially the interns that I supervised. …I have entered the arena of private practice and the skills I have learned over the years from Tips and Topics come in handy with almost every client.  When I think of the ripple effect of your life works and how many it impacts I stand amazed.

I do have to say one of my favorite aspects is when you share details of your life — from your journeys home to Australia, to your kids and their accomplishments…..And just know that I am looking forward to at least another 10 years of Tips and Topics!

Happy Anniversary!

Theresa Buzek, MS, LPC-S
4009 Banister Lane, Ste 356
Austin, Texas

***

Thank you for the work you do and the newsletter.  I just wanted to let you know I really appreciate it, and pass it along to our staff and my peers in the field

Yvonne Jones, LCSW
Senior Psychiatric Social Worker
CONREP
San Leandro, California

***

Your last e-mail has finally motivated me to write my appreciation to you and your monthly newsletter.  If I receive the e-mail during a particularly busy time at work, I leave it unread until I can make the time to bring my full attention to the tips and topics and have time to contemplate how to apply it to my work and life.  I not only read it myself, but share it with my colleagues and have also forwarded it on to my boss on occasion.  Your thoughts push me to think about how to approach my work differently, to question my current techniques, and how to be an effective clinician (and sometimes parent!).

Thank you very much for all you do.

Stephanie R. Steinman, LPC CSAC
UW Health Gateway Recovery
Madison, WI

***

I am reflecting on your upcoming ten year anniversary, and can hardly believe that you have been publishing this long!!  I recall conversations with you about my interest in searching the archives, long before you had that capability!  Guess that means I am getting old!

I read Tips and Topics fully, and can honestly say that every issue has caused me to pause and think; despite over 30 years in the addictions field, I learn something new each and every time.  I share access with everyone I can, and encourage others to sign up on-line in all of my trainings.    I imagine that this is just one of many competing priorities for you, but know it is thoroughly enjoyed, valued and appreciated!

Dotti Farr   LSW, LADC, CCDP-d
Director of Quality Management
Bucks County Behavioral Health System
Warminster, Pennsylvania

Useful learning and appreciating the TNT edition on Therapeutic Communities

David, we worked together briefly in Delaware and, even in a short time, I learned a great deal from you. I read every edition of your newsletter and wanted to compliment you on the Therapeutic Community article.  You handled the subject productively and ‘gingerly’.  There are probably some who would say you were too gentle but change usually requires persuasion not coercion.

Thanks for your efforts to inform and improve the field.

Colette Croze
Principal, Croze Consulting

Dr. Mee-Lee,

I certainly look forward to Tips and Topics each month, I have yet to read an edition and not get something useful from it. The edition on Therapeutic Community was especially interesting.  When I started working in the field in the late 80s …one of my first experiences was with a seasoned counselor conducting what he called “Gestalt empty chair technique”, but what actually seemed to have as its only goal to have the group make the person cry or storm out of the room…..Things have certainly changed for the better. Thank you for the publication each month.

Dan Adams, MBA, MARS
Assistant Director
Southeast Missouri Behavioral Health
Salem Center

***

Dear David:

My note of appreciation is simple. Somehow, you have a hidden camera in our program, in my office, and in my head. Lest you think that I fit the textbook definition of paranoia, let me say instead that you have, since I started in this position, managed to elegantly publish in your Tips and Topics exactly what I was trying to say just days before in a staff meeting, in a supervision, or in a training. I find myself EVERY month simply forwarding your email to someone else in the program or printing it out for everyone and putting it in mailboxes with a simple….”This is what I was trying to say—he says it so much better”!!!

The best example of this was in Nov 2012 with your response to Ray from Cape Cod.  Being from the “other” large substance abuse agency in Southeastern Mass, I recognized Ray Tomassi of Gosnold and his way of thinking immediately. I immediately copied that article on how we use words and how our words shape our actions and handed it out to everyone in our program—staff and clients alike. It lead to such interesting conversations-not only about those words and actions, but about the role of shame and coercion in treatment. Especially for us as a program that walks that tightrope between voluntary and “court ordered”, we look at issues like relapse and discharge daily—and struggle to be client-focused and evidence-based in our actions and approaches.

The other edition that was so helpful was your Tips and Topics that took on the sacred cow of “Therapeutic Communities”. Technically, we are by our RFR, a “modified therapeutic community”. Given our varied mandates and our population of 100% of our clients with co-occurring other mental health challenges, we find ourselves always searching for the balance between being “client centered and individualized” and “community-based” recovery. As we try to do that while following Motivational Interviewing practices across all levels of the program and integrating as many EBP’s as possible, the core of our model shifts and morphs. For some of us, that is comforting that we are always “making it up as we go along” to be as successful as possible. For others, it creates such panic that “no one is in charge and no one knows what is happening next”. This edition helped calm some of those fears and helped the “old-timers” see that there really is a method in the constantly shifting landscape and that parts of the tried and true will always be a part of what we do.

For the record, we are a pilot program in Mass—the ONE specifically funded year-long program (combination of residential(3 months or so)/community based(9 months)) jail diversion substance abuse treatment program for clients facing incarceration for crimes directly related to substance abuse issues. In year 3 of a 5 year pilot, we have such tremendous support and freedom to try to get it right….and such wise counsel both from our agency leadership and Bureau of Substance Abuse Services to help us be successful and create a program that can be replicated. Please know that I count you as one of our “distance mentors” as well.

Thank you for being part of the knowledge and wisdom that helps shape who we are and what we are doing!

Mary R. Bettley MSW, LICSW
Program Director
Reflections-Court Alternative Program
High Point Treatment Center
New Bedford, Massachusetts

Inspirational, informative and influential

I’ve been a subscriber to your newsletter for a while now….I look forward to its arrival every month. (I confess that I also hoard them.) I’ve been working with individuals who struggle with substance use disorders for over 40 years now and there are a few individuals, including yourself, who I consider to be inspirational. You are those people who I can count on one hand (with fingers left over) who seem to be able to bring “things” into focus for me. I don’t __always__ agree with “you guys” but I love to read everything that you write and I try to hear you speak whenever I can….. I’ve been blessed to consult with other organizations in many states. I try to share your newsletter with as many of these people as I possibly can. You are very inspirational and informative. Sometimes you even manage to interject some humor! Thank you for taking the time to make an investment in my life. I believe that you’re making a difference in our world.

Michael W. Bennett MBA CAP CPP ICADC CCCJS CCFC
8495 Bluestem Court
Jacksonville, Florida

***

Dr. Mee-Lee, I love reading the Tips and Topics even though I don’t counsel in substance abuse treatment. I still have contact with people in recovery as a case manager in a transitional housing program.  Knowledge is always great even if you don’t use it right away.

Michael McMullen

***

Mahalo Dr. Mee-Lee:

For 10 years of sharing your “mana” (interpersonal power, strength, authority, efficacy) with those of us attempting to follow your lead by reading your Tips & Topics newsletter each month.

Your generous offerings and influence have been a guiding light for a me, a substance abuse counselor in a rural, island community.

I’m looking forward to 10 more years of your influence.

In the mean time, I wish you a very fond……..

Aloha,

Lorrain Burgess, CSAC
Makakilo, HI

A couple of suggestions

Dear Dr. Mee-Lee:

I read your TNT with great interest every month. Over the years I have saved the ones that have been particularly helpful to me, as I work in a community mental health center.

I would like to see a new category added to TNT to trumpet new and innovative approaches to Co-Occurring Disorders (COD), or old approaches that are not well known…..

Another thought I have is soliciting a Guest Column each month on something directly related to COD treatment. Along these lines, you could identify a topic such as Guidelines for the First Session, and then invite your readers to solicit brief summaries for review…..

In any case, thank you for being on the cutting edge of treatment!

Harry Ayling, LCSW, ACS
Mental Health Supervisor
Fairfax County, Virginia

Thinking outside the box

***

David I truly appreciate your objectivity, open-mindedness and willingness to think outside the box. In helping addicts help themselves most often the instrument for change is that non-judging compassionate empathic therapeutic alliance that springboards the person to make that most important choice for a path on the road to recovery.

Chris Keeley, LICSW

***

Tips and Topics is always spot on! Thanks for keeping us at the head of the curve. Your ability to eloquently bridge theory with practice has been a real gift to the addictions field!

Bob Lynn Ed.D
Clinical Systems Development
Origins Recovery
C4 Recovery Solutions
Counseling Group and Family Institute

Favorite things

I read TNT pretty voraciously each month.  One of my favorite parts is the SOUL section.  Sometimes it ties into the content from the rest of the month, and sometimes not, but it is a helpful reminder to me of the toll and the wonderfulness of the work we do, and that we face the same challenges of families throughout the lifecycle that our clients do.  I especially like the SOUL about:

Jennifer Harrison, LMSW, CAADC, Western Michigan University, my co-author for the TNT book (see later for a special anniversary offer) wrote the above appreciation note.  When I asked her how she wanted to be identified she added “and awesomest co-author ever would be great.” Jennifer is indeed a great co-author but since I have several co-authors who might read this, I’ll let her say “awesomest co-author ever.”;

Helping clinicians help others

I appreciate that you keep the focus on the idea and reality that the “illness” I see is actually an accommodation my client has made to his or her world and makes sense to the person who holds it.  To assist in the change process, I must show how what I have to offer is a better accommodation to his or her world–otherwise I am not worth my pay.  (No one pays a bully.)  I have just found myself down at the end of that alley with one of my folks–resulting in his leaving the program.  I have to own that, at first, I was relieved.  He’s gone, MY WAY is reaffirmed by events.  Then, I read through this most recent post of yours and felt the underlying guilt based on “How could I have allowed myself to fall into that old trap again!?”

http://changecompanies.net/tipsntopics/2013/03/march-2013-new-meanings-to-old-cliches-baby-steps-10-years-coming-up

That was the question I needed to ask weeks back before events worked out the way my ego had ordained that they would.  I can and will look for a way to re-engage with this person so that I can feel better about payday.  Thank you again for holding our feet to principles of good behavior, ethical treatment, and service.  Peace!

Jim Recktenwald

***

While I have read and enjoyed your Tips & Topics, what I have appreciated most was your willingness to help us in our struggles as clinicians. Several years ago, the agency I was working for was moving toward a one-size-fits-all model trying to get everyone to do their Intensive Outpatient Program (IOP)…..I was the Intake Specialist and believed in meeting the client where he/she was and referring them to a level of care that matched their needs at that time.

THANK YOU for your hard work and dedication!

Carol Goulette LCPC, CCS

***

I just want to thank you for this regular piece of sanity in my mailbox. Some days it is hard to put one foot in front of the other in the midst of non-client/programmatic madness.  Seeing your words reminds me that I’m not alone and neither my clients nor I are crazy.

Staci Hirsch, Psy.D. – Program Supervisor
NEIGHBORHOOD SERVICES ORGANIZATION
Supportive Housing/Bridges
Detroit, Michigan

Subject: How Tips and Topics have helped me.


Dr. ML,

My brother, Bill, died on Feb. 4, 2013.  He was diagosed with schizophrenia in his twenties.  He was probably ill since his teens.  He was “hyper-religous”, “hyper-alcoholic”, and smoked as many cigarettes as he could get his hands on.  In retrospect, I think that he sought a community of accepting people (religion), an escape from psychic disturbance (alcohol), and probably an element of the first two conditions in socializing and rewarding himself with what relaxed him (cigarette smoking).  He was a very bright man. People questioned why he didn’t just “take his medications” and “fly right”.  I think, in his own way, that is precisely what he did.  I think of the John Nash story, “A Beautiful Mind”, where, under what might be considered more optimal conditions, people encouraged him to follow his treatment regimen. Why? What is a person giving up to trust another to do what is in their best interest?  I think the Tips and Topics literature has helped me to ask this question.  Why should a person who has many gifts give someone like me an opportunity to assist them in living in a way that others might consider “better”?  What stage of change am I in?  Keep up the good work.

Respectfully,

Peter Fuller, LCSW, LADC

And now for an appreciation note from me

  • Firstly, my heartfelt thanks to you all for signing up for TNT and for the many readers who through the years have taken the time to write notes of appreciation. Your telling me when a certain tip or topic spoke to you and helped you personally/professionally is very gratifying as a writer. Without readers and without knowing if ‘message sent’ is actually ‘message received’, all these words could just be traveling into outer cyberspace. So thank-you.
  • Secondly, if there have been some long and complicated sentences that left you scratching your head, I probably wrote those and they weren’t caught by my life partner and TNT editor, Marcia, my wife without whom none of the 10 years of TNT editions could have been successfully communicated to you in the straight forward and efficient sentences you usually receive and understand when you read TNT each month. (The long sentence is a joke, sort of, but the appreciation is real.)

Each month, I churn out the first draft. Then Marcia and I ‘fight’ over what I meant in some obscure paragraph and how to make it shorter, readable and comprehensible. She keeps me honest and keeps you reading. So thanks to my editor too.

SKILLS

Join me in a retrospective of April’s SKILLS Tips – from year 1 to year 10!TIP 1

See which TIPS take your fancy and click on the link to read more.

April 2003

When assessing the severity or level of function (LOF) for each ASAM dimension, it is useful to consider the three H’s:

History; Here and Now; and How Worried Now.

Read more at:

http://changecompanies.net/tipsntopics/2003/04/april-2003/#more-552

April 2004

The more the identified client is ambivalent or resistant to recovery, the more you focus on _who has the power_ in the client’s system…….http://changecompanies.net/tipsntopics/2004/04/april-2004/#more-385

April 2005

Ask “How much?” and “How often?” questions, rather than “Do you?” or “Have you?” questions…http://changecompanies.net/tipsntopics/2005/04/april-2005/#more-352

April 2006

Every client who is talking to you in an assessment, treatment session or outreach visit is treatment-ready…http://changecompanies.net/tipsntopics/2006/04/april-2006/#more-319

April 2007

Tune into what your clients are feeling on that first visit. Identify what methods you use to effectively engage a reluctant client. Here are what probation officers see and do (in no particular order)…http://changecompanies.net/tipsntopics/2007/04/april-2007-2/#more-79

April 2008

For alcohol, the NIAAA one question is a good start: How many times in the past year have you had 5 or more drinks in a day (men); 4 or more drinks in a day (women)?
http://changecompanies.net/tipsntopics/2008/04/april-2008/#more-54

April 2009

When clients are ambivalent, don’t always argue for the healthy choice: “You can hangout with those friends if you want to. Why not continue going to parties with them?”http://changecompanies.net/tipsntopics/2009/04/april-2009/#more-786

April 2010

Even if there was not the current political focus on healthcare reform, we would need to re-think how we do behavioral health care.

Identify one innovation you are willing to do in at least one of the following three C’s – even if you have to start small.

http://changecompanies.net/tipsntopics/2010/04/

April 2011

Identify where to start on PEOPLE, PARTNERSHIPS and PERFORMANCE MEASURES

http://changecompanies.net/tipsntopics/2011/04/april-2011-tips-topics/#more-1644

April 2012

Conflict is normal. Not resolving conflict is the problem.  See more SAVVY Tips at: http://changecompanies.net/tipsntopics/2012/04/april-2012-tips-topics/#more-2819

SHARING SOLUTIONS

As a special anniversary celebration, I am offering the Tips and Topics book for a $1 for each year. So for $10 total (shipping and handling free), you can receive the TNT book if you purchase in April and May. After May 31, it will revert to regular pricing of $19.95 plus shipping.Get selected relevant clinical and systems tips from the years of Tips and Topics all in one place, “Tips and Topics: Opening the Toolbox for Transforming Services and Systems” by David Mee-Lee, MD with Jennifer E. Harrison, MSW. (158 pages; usually sells for $19.95 plus shipping but through May 31, $10 all-inclusive)

You can buy in two ways:

    1. Go to http://www.changecompanies.net/products/product.php?id=TNT and buy online; or
    2. call The Change Companies at (888) 889-8866 and ask for the anniversary deal for the Tips and Topics book.

SOUL

SOUL

On Friday, April 12, 2013, on National Pubic Radio’s Science Friday program, I was introduced to Zachary Sawyer (“Zack”) Kopplin.  Zack is 19 years of age and is an American science education activist from Louisiana.

http://www.sciencefriday.com/segment/04/12/2013/the-teenage-troublemaker-fighting-for-science.html

A week later on CNN, I was introduced to Dzhokhar Tsarnaev.  Dzhokhar is also 19 and is an alleged bomber, charged with using a weapon of mass destruction to kill in Boston, Massachusetts.  He was found hiding in a boat about three miles from where we lived for 17 years.

Both 19 year olds have been in the media quite a bit for just being 19.  Zack and his tireless campaign to elevate the importance of science education in the USA has been covered in hundreds of newspapers and radio and television interviews.  He has been interviewed in both national and international media, including Vogue Magazine, MSNBC, and the Washington Post.

Dzhokhar has been interviewed by a special team of federal investigators at Beth Israel Deaconess Hospital in Boston, and his radio and video presence now far outstrips Zack’s for many sad and tragic reasons.

What a contrast in two young men- one with focused energy to do good and the other to destroy.   One who channels his youthful idealistic fervor to build; the other who channels his to tear down and terrorize.  It is easy to deify or demonize and that is not what this is about.

What it is about is the important responsibility we all have to nurture our children and youth: to harness their idealism for good, to protest peacefully, to preserve and uphold life, not destroy and kill; and to speak up for what they believe while respecting the rights of others to differ.

Somehow Zack got that message and Dzhokhar didn’t. One has his life ahead of him to keep being a force for positive change. The other will languish incarcerated forever, or may even be killed as he allegedly did to others.

SHARING SOLUTIONS

As a special anniversary celebration, I am offering the Tips and Topics book for a $1 for each year. So for $10 total (shipping and handling free), you can receive the TNT book if you purchase in April and May. After May 31, it will revert to regular pricing of $19.95 plus shipping.Get selected relevant clinical and systems tips from the years of Tips and Topics all in one place, “Tips and Topics: Opening the Toolbox for Transforming Services and Systems” by David Mee-Lee, MD with Jennifer E. Harrison, MSW. (158 pages; usually sells for $19.95 plus shipping but through May 31, $10 all-inclusive)

You can buy in two ways:

    1. Go to http://www.changecompanies.net/products/product.php?id=TNT and buy online; or
    2. call The Change Companies at (888) 889-8866 and ask for the anniversary deal for the Tips and Topics book.

Until next time

Thanks for joining in the 10th anniversary celebration. I look forward to seeing you in late May.

David