Transcript Document

Supporting Stage II Recovery
Lynda Steele, LCSW
Clinical Director, Project Recovery
[email protected]
What is necessary for long term
recovery from addictive disease?
What are the stages of this disease &
recovery process?
What is supportive of the stages of
the recovery process?
Step 1. A glass with a friend.
Step 3. A glass too much.
Step 5. The summit attained. Jolly
companions. A confirmed drunkard.
Step 7. Forsaken by Friends.
Step
Step
Step
Step
Step
2.
4.
6.
8.
9.
A glass to keep the cold out.
Drunk and riotous.
Poverty and disease.
Desperation and crime.
Death by suicide.
BIO/PSYCHO/SOCIAL PROBLEM SEVERITY &
TREATMENT NEEDS ASSESSMENT
Treatment Need Indicators
Outpatient
Residential
Active Alcohol/ Drug Toxicity
Absent
Present
Destructive Behavior Risk
Low
High
Emotional/ Mental Control
Good
Poor
Reality Testing re: Chemical Use
Realistic
Unrealistic
Motivation to Abstain
Good
Poor
Family Awareness/ Support
Good
Poor
Social Environment Support
Good
Poor
Life Function Impairment
Mild
Severe
BIO/ PHYSICAL/ NEUROLOGICAL/
NEUROCHEMICAL
ASSESSMENT & FOCUS
Primary Treatment
Secondary Treatment
PRIOR TRAUMA
LIMBIC SYSTEM FREEZE
USE
ABUSE
DEPENDENCE
ABSTINENCE
NEUROLOGICAL CONFUSION/
SWITCHING
TYPES OF TRAUMA
Little Traumas
Big Traumas
C-Section
PTSD
Rape
MVA
Chronic Drug Abuse
Axis I, II & III Disorders
i.e. Personality, Chronic Pain,
Mood Disorders, RSD, Process
Addictions, Dissociation
Classical Conditioning
BIO/ PHYSICAL/ NEUROLOGICAL/
NEUROCHEMICAL
TREATMENT INTERVENTIONS
Primary Recovery Concepts
Abstinence from Drug of Choice
Detox – Social/ Medical = Abstinence
Medication Management (Harm Reduction)
Methadone
Suboxone
Etc.
Physical Stabilization
Time
Medication Management
Sleep
Nutrition - Supplements
Exercise
BIO/ PHYSICAL/ NEUROLOGICAL/ NEUROCHEMICAL
TREATMENT INTERVENTIONS
SECONDARY RECOVERY CONCEPTS
Maintaining Primary Abstinence & Stabilization
Creating a Sense of Safety & Security in our Environment
Soothing & Healing the Limbic System
Individualized Nutritional, Exercise, Sleep Hygiene Program
Nonverbal, non-rational Techniques and Strategies that decrease/
discharge the triggered fight/ flight/ or freeze response of the midbrain
Energy Kinesiology
Play
Neuro-linguistic Programming
Music
EMDR
Movement
Somatic Experiential Therapy (Levine)
Time in Nature
Individual Ongoing Practice of Ceremony & Ritual
Silence
Mindfulness/ Meditation
Cranial Sacral Therapy
Massage
Acupuncture
Yoga
Pilates
Psychological Treatment Interventions
Primary Treatment
Thorough Assessment & Education Regarding
USE – Primary Coping Strategy
Decreasing suffering,
increasing pleasure
ABUSE – Continuing use in spite of consequences
(psychopathology)
CYCLE OF SHAME
DEPENDENCE – Psychological process of rationalizing, minimizing,
intellectualizing (DENIAL)
Obsession/ Compulsion
Memory of only euphoric recall
Classical conditioning
CYCLE OF SHAME
SHAME: Feeling/ Thinking Badly About Who I Am
GUILT: Feeling/ Thinking Badly About What I Do
CLASSICAL CONDITIONING
THE STRONGEST FORM OF CLASSICAL CONDITIONING
IS PAIRING INTERMITTENT POSITIVE WITH NEGATIVE
REINFORCERS
Example – Vernon Johnson’s Cycle of Shame
Primary Recovery Concepts
Psycho-education of the PROBLEM
Physical Effects of Abuse and Dependence
Psychological Effects
Different Treatment Models Address Different Effects
Social/ Spiritual Effects
Relationships
Self & Others
Psycho-education of the SOLUTION
Knowledge of a Recovery Lifestyle
Physically
Psychologically
Socially
Spiritually
Development of a Continuing Care Plan
“spiritus contra spiritum” - spirits against spirit; “alcohol
face to face with soul”
“You see, Alcohol in Latin is "spiritus" and you use the
same word for the highest religious experience as well
as for the most depraving poison. The helpful formula
therefore is: spiritus contra spiritum.” (Jung, 1961.
Letter to Bill Wilson.)
Psychological Treatment Interventions
Secondary Treatment
Thorough Assessment & Support to Address
Individuation Phase/ Developmental Stage
Trauma (Accumulative/ Little & Big)
Co-occurring Illnesses
Individualized Plan for Addressing Findings of Assessment
Application & Habituation of Recovery Lifestyle
Addressing Accumulative Trauma
Individuation Process
Relatedness/ Self – Other
Classical Conditioning
Social/ Spiritual Treatment Interventions
Secondary Treatment
An ongoing process of building relatedness with
Self & Others.
Requires Individuation
Trends Being Seen in Transitional Living
Environments
Primary abstinence & stabilization
Trauma/ co-occurring mental disorder symptoms begin to
surface
Delayed Developmental Individuation Process
- Interruption of Autonomy
UNIVERSAL PROCESSES
Individuation/ Relatedness
Individuation – An ongoing, confrontational dialogue between
consciousness and the unconscious. Conscious and unconscious
content is united in symbols. (Verena Kast, The Dynamics of Symbols,
1992)
Goal –
Become who we really are
To differentiate our uniqueness
Process of self-acceptance
Acceptance not only of one’s possibilities but also one’s difficulties
To increase one’s autonomy or coming of age
Earmarks: a strong sense of independence, need for space
Basic Fear: fear of entrapment, being limited or restrained
Need: Space, time, leeway
Process: exploration of how to “count on oneself”
Desire: to be trusted by others and by oneself
Balanced with “relatedness”
Healthy outcome:
ability to be alone, self-sufficient
the Hero/ Heroine’s Journey
Taken to Extreme:
Narcissism, Myth of Narcissus
Hero
Psychological Recovery Lifestyle
Discovering Possibilities
Possibilities - from late Latin possibilitas, from possibilis
‘able to be done’.
posse - [M17th] The key element in its meaning is not the
pursuing, though, but the fact that the sheriff has
empowered this group of people to enforce the law. In
medieval Latin posse meant ‘power’, and came from Latin
posse ‘to be able’. See also power. Possible [LME] comes
from the same root, while Latin potentia ‘power’ formed
from posse, gives us words such as potent, potentate, and
potential (all LME).
Secondary Recovery Concepts
Discovering Difficulties
Difficulties - ORIGIN late Middle English (in the senses
‘requiring effort or skill’ and ‘something difficult’): from
Latin difficultas, from dis- (expressing reversal) + facultas
‘ability, opportunity’.
Acceptance that my difficulty is a REVERSAL of my ability or
my opportunity (Neurological Switching/ Kinesiology
Literature)
Discovery & Acceptance support development of
Autonomy – the main goal of Individuation
THE HERO/ HEROINE JOURNEY
Leaving Home
Enter Darkest, Densest Edge of Forest/ Psyche
No one else has tread, no path
“Ordeal”
Rescue fair damsels
Slay ferocious dragons
Handless Maiden
Dancing w/ Red Shoes
Rite of Passage
“Bringing Home”
“The Gift”
“My Solo”
The New Name
New Wisdom
“Welcoming Home”
Ritual/ Ceremony
Relatedness
“Relationship to the self is at once relationship to our fellow
man. No one can be related to the latter until he is related
to himself.”
– Jung
“The unrelated human being lacks wholeness, and can
achieve wholeness only through the soul, and the soul
cannot exist without it’s other side, which is always found in
a ‘YOU’”
- Jung
(Excerpt from The Dynamics of Symbols, Verena Kast, 1992.)
Relatedness: the need to share,
connect or join together.
Earmarks: time equated with love.
Basic fear: fear of loss or abandonment, exclusion
Process: time shared
Symbols of this phase are:
Journey of the Twins
The Sun and the Moon
Caduceus
Balanced with “individuation”
Healthy outcome:
Ability to connect & be intimate with others
Taken to Extreme:
Loss of identity, loss of self
Autonomy
The Main Goal of Individuation
You must first be autonomous to be
related & intimate
ORIGIN early 17th cent.: from Greek autonomia, from
autonomos ‘having its own laws’,
autos ‘self + nomos ‘law’
A delay or lack of autonomy supports
ISOLATION & SEPARATION
Self
Skills to Support Individuation & Autonomy
“OWNING YOUR OWN AUTHORITY”
Defined as, from a Jungian perspective: Experiencing
legitimacy in one’s thoughts & feelings in ALL social
situations
An integration and related process between one’s inner
psyche “mothering” principle & “fathering” principle
An experience of how to “mother” & “father” self
Mother
Father
Long-Term Recovery
Healthy/ Safe/ Secure “Animal”
Individuation
Autonomy
Relatedness
Supporting Leaps of Faith
And Thus a Transcendent Process