Being Real: The Power of Authentic Therapeutic ......of Authentic Therapeutic Relationships in Women’s Services February 21, 2017 #relate4HERR. Slide 1. ... LLC Senior Training Consultant

Being Real: The Power of Authentic Therapeutic

Relationships in Women’s Services

February 21, 2017

#relate4HERR Slide 1

Deborah Werner, M.A., PMP

Project Director

SAMHSA’s Women, Children and Families Technical Assistance and Training.


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• NAADAC and NBCC CEHs are available for this webinar through the Addiction Technology Transfer Center Network (ATTC) Coordinating Office.

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During and after this webinar, join the conversation about Relationships Matter! and women’s behavioral

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Disclaimers

• This webinar is supported by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Department of Health and Human Services (DHHS).

• The contents of this presentation do not necessarilyreflect the views or policies of SAMHSA or DHHS.

• This webinar should not be considered a substitute for individualized client care and treatment decisions.


Shannon B. Taitt, M.P.A.

Public Health Analyst

Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Treatment (SAMHSA/CSAT).


Why Relationships Matter?

• Women place a great emphasis on the relationships in their lives.

• Relationships play a critical role in women’s substance use and its consequences, experiences of trauma, and the expression and severity of symptomology.

• Healthy relationships are essential in engagement, treatment and interventions, and ongoing recovery.


Relationship Matters! Webinars


Tuesday, February 21, 2017, 2:00-3:30 P.M. EST (1:00 CST, 12:00 MST, 11:00 PST)

TODAY’S FEATURE:

Being Real: The Power of Authentic Therapeutic Relationships in Women’s Services


Stephanie Covington, Ph.D., L.C.S.W.

Co-Director

Institute for Relational Development and the Center for Gender and Justice


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The Power of Authentic TherapeuticRelationships in Women's Services

Stephanie S. Covington, Ph.D., L.C.S.W.Center for Gender and Justice

Institute for Relational DevelopmentLa Jolla, CA

SAMHSARelationships Matter!

February 14, 2017 Webinar

© S. Covington, 2017

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Relationship is an Essential Partof our Humanness


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Definition of Relationship

• Satisfaction of the wish...desire...longing to be experienced

• To be in a relationship

• To be experienced anew with another

• To experience the self anew with another


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• Each person feels a greater sense of “zest” (vitality, energy)

• Each person feels more able to act and does act

• Each person has a more accurate picture of her/himself and the other person(s)

© S. Covington, 2017(Stone Center, Wellesley College Wellesley, MA 02181)

Growth-Fostering Relationships (1 of 2)

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• Each person feels a greater sense of worth

• Each person feels more connected to the other person(s) and a greater motivation for connections with other people beyond those in the specific relationship


Growth-Fostering Relationships (2 of 2)

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• Therapy refers to “treatment.”

• Treatment providers required to have a professional license.

• Therapeutic refers to

• healing

• being attended to

• restorative


Therapeutic Relationships(1 of 2)

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Therapeutic Relationships(2 of 2)

• Cambridge English Dictionary answers the question, “What is therapeutic?”

“...causing someone to feel happier and more relaxed or to be more healthy.”

• Therapeutic relationships promote wellness and resilience. We all need this in our interactions with each other.


21

Traditional model

• Objectivity

• Neutrality

• Distancing

• Unemotional and impersonal attitudes


In Clinical Settings(1 of 2)

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Relational model

• “Caring about” instead of “caretaking”

• Empathy

• Mutual development

• Impacted by the client


In Clinical Settings(2 of 2)

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Mutuality

Not fully mutual

• One discloses more

• One seeks help by another; to be listened to and understood

• Client’s subjective experience is at the center


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Feeling of Mutuality

• Mutual respect

• Emotional availability

• Openness to change on both sides


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Capacity for Relatedness

• Open to self-examination (reflection)

• Ability to self-soothe (containment)


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Based on knowing ourselves

• Inner self – our thoughts, feelings, values and beliefs

• Outer self – our relationships, behavior and appearance


Authenticity

27© S. Covington, 2017

Upward Spiral

Addiction & Trauma

(constriction)

Recovery &Healing

(expansion)

Transformation

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Who am I?

Describing myself

• Feelings

• Beliefs

• Qualities


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Don’t ignore your inner voice.

It’s who you really are.


Being Authentic

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Definition of Empathy

The ability to understand the feelings, thoughts and experiences of another.


Empathy Expanded

Dr. Richard Mollica says we also need to imagine and envision. Envision the lives of others.

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Our Work

Therapeutic Relationship


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Demonstrate Engagementin Four Ways

• Gaze

• Posture

• Experience-near questioning

• Affective response


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Therapeutic Alliance

Over 1,000 studies have demonstrated the alliance between client and therapist is over 7 times more important than technique.

© S. Covington, 2017(Orlinsky, et al., 2004)

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What Works?~

Evidence-Based Practice


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Institute of Medicine (IOM)

• Research trials

• Physician's clinical wisdom

Behavioral Health

• NREPP

(randomized control trials)

© S. Covington, 2017© S. Covington, 2012

Evidence-Based Practice(1 of 2)

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American Psychological Association (APA)

• Research

• Clinical expertise

• Client culture, preferences

© S. Covington, 2017© S. Covington, 2012

Evidence-Based Practice(2 of 2)

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“...the integration of the best available research and clinical expertise within the context of patient characteristics, culture, values, and preferences.”

© S. Covington, 2017(APA Presidential Task Force, 2005)

Definition of Evidence Based(American Psychological Association)


Necessary Elements (EBP)

• Therapeutic alliance

• Value-based services

• EB interventions

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Value-Based Services

• Gender responsive

• Trauma informed

• Recovery oriented

• Culturally relevant


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We bring evidence-based interventions into these value-based services/agencies.


And then...

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Women’s TreatmentLong-Term Outcomes(10 year follow-up)

• Women-only (WO) treatment compared to mix-gender (MG)

• WO increased odds of successful outcome by 49%

• Substance use, mental health, criminal justice involvement

© S. Covington, 2017(Evans, et. al., JSAT, 2013)

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• Trauma informed: Raising awareness. All systems, all organizations, all people. Basic knowledge. Identification of the problem.

• Trauma responsive: This greater knowledge creates/requires a significant level of responsiveness. Design and implement innovative changes in agency culture and environment.

• Trauma specific: Some people require treatment for symptoms or referral to other resources.

© S. Covington, 2017(S. Bloom, 2016)

Trauma(1 of 3)

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“...the disease of disconnection.”

~ Judith Herman


Trauma(2 of 3)

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Fragmentation is the hallmark of trauma and integration is the hallmark of health. Women who have experienced trauma often struggle to put themselves back together. They need the compassionate and intelligent help of other people in order to heal and recover.


Trauma(3 of 3)

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Gender-responsive Materials(trauma informed)

(1 of 3)

• Helping Women Recover

• Beyond Trauma: A Healing Journey for Women

• Healing Trauma: A Brief Intervention for Women

• A Woman’s Way through The Twelve Steps

• Voices:A Program of Self-Discovery and Empowerment for Girls (2nd Edition May 2017)


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• Beyond Violence

• Beyond Anger and Violence

• Women in Recovery

• Women and Addiction

• Becoming Trauma Informed: A Training Curriculum for Correctional Professionals



(2 of 3)

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• Helping Men Recover

• Exploring Trauma:A Brief Intervention for Men



(3 of 3)


Covington Curriculum ConferenceJune 6 – 8, 2017 in Mystic, CT

For additional information visit www.covingtonconference.comOr email [email protected]

http://www.covingtonconference.com/

mailto:[email protected]


LOVE

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Eros

• Passionate love

• Falling in love

• Sexual attraction


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Agape

• Selfless love

• Love for all

• Universal loving kindness



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When we seek for connection, we restore the world to wholeness. Our seemingly separate lives become meaningful as we discover how truly necessary we are to each other.”

~ Margaret Wheatley


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Bloom. S. L. (2016). “Advancing a national cradle-to-grave-to-cradle public health agenda.” Journal of Trauma and Dissociation 17 (4).

Covington, S. (2003, revised 2016). Beyond trauma: A healing journey for women. Center City, MN: Hazelden.

Covington, S. and L. Beckett. (1988). Leaving the enchanted forest: The path from relationship addiction to intimacy. San Francisco: Harper San Francisco.

Evans, E., D. Levin, L. Li, and Y. Hser. (2013). “Explaining long-term outcomes among drug dependent mothers treated in women-only versus mixed-gender programs.” Journal of Substance Abuse Treatment 45 (3): 293–301.

Goodheart, C., Kazdin, A., & Sternberg, R. (Eds.) (2006). Evidence-based psychotherapy: Where practice and research meet. Washington, D.C.: American Psychological Association.

Johnson, D. and Lubin, H. (2015). Principles and techniques of trauma centered psychotherapy. Washington, DC: American Psychiatric Publishing.

Jordan, J., Kaplan, A., Miller, J., Stiver, I., and Surrey, J. (1991). Women’s growth in connection: Writings from the Stone Center. New York, NY: The Guilford Press.

Mollica, R. (2006). Healing invisible wounds: Path to hope and recovery in a violent world. New York, NY: Harcourt, Inc.

Orlinsky, D. E., Ronnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: Continuity and change. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (pp. 307–391). New York: Wiley.


References

Questions and Discussionwith Stephanie Covington, Ph.D.


Cathy Cave, B.S.

Co-Founder

Inspired Vision Consulting and a Senior Training Consultant at the National Center on Domestic Violence, Trauma and Mental Health.


The Power of Authentic Relationships in Women’s Services

Cathy Cave, B.S., Inspired Vision, LLCSenior Training ConsultantNational Center on Domestic Violence, Trauma & Mental Health

Slide 57

Reflecting on Experience

Culture matters in

• What we experience and the sense we make of it,

• What we find helpful,

• How behavior is interpreted,

• Our experiences of mutuality, and …

• How we determine if authenticity feels present. Slide 58

Slide 59

Cultural AttunementAction taken to understand and adapt to another’s values, priorities and approaches to connection to create relational alignment.

What gets in the way?

Slide 60

Provider and Organizational Attitudes and Behaviors

• Current engagement rests on a foundation of previous experiences for both providers and people seeking services.

• Often, good intentions and current actions are not in alignment.

• People who use services are often seen as the problem when relationship disconnections occur.

61

Qualities of Attunement

Human Qualities

• Compassion• Love• Empathy

Cultural Attunement Dimensions

• Cultural insight (understanding)

• Cultural acceptance (humility)

• Cultural esteem (honor)

• Cultural kinship (mutuality)

• Cultural openness (not knowing)

Oakes, 2011Slide 62

Culturally ResponsiveUnderstanding the centrality of culture in people’s lives and incorporating this understanding into service design and delivery.

Providers promote accessibility, equity and mutual respect as a cornerstone of the work and infuse these values into relationships, environments and practices.

Slide 63

Culturally Responsive

Providers demonstrate interest in, learn about and acknowledge cultural identities, values, connections, experiences and considerations in effort to provide services that are in alignment with multiple facets of people’s lives and the languages they speak.

Slide 64

Cultural Responsiveness: Shifting Attitudes and Behaviors

Relationships can be positively shaped by:

• Commitment to learning

• Self-reflection and self-assessment

• Curiosity and effective cultural inquiry

• Community engagement

• Accessibility focus

• Provider’s willingness to adapt and changeSlide 65

Culturally-informed Relationships Contain:

• Welcoming individualized uncensored expression,

• Individualized defining of safety and working collaboratively to honor it,

• Flexible environments that accommodate a range of experiences and responses, and

• Relationships that can sustain connection through doubt, distance, and time.

Slide 66

We Are All Continually Healing

Restoring a sense of safety and protection within a consistently nurturing and trustworthy relationship supports resilience.

Warshaw, C., Blumenfeld, S., Bland, P., M.A., Cave, C., Pease, T., 2014

Slide 67

Peer Support: Nurturing and Trustworthy Relationships

A dynamic, flexible approach to connection and mutual understanding among equals, based on a core set of values and principles.

Blanch, A., Filson, B., Penney, D. and Cave, C., 2012

Slide 68

Peer Support Values

• Voluntary

• Non-judgmental

• Respectful

• Mutual

• Reciprocal

• Flexible

• Empathetic

• Compassionate

• Strength-based

• Recovery focused

• Culturally attuned

• Trauma informed

Slide 69

The Power of Sharing Experience

Types

• Individual• Groups• In person • Virtual• Local• National• Global

Benefits

• Creating understanding

• Alleviating loneliness and isolation

• Sharing strategies in moments of distress

• Illuminating pathways to recovery

Slide 70

Why Peer Support Helps• Mutuality is at the core.

• Power is shared.

• Connection on one's own terms is expected.

• Finding voice and connection to personal power is foundational.

• Honesty and accountability to self and others expands.

This can powerfully counter previous negative experiences!

Slide 71

We share unique qualities in peer support: our experience, strength, and hope.

Slide 72

Self-Awareness

“In the thick of this work we often forget about our own needs until they can no longer be met in simple ways.”

Shery Mead, 2010Slide 73

I know there is strength in the differences between us. I know there is comfort where we overlap.

Ani DiFranco, 1994

Slide 74

References• Blanch, A., Filson, B., Penney, D. and Cave, C. (2012). Engaging women in trauma-informed peer

support: A guidebook. SAMHSA’s National Center for Trauma-Informed Care. Available at http://www.ahpnet.coFilesPeerEngagementGuide_REVISED_10_2012.aspx

• Cave, C. (2014) Incorporating a Trauma Lens Into Domestic and Sexual Violence Advocacy Services, National Center on Domestic Violence, Trauma & Mental Health (PowerPoint Slides)

• DiFranco, A. (1994). Overlap. On Out of Range [CD]. New York: Righteous Babe Records.

• Mead, S. (2010), private communication. Cited in Cave, C. and Penney, D. (2012). Trauma-informed peer support [PowerPoint slides].

• Oakes, E . (2011) Health Care Disparities and Training in Culturally Competent Mental Health Counseling: A Review of the Literature and Implications For Research. In International Journal of Humanities and Social Science Vol. 1 No. 17 Special Issue.

• Warshaw, C., Blumenfeld, S., Bland, P., M.A., Cave, C., Pease, T. (2014). Core Curriculum on Trauma-informed Domestic Violence Advocacy Services, Module 3, National Center on Domestic Violence, Trauma & Mental Health.

Slide 75

http://www.ahpnet.com/Files/PeerEngagementGuide_REVISED_10_2012.aspx

Cathy Cave, Inspired Vision, LLCSenior Training [email protected]

Main office: (312) 726-7020 55 E. Jackson, Suite 301, Chicago, IL 60604www.nationalcenterdvtraumamh.org

Slide 76

mailto:[email protected]

http://www.nationalcenterdvtraumamh.org/

Questions and Discussionwith Cathy Cave


Panel Comments

#relate4HERR

Stephanie Covington, Ph.D. Cathy Cave, B.S. Shannon B. Taitt, M.P.A.

Deb Werner, M.A.

Introduction to Women with SUDs online course http://healtheknowledge.org/


Selected SAMHSA Websites

• Women Children and Families Training and Technical Assistance Site

• Introduction to Women and Substance Use Disorders online course

• National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC)

• National Network to Eliminate Disparities in Behavioral Health

• Culture, Language and Health Literacy


http://www.samhsa.gov/women-children-families

http://www.healtheknowledge.org/

http://www.samhsa.gov/nctic

http://nned.net/

https://www.hrsa.gov/culturalcompetence/index.html

Selected SAMHSA Publications

• TIP 51: Substance Abuse Treatment: Addressing the Specific Needs of Women

• Supporting Women in Co-ed Settings

• Improving Cultural Competence

• Substance Abuse: Clinical Issues in Intensive Outpatient Treatment

• Getting Started with Evidence Based Practices#relate4HERR Slide 81

http://store.samhsa.gov/shin/content/SMA14-4426/SMA14-4426.pdf




http://store.samhsa.gov/shin/content/SMA09-4463/GettingStarted-IMR.pdf

Continuing Education

• Session evaluation and CEH quiz:http://www.surveygizmo.com/s3/3337528/RelationshipsMatterFebNAADAC

• All registered attendees will also receive an email containing this link after the event.

• Each person seeking continuing education credits must take the quiz individually.

• You will be able to download your certificate immediately after completing the quiz with a passing grade.


http://www.surveygizmo.com/s3/3337528/RelationshipsMatterFebNAADAC

Join Us March 9 for#RelationshipGoals

Click to Registerhttp://www.tinyurl.com/relationshipsmatter2

#relate4HERR

http://www.tinyurl.com/relationshipsmatter2

THANK YOUVisit SAMHSA’s Women, Children & Families

Training and Technical Assistance Website for more information on this series, including PDFs of the

slides and archives for later viewinghttps://www.samhsa.gov/women-children-

families/trainings/relationships-matter

#relate4HERR

https://www.samhsa.gov/women-children-families/trainings/relationships-matter

Documents

Being Real: The Power of Authentic Therapeutic ......of Authentic Therapeutic Relationships in Women’s Services February 21, 2017 #relate4HERR. Slide 1. ... LLC Senior Training Consultant