This presentation was given at CORE in Amelia Island, FL in 2016. Presentation objective: Identify, Describe & Explain Resistant Clients Learn alignment strategies using MI, SFT, Daring way & Rising Strong strategies Practice Crucial Conversations Identify Role of Shame and the Practice of Empathy and Compassion Show how these strategies may be integrated into practice using case examples

1. Are Your Clients a Pain ?
MI , SFT, Brene’ Brown, Parallel Processes & Pain Recovery Strategies
July 21, 2016
Core Conference

2. Louise Stanger Ed.D, LCSW, CIP
With James Flowers PHD, Director
Kemah Palms, Houston Texas and a
Pain Recovery Expert
Dr Stanger is An Author, Educator,
Writer, Clinician and Interventions and
Thought Leader on Families

3. Objectives
Identify, Describe & Explain Resistant Clients
Learn alignment strategies using MI, SFT, Daring way & Rising
Strong strategies
Practice Crucial Conversations
Identify Role of Shame and the Practice of Empathy and Compassion
Show how these strategies may be integrated into practice using case
examples

4. How Do Our Clients arrive ?
Substance Abuse
Mental Health
Chronic Pain
Legal Issues
Money Problems
Relationship Failures
Sex, Shopping, Gambling
Intergenerational Wounds

8. Attributes of Healthy Families
McMannis PHD & MacMcMannis MSW
Talking and Loving Balancing Closeness & Difference
Expressing Language Accepting Difference
Adapting to Change Seeing The Positive
Sharing Time together Effective Problem Solving
Who’s in Charge Parenting Together

10. Keeping The Status Quo
SA. MH, CP etc .
Organizing structure
Unconscious and
Consciously Gratification
Strategies must be
employed that change
usual ways of relating,
categorizing , and thinking

11. Family and Confabulations

12. Before Treatment
CONFUSED
BEWILDERED
CONFABULATORS- DENIAL
MINIMIZE
FEAR DRIVEN
FRAZZLED
SHAME and GUILT

13. What Kind Of Families do You
Meet
AGREEABLE
ANALYSIS
INVISIBLE
QUESTIONER
KNOW IT ALL
COMPLAINER
TALKER
WORRIER
MICO-MANAGER
BOOMERRANG

14. HAVE YOU EARNED THE RIGHT TO
HEAR ANOTHER’S STORY ?

15. ASSUMPTIONS ABOUT FAMILIES
THAT SEEK OUR HELP
HURTING EXPERTS
MOTIVATED
SEEKING SOLUTIONS
WOUNDED FAMILY OF ORIGIN
BEEN UNSUCCESSFUL IN SEEKING
SOLUTIONS
THEY MAY NOT SEE THEIR PART IN THE
PROBLEM -want you to FIX LOVE ONE
AUTHENTIC- VULNERABLE-
COURAGEOUS

17. BRAVING - Brown
Am I clear in helping client accept own
boundaries ?
Am I reliable ? Do I do what I say I will do?
Do I hold myself accountable-Ethics,
professional standards &, seek
collaboration when necessary
Confidentiality
Nonjudgemental
Am I generous in my interpretation of self
and others ?

19. Motivational Interviewing
Miller and Rolnick
NOT a Curriculum
ROLLING WITH RESISTANCE
DIRECTIONAL-GOAL
MOTIVATION IS BOTH EXTRINSIC
AND INTRINSIC
SCALING QUESTIONS
DECISIONAL BALANCE
CHANGE TALK

20. START WHERE YOUR CLIENT IS

21. Different Ways of Talking
- “MY Mother is driving crazy”
SIMPLE
AMPLIFIED - Exaggerate
“It would suck to lose my job or my
parents support because of my partying
but I do not want to quit just because of
that .
DOUBLE SIDED

22. SOLUTION FOCUSED
InSoon Young & Peter Berg
HERE & NOW
NOT NECESSARY TTO KNOW
DEEPER CAUSE
COUNSELOR EXPERTISE CALL
SMALL CHANGE Can Lead To Big
Change

23. SFT STRATEGIES
PROBLEM TALK
SEPARATE THE PERSON FROM THE PROBLEM
MIRACLE QUESTION
EXCEPTIONS
SCALING QUESTIONS -CONFIDENCE
GOALS -FEEDBACK
COMPLIMENTS
TASK SETTING

24. The DARING WAY
SHAME-GUILT - HUMILIATION
COURAGE -asking what you need,
seeking support, owning your story ,
setting boundaries
Vulnerability
THESE AE NOT THERAPUTIC
STRATEGIES

26. STORY

27. INDIGENOUS TO ALL OF THIS IS
GRIEF
LOSS
INTERGENERATIONAL
TRAUMA WORK

28. Parallel Processes
Krissey Pozak
Families Grow Alongside of Identified
Loved One
Letting Go
Reflective Listening
Learning How to Speak
Shifting Responsibility Back to Your
Loved One
Separated but coordinated processes
bringing in our Clients motivators

30. INTERVENTION- BAR
RELATIONAL ATTACHMENT

32. The TEAM
3 Sisters
2 Attorneys
Family
Friends
Relatives
Security

33. Modalities USED
MI- Rolling With Resistance
SFT- In A Perfect World what would life
look like
Brown- You Can Write Your Own Story
Family MAPPING
Parallel Processes-
You Can ALL FALL UP

34. Paradigm Shift
Moving From Passive :Cure me
Doctor to
Being an ACTIVE
PARTICIPANT

35. Meet Harriet - 62 y.o Female

36. How Harriet’s Lights Went Out
Small Tumor on Cervical
Spine- Operation-Radiation &
Chemo
Oops clipped a nerve-
INTENSE PAIN = OxyContin,
Xanax , Ambien on and on and
on
Finally ended with a Actig
Fentanyal Lollipop

37. Losses
Lost Family Business
Lost Insurance
Lost Family Money
Lost Self Esteem
Lost Ability to Walk
Lost Her Smile

38. Strategies
15 day detox- Pain still 20% due to
Hyperalgesia
Education
Cognitive Behavioral Therapy
Mindfulness
Mediation
Yoga etc
Peer Support

39. OutComes
REDUCED PAIN
45 days later lightly jogging 3
miles
SMILE REMADE
BUSINESS BACK ON TRACK
MARRIAGE BACK ON TRACK
GRANDMOTHER DUTY

40. MEET KING BABY and His
Parents
MULTIPLE TREATMENT EPISODES
ANXIOUS PARENTS
NO BOUNDARIES
2 years of work with one
9 months with another

41. Meet JAVIER
Car Accident- 8 years
ago
Previous Experience
with AA
Intergenerational
Stylist for Major Stars

42. Meet Jack
50 yo male
Previous TreatmentPrevious Treatments
Laminectomy L3/L4, L4/L5
Outcome – increased pain,
radiculopathy
Lumbar fusion and Lysis of
adhesions
Outcome – failed fusion, pain
continued
Physical therapy
Outcome – moderate but
temporary

43. Jack
Presupposed Treatment: Drug Delivery with morphine
Behavioral Assessment ; Clinical Interview , MMPI-2, MPI,BAI/
BDI , Chemical use questionnaire
RESULTS:: Activity < 3, Reported 10/10 constant pain, Sleep < 3, Used
Alcohol to increase drug effect, Severe Anxiety/Depression, Results of
the MPI indicate that the patient is experiencing average pain
severity, above average interference (+2 SD), below average life control
(-2 SD) and an above average level of affective distress (+1 SD). These
findings are compared with other chronic pain sufferers. A
significantly reduced general activity level (-2 SD) was endorsed. These
findings are consistent with many chronic pain sufferers

44. Goals
May not be the Abolition of
pain but adaptation to Pain
ACCEPTANCE CAN BE
KEY

45. Treatment Plan
Biofeedback and relaxation
therapy
Psychophysiological education
CBT , MI, Group Therapy
Postpone implantable drug
delivery

46. QUEEN BABY and her MOM
Intergenerational
Change Agreements
Treatment for Whole Family

48. Resources
The Daring WAY & Rising Strong- Brown
Crucial Conversations -Patterson et al
Parallel Processes- Prozatek
Journey of The Heroic Parent-Reedy
Motivational Interviewing- Miller & Rollnick
http:www.motivationalinterviewing.org
Solution Focused Therapy - Young & Berg
Dr. Louise Stanger http://www.allaboutinterventions.com
Are You A Helicopter or Submarine ? Sober World -, Spring 2016 Stanger

49. Pain Resources
Center for Disease Control, March 2016
Scientific America -Crucial Conservations , May, 2016
ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction and
Opioid Use,2016
Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for
chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention
Workshop. Ann Int Med. 2015;162(4):276-286.
Centers for Disease Control and Prevention. NCHS Data Brief. Prescription opioid analgesic use
among adults:United States 1999-2012 , Number 189, February,2015
2013 National Drug Student Data Bank
Kemah Palms Recovery https://kemahpalms.com

50. An Intervention Guidebook
for Loved Ones and Their Families
Learn
Thrive:to
LOUISE STANGER
ED.D., L.C.S.W., BRI II, CIP