28 May 2012

Self-Destructiveness Workshop

It was over a week ago that I attended a super workshop entitled "Working with Self-Destructiveness" with Andy White. I wish I had got around to blogging about it the next day but I had work, and have only just got around to it. The regret is that some of the content was esoteric and quite abstract and hard to define in writing, and possibly even more so 9 days on.

The workshop was described as being for practicing counsellors who would like to strengthen their ability to work with issues of self-destructiveness in their client group. Andy White, who has stacks of initials after his name (Dip Adv Ex Psych, Dip RF, Dip Adv HIPS, Dip Psychosynthesis), is a very charismatic and creative individual and was a great teacher. 

First of all we went into groups of three to discuss self-destructiveness, then to thrash out a definition. My group came up with;

"Engaging in thoughts, actions or patterns of behaviour, which can be outside of conscious awareness, and are against our self-interest or authentic long-term goals and/or ideals."

Most groups came up with something roughly similar and there were philosophical and semantically-based challenges to each definition. It certainly got us thinking anyway. There were some pertinent quotes banded about by Andy, such as; 

"We are destroyed by anything with which we are unconsciously identified." Jung

There was a loose Venn diagram sketched alluding to the origins of inferiority and superiority; the inferiority being based upon the parts of ourselves that were not melded with Mummikins, and superiority where we had a sense of omnipotence and oneness with mother. Andy told us that inferiority and superiority are two sides of the same coins, that they exist in all of us and that there is a dialogue between them. 

I didn't take much in the way of notes, but I did jot down some names and quotes as they seemed very valuable. Andy explored self-destructiveness versus creativity and it edged into the realm of existentialism, with a great Viktor Frankl quote;

"Some refuse the loan of life to avoid the debt of death."

...and someone referred to as Hillman, who I can't for the life of me find reference to on the 'net;

"To create is to have a brush with death."

Spiraling well and truly into the vortex of existentialism, I am going to repeat this quote in it's entirety, lifted from a book Dionysus: Myth & Cult, by Walter Otto:

"He who begets something which is alive must dive down into the primeval depths in which the forces of life dwell. And when he rises to the surface, there is a gleam of madness in his eyes because in those depths death lives cheek by jowl with life. The primal mystery is itself mad–the matrix of the duality, the unity of the disunity, ..The more alive this life becomes, the nearer death draws, until the supreme moment when something new is created–when death and life meet in an embrace of mad ecstasy. The rapture and terror of life are so profound because they are intoxicated with death. As often as life engenders itself anew the wall which separates it from death is momentarily destroyed...Life which has become sterile totters to meet its end, but love and death have welcomed and clung to one another passionately from the beginning."

There was also a great Navajo story of the jumping mouse. I had goosebumps at the end of the story on the day, and his ending was way better. It entered the realm of psychosynthesis, as did the next part of the workshop, which was about our self-saboteurs.

The best learning, for me at least, is experiential and I very much enjoyed taking part in a visualisation exercise which involved being in a forest glade then taking a path through the trees to meet our internal saboteur (we all have one you know!). I found mine straightaway, but it morphed a few times, before settling down. We asked our saboteurs questions such as "What do you need" and "How can you help me". I quite like visualisations and the images came easily. It was fairly emotional for me, then we were invited to go back to the glade, then resurface to the room, and the everyday reality. Then we had to draw what we saw, with some crayons.

Off in pairs, we shared details of our self-saboteurs then in the larger group compared notes. What struck me, is that it seems that the self-saboteurs, an aspect of our subconscious, knows us better than we know them, which I found intriguing. People's images were very varied although many were archetypes in the Jungian sense. Here's a picture of mine (remember, crayons make for tricky drawing!); 

So, the next exercise was to remember a time when we had to make a very difficult choice, and discuss with a partner. Something that came up for me (and some others) was that life-changing decisions can involve a brush with death (when a decision is too agonising we may feel that it would be easier for fate to take away the decision for us) and that they involve our relationship with our shadow. Also, there were very existential agonies  for me - I felt like my self-construct was ripped apart and changed forever as there were permanent mental/neurological shifts happening.

We moved towards more philosophical discussion about the purpose of suffering and the concept of depression being something we should make friends with (something I agree with), that we could be "instructed by melancholy" (Thomas Moore - Care of the Soul). We ended up on sadism and masochism too - how did that happen?

The day went by far too quickly and I would definitely like to attend Andy's next workshop on working with dreams. He trained and worked in psychotherapy for years then found himself expressing himself creatively and is now a mosaic artist. 

23 May 2012

Devon DAAT Exploring Recovery Day, Exeter

Exciting things are happening in the world of recovery in Devon. I was delighted to be able to attend the Devon Drugs and Alcohol Team's (DAAT) Exploring Recovery Event which was held on Monday 21st May, at St James's Park.

The morning kicked off with an introduction to the day by Kristian Tomblin, manager of DAAT. We were encouraged from the start to think about our own definitions of recovery and try and identify which part of the recovery continuum our work belongs to. The continuum starts at one end with harm reduction and at the other end with a dependence free lifestyle.

During a further talk by Francis de Aguilar of Addictions Solutions UK. We were told that the various definitions of recovery agree that:

  • The individual's acceptance of the problem is key
  • Recovery flourishes best with abstinence
  • Partcipation in self-help groups is very helpful  and
  • Recovery often means big life style changes

Then there were some words from Ian Sherwood, from the National Treatment Agency, on offshoot of the Department of Health. My ears really pricked up when I heard him share these ideals for the recovery process:

  • Recovery is an individual, person-centred journey
  • Service users lead their treatment

He also stressed the importance of developing a therapeutic relationship and said that we require a "whole systems approach" i.e. all those involved in the recovery process are united in their approach. Whilst I really enjoyed hearing these things I was also wondering how these ideals would fit into the bureaucracy that I notice is an inevitable aspect of any public sector entity.

Next we split off to go to various workshops. My first selection, on Mental Health, was very much worth going to. It was run by John Lilley from Devon Partnership NHS Trust. There was a talk by a service user - a man who had been addicted to alcohol but, it was discovered, had underlying mental health problems. This helped to get the recovery issue into context. There was then a talk from somebody who worked for the trust but also had children who are or who had been service users - a very useful perspective. She listed 3 things that she said were helpful about the current system, and 3 things that weren't:

What doesn't help

  • Lots of differing opinions from professionals
  • Labelling e.g addictive personality. She believed that this gave her son an excuse to not strive for recovery
  • The lack of a personalised approach

What does help

  • The relationship one of her sons had over 2 years with a CPN (Community Psychiatric Nurse)
  • Simple advice at times of crisis - "support not rescue"
  • The 12-Step programme

John Lilley got us to examine the correlation between mental health and recovery - "the mental health and recovery interface" and we were asked in teams to pictorially represent currents problems with this and how we would like it to look ("Rich Pictures"). Cue lots of interesting, metaphorical and frankly bizarre illustrations involving lots of bags of cash and shiny happy people.

The second workshop I attended was the Devon Drug Service talk for which I was a teeny bit late having got lost in the maze of corridors. This was a straightforward chat about the recent changes they have made and challenges faced. The way drug addiction was handled in the past was to put users onto methadone, a "holding bay" - parking users and hoping things will change. However, switching to methadone does not deal with the problem of "me". Now there is more emphasis on psychosocial intervention and there are workshops in place to educate users. DDS are attempting to bridge the gap between treatment for addiction and reintegration into society.

A couple of interesting points that came up in this talk was the importance of out of hours support for users who may need support at times of crisis. Also,  DDS expressed that although the recent financial cuts have been unfortunate, it has prompted creative thinking in their approach.

There were other workshops available - SMART Recovery, Soberlink, Alcoholics Anonymous, Howell Road Recovery Community and Narcotics Anonymous.

Lunch was a total carbfest, and a very enjoyable one at that (pasta, quiche, sandwiches, cake).

After lunch we were treated to an incredibly powerful poetry recital by Steve Duncan which brought tears to my eyes, such was it's powerful and poignant message. I think it was called "Welcome to My Judgment Room" and it was empathy, horror and shame inducing all at once. You can find a different poem recited on a youtube performance here.

We all split off into groups of 10 for roundtable discussions asking 4 questions about recovery - what is the most important stage? What is going well? What are the gaps? And what proposal would we make to improve recovery?

These were all fedback to the wider group and there was a lot of overlap in the proposals. People wanted greater collaboration between agencies and an improvement in access to the service users ("multi-agency case conferencing", "professional networking site", "service mapping", "central communications hub").

There was more poetry and some feedback about what delegates had written on the "What Recovery Means to Me" wall (legitimate graffiti!). Unfortunately, the event was running a bit behind and I had to slip out early due to a childcare catastrophe.

What did I get out of it? Well, I did my fair share of SMART Recovery promotion, seeing as I wholeheartedly believe in it and there were some there, working in the addictions industry who knew nothing about it. In fact, I think that SMART Recovery deals with the integration into society aspect of recovery very well, which was a theme that arose more than once that day.

There was also the promise of a shift in perspectives and approaches to addiction; more peer-led mentoring and educating, a client-led recovery system and the bringing together of the various agencies involved in recovery. I also heard mooting of the importance of therapeutic alliance and the relational aspect. Music to my humanistic ears.

I did put my feelers out with regards to one-one therapeutic work as previous readers will know, I have a particular interest in the field of addictions, but there doesn't seem to be much in the way of funds for that purpose.

17 May 2012

SMART Recovery - addictive behaviour support and training

I have recently been doing some online training for an organisation called SMART Recovery. I came across them by accident, when a local facilitator and representative of SMART Recovery found my blog on REBT versus CBT and called to ask about that. We got chatting and I found out what he does - facilitates meetings for people with addictive behaviour issues. 

The chap in question had some good things to say about the system, so I looked into it further as I have an interest in the field of addictions. As some of you know, I did a voluntary placement with Chandos House Treatment Centre in Bristol last year (blog posts here and here).

I read up on SMART Recovery, attended a couple of meetings (they are open to interested professionals - just ask beforehand) and have just completed the online meeting facilitator training. I am fortunate enough to be able to attend Devon Drugs and Alcohol Action Team's Exploring Recovery Event day this Monday 21st May, as a professional interested in substance misuse, sharing what I have seen of how SMART Recovery works. This will be an opportunity for people from different agencies dealing with addiction to come together and share ideas. SMART stands for Self Management and Recovery Training, by the way.

I would sum up what I know of SMART Recovery thus:

1) It is a meetings based system for self-help to educate, inspire and support those committed to dealing with their addictive behaviour. This can involve any form of addictive behaviour - drugs, alcohol, gambling, compulsive shopping etc.

2) It draws heavily from Albert Ellis' Rational Emotive Behaviour Therapy which, as some of you may know, I am a huge fan of, in contrast to CBT which I think is more feeble (blog post on REBT versus CBT here). The sessions involve teaching the ABC system - A is the activating event, C is the emotional consequence. Initially clients will have a tendency to say that A causes C, For example, if I fail my exam then I will feel awful. We teach the client to see that there is a B - their beliefs about A, and this is what is causing the problem. D is to dispute the belief - the irrational outlook and E is the new, effective, rational outlook. So in this example, the belief might be, if I fail my exam it will ruin my life and I will be a failure. Well, the client might really be believing that but through Socratic questioning we can help the client to challenge their sedimented belief and see that it is their own irrational beliefs that are leading them to feel so anxious. So the anxiety will reduce. Of course, this is to be delivered in an understanding and empathic way. I have seen it work very well with the SMART Recovery meetings. Eg Somebody feels terrible because they've had a relapse. Then feeling awful about the relapse then makes them more likely to stay lapsed, because they feel so terrible about themselves. By ABC'ing them - which they do in groups at the meetings, and are given a handbook to do it at home, they can feel less bad about lapsing, and therefore not likely to relapse. The B for them might be "if I lapse then that proves I'm a failure so I might as well carry on being the failure I so obviously am". The D - disputing, would be that nowhere is it said or written that lapsing makes you a failure. The person can feel regret at their action but not shame, for they are human! It's the fundamentally humanistic quality of REBT that I like so much, but also that the client can take away a system of help which they can apply to other irrational thoughts in the future.

3) There is no affiliation with any religion, which makes it a good alternative to those that are uncomfortable with that aspect of Alcoholics Anonymous.

4) The belief behind the Smart Recovery system is that nobody is an addict; they have problems with addictive behaviour.  The use of words such as "addict" and "alcoholic" are banned at meetings to ensure that there is a clear distinction between the person and their behaviour. I think that this fundamentally humanistic stance helps attendees to stop judging themselves (and others) - judging oneself leads to more bad feelings - so why do it? REBT fosters unconditional self-acceptance (USA). Unconditional other acceptance is a natural by-product of USA.

5) In contrast to Alcoholics Anonymous, people who attend meetings are invited to attend for as long as they wish to. When they feel they no longer need to attend there is no pressure to do so. The belief is that a person can choose to make changes to their addictive behaviour and can get the support when they feel that they need it. When they no longer feel they need it they can stop. People with addictive behaviours are not believed to be addicts all their lives - they can make choices. SMART Recovery believes that calling people addicts or the like promotes a sense of helplessness at their situation.

6) The system involves many tried and tested tools to help people make changes, such as the Motivational Matrix, and the Hierarchy of Values. I have tried these on friends and family, and the odd client, and they are valuable and effective.

I think that SMART Recovery will continue to go from strength to strength. The meetings I attended had a very warm and sharing atmosphere. There is really good work going on here, and sometimes attendees go on to become facilitators - using what they learned to transform their lives to help transform the lives of others. I found the attendees and facilitators inspirational and it is certainly a privilege to be able to be part of their sharing.  I look forward to learning more at the Exploring Recovery Event on Monday and no doubt will have something to impart next week.

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