 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation. This is our final presentation on strengths-based biopsychosocial approaches. Today, we're going to be talking about addressing addiction, but a lot of what we're going to talk about really applies to mood disorders as well. I want you to think broadly, not just narrowly for addiction. Well, identify relapse triggers, the components of a strengths-based approach, the types of strengths in each of the nine life domain areas, and then we'll finish by reviewing some basic strengths-based questions that you can ask clients in order to elicit more strengths from them. Why is this important? Well, relapse, whether it's depression, anxiety, or addiction, is a big issue, because when people are starting to feel better and then all of a sudden they relapse, their motivation for change may wane a little bit. They may feel more hopeless, more helpless. They may lack self-confidence now because they're like, well, maybe I can't do this. Maybe I can't stay sober. Maybe I can't be happy. Their self-esteem may go down because they look at it and they say, I should be able to be happy, be clean, be sober, be whatever, and they're not. So we want to make sure we develop their self-esteem. It can influence their relationships and lack of social support, and relationships, all of these can also trigger a relapse. Ineffective interpersonal skills can trigger relapse. So we want to make sure that we're helping clients build on their interpersonal skills, and a lack of sufficient resources can also trigger relapse. So five components of a strengths-based approach. The clients have to have a responsibility for their own recovery. If they expect us to fix them, then if they relapse, or if they don't succeed in treatment, it's our fault, not theirs. Now, in a collaborative relationship, we both have a stake in it. We're both involved participants in this process, but we can't make anybody change. They have to be willing and motivated to change themselves, and they have to be willing to do the work. The clients direct their own goal setting. So this is really helpful because it moves away from us telling them what they need to do, which may or may not be what they want to do, or even what they need to do. I mean, each individual is unique, and it helps them identify goals that they think are going to help them, and that they're motivated to work on. It focuses on strengths and resources that are already in existence, or they can easily be put into play, because it's easier to start with what you've already got instead of trying to reinvent the wheel. It's a collaboration and a partnership. I want the client to feel that this can't succeed without their input. I'm not doing something to them. It's not like going to the barber and getting a haircut. You go to the barber and they cut your hair. You don't have to do anything, but sit there and be still. That's not what counseling is like. Counseling may have to do the hard work and be an active participant. They have to be willing to be open and say, this isn't working for me, or this might work better. A strengths-based approach looks at community-based services and resources, because we're building on the client's strengths, but the client's strengths are not only internal, but they're also external. Who are their social supports? What types of supports and resources do they have in their environment and in their community that they can work with? A lot of times, clients try to do things on their own. They think, I should be able to do this. I need to get healthy. I need stress reduction. Let's think about some of the things that stress a person out, and then think about what types of community resources are out there that could help defray some of that stress. These are the things we want to encourage clients to look at. Instead of thinking it's all on them, help them realize that there are places they can reach out to. The function of a strengths-based approach makes the most of client and community strengths. We're going to build on their strengths, but we're going to encourage them to admit that they can't do everything all by themselves all the time. Builds on the most effective therapeutic relationship with the client because they're involved and they feel like they have a voice. And it develops the client's ability to believe in themselves and in the success of treatment. So they're creating these goals, and then when they start seeing positive change, they are going to feel like not only does treatment work, but hey, I can do this, I the client. So the domains for strengths and goals that we're going to learn about, life skills, finances, leisure, relationships, living arrangements, occupation, education, health, internal resources, and recovery. And we'll define each one of those as we go through a little bit later in the class. But there are a lot of different areas looking at a biopsychosocial approach that we need to help clients pay attention to. So why is responsibility for recovery important? When people take responsibility for their own recovery, they feel a greater sense of investment in the outcome. An urge to go back to self-destructive behavior, it looks like rebellion or resistance and more like a threat, less like rebellion or resistance, and more like a threat to their own interests. They'll be saying, I have worked so hard that I don't want to sabotage myself versus when clients feel that something's being done to them or they're being forced to do something, then they may push back and rebel because they want to regain control. But when they were using this approach, they already have the control. So if they choose something else, they're sort of, they're keeping control, I guess you could say, but they're working against themselves. They're not trying to regain control over you. As the ability to take responsibility is exercised and strengthened, a sense of confidence and self-esteem grows. Remember, we identified those as two relapse issues that we need to be aware of. Well, we start using this and helping them solve their own problems and learn how to set successful goals. They start developing self-efficacy and self-esteem. Wow, that's awesome. Okay. So the focus is on the client's own strengths and resources, which helps them become empowered and feel confident in their abilities to succeed in recovery. They're identifying these goals. They're looking around and suddenly realizing, you know what, I've got more strengths than I realized I had. I have access to more resources than I realized I had. That is so awesome. So they start feeling empowered to make changes. They're like, oh, I didn't realize that resource was over here. Let me tap into that for a little while. The strong sense of collaboration and partnership in the treatment process creates a more active partnership role. So the client is going to be less likely to defer to us and go, well, whatever you think, they're going to say, I think we need to do this. Sometimes they'll even surprise you and come in and say, I was doing some research since our last session and I came across this and I'm wondering what you think about it or if you think it would help. So clients can start getting really involved in their own treatment program and curious and enthusiastic and it's really awesome. And it takes a lot of pressure off of us sometimes when clients come in and they are feeling that excited. Finding resources within the family, culture and community helps develop supportive relationships. If they don't have healthy supportive relationships, that's a relapse trigger and a relapse is also going to hurt relationships. So we want to make sure we help them look to who's healthy and who's supportive in your environment, not just your family, but also in your community, whether it's a faith-based organization or a community center or wherever they're finding people. I do a lot of volunteer work. So the people that I volunteer with, they are awesome resources. We don't necessarily center around and chat about human stuff a lot because it's animal rescue. But if I ever needed something, we get together and we support one another. We periodically call each other for referrals for whatever each person's expertise is. So we develop those relationships and they're in the community. They are tangential. Like I said, animal rescue has nothing to do with mental health support. But I've had more than one of my animal rescue friends call me and say, I have this person who needs help. What can you do? Or what would you do if you were in this situation? Can you provide me some guidance? So that's one of those things we're going to look at as when we start talking about strengths. Clients in this approach learn more about themselves and their goals as they try out their plans in real life and reflect on the results and treatment setting. Clients learn and practice goal-setting and solution-building skills that they'll be able to use throughout their life. Most of the time, I find that clients I work with have never learned how to set effective goals. They don't know how to set smart goals. So when they've set goals before, they've failed. Not because they didn't try, but because the goal they set was ineffective for some reason. So we start talking about how to identify effective solutions and set smart, specific, measurable, achievable, time-limited, and SMA results-based, sorry, in order to create effective goals. And each revision of goals carries clients farther in the recovery process. And this is another thing I want them to realize is when they set goals, you know what? The first time we set a goal, it's probably not going to be the final thing. Think about when you went to college. How many different times did you change your major? You know, some people change it seven times. Some people change it two or three. But most people change their major at least once. That's not a ding against them. That's them getting into it and realizing, okay, my strengths may be over here, or the resources I have really are pointing me in this direction. Same thing with goals for anything, whether it's getting in shape or stopping smoking or staying clean and sober. People will set goals and they'll say, okay, this is how I'm going to achieve my goal. And they get into it and they may realize, I need something more. It's I need a little bit more than going to 12-step meetings or I need a little bit more than treatment or whatever the case may be. And they modify their goal as they become aware of what they need in order to successfully complete it. Have you ever tried doing some sort of a handyman project? And you set a goal, you're like, I'm going to fix this toilet. And so you go and you get the little flapper thing or whatever it is that you need at Home Depot. And you come home with the goal of fixing that toilet. And you open it up and you take the flapper thing off and you realize that there's a gasket that's gone bad. And I'm just throwing words out right now. But you're following. Your goal was a great one. But once you got into it, you realized there was more wrong with the toilet than you really thought. So then you got to go back to Home Depot. It doesn't mean you failed. It just means there's more to it than initially met the eye. And this helps clients learn not to get down on themselves when they set a goal and they have to revise it. Life happens. And sometimes they're going to have to drop back and punt here and there. Client directed goal setting, strengths-based providers become teachers, coaches and resources to our clients. As clients learn to set their own goals, including treatment goals. So we're going to slowly back out. You know, we start as a real active participant in this. And as treatment goes on, we're going to slowly back out and let the clients start really taking the lead and taking the reins until they feel comfortable going at it, you know, on their own. Clients are going to make plans to meet their goals using the strengths that they continue to identify. So again, we want to teach them how to identify their strengths, not just go, okay, not just sit through and go through a litany of questions. Help them understand why you're asking these questions. Why strengths are important. What strengths are. They're going to try out their goals and report on the results. They're going to bring the results back. They're going to say, I tried this and it went really well. And we can say, awesome. Let's remember that for the next time. Or they may come back and they say, I tried, you know, handling this situation with my mother-in-law this way. And it really didn't go how I thought it was going to. Or it went very poorly. And we can talk about why it didn't go well and what needs to change the next time. But they can come back and report and we can talk about how to modify those goals in order to make them and those interventions in order to make them effective for the client. As they revise their goals and plans, they gain more information and experience. Think about when you learned cognitive behavioral therapy. I think most of us have learned it. You know, when you first start learning it, you learn the ABCs and you go through that. And that's really R-E-B-T, but whatever. The same ballpark. You have that and that is your tool. Okay. You start working with clients using the ABCs and you realize that, you know, that doesn't work for every client. So then you got to go do some research. You gain more information and experience. You learn different techniques and cognitive behavioral. And then you start learning which one of those techniques is going to work for which type of client and you start getting a better feel for which interventions to use when. Same thing for our clients. As goals are defined, providers also help people identify small manageable steps towards these goals. We want them to have frequent successes. Concrete actions they can take. So they can do it or not do it. But we can clearly say it was either done or not done. Resources they can call on to complete these tasks. A lot of people aren't familiar with United Way. You know, they can call United Way information and referral and find a lot of resources. They can Google and find a lot of resources. I recently had a client who was coming out of a domestically violent situation and needed to find a new place to live. And she was like, you know, I've got rent but I don't know how I'm going to come up with first, last and security and the down payment for the utilities. And so we were able to look online and find some resources. There was one place that that's what they specialized in was providing the initial down payments to help women get out of violent situations. So, you know, Bada Bing, that resource was there and she had no clue. So we can help clients become more aware of sometimes all you got to do is ask Google. And Google is not my favorite but, you know, it can be a help. Clients will also start to identify strengths within themselves that will help them reach their goals. And we can point this out, their courage, their creativity, their determination, their, you know, all of these things that we see. A lot of times clients are going to discount those in themselves and they're going to see what's going wrong and they're going to see that they feel like giving up. Whereas, you know, we can help them see how far they've come and how much courage it's taken to get there and kind of balance out their negativity. Help them embrace those dialectics. Yes, they want to give up. I got that. Is it really what they want to do or are they just feeling exhausted at this point? And what can we do to help them recharge and get moving again? It's kind of like going on a long trip periodically. I don't know about you. Maybe it's just me. But periodically I have to get out and just kind of walk around because my butt goes to sleep driving for too long. And clients may get to that point where they're just road weary and they need to stop and regroup and then start again. You know, they can get their energy back. This approach is a paradigm shift from pointing out the problems to eliminate. We're helping them instead of saying you don't want to be depressed. We're saying you want to be happy. How can I help you be happy? We're helping them identify where they want to go instead of what they want to get rid of. We're not developing treatment goals for clients or directing them in the goal setting process per se. We're saying what do you think would help? Now you may need to start with some psychoeducation. Like if you're working with a client with addiction, help them understand what addiction is the post-acute withdrawal process, things that they may be going through, help them identify what's helped them stay clean in the past, you know, stuff that they need to know and then say, okay, what is it that you need to do right now to stay clean and sober for the next 24 hours or the next 48 hours? Let's not look six months. Let's say, what do you need to do to stay clean right now? And as they start doing that more and more, they're going to start building on it and going, I know what to do next. The other thing that this approach focuses on is having clients define their own goals. A lot of clients are not, when we're talking about addiction, are not really 100% okay with saying, I am never going to drink again or I'm never going to use drugs again. You know, it's been such a big part of their life for so long, they don't know if they can do it. They don't know if they want to do it. So what we look at instead of focusing on complete abstinence is what does the client see as a reasonable goal? You know, they may be polysubstance abusers and maybe they're willing to give up the cocaine but not the alcohol. Okay, you know, let's work on that first and then we can start looking at other things instead of saying, no, the only way I'm going to treat you is if you give up all mood altering substances. You know, clients may feel a huge apprehension about that. A number of techniques help in strength finding, including first learning about the clients from their own words rather than from case histories or primarily negative intake or assessment forms. What's the problem? What kinds of problems have you had as a result of your addiction? As all talking about the problem, they're here because of the problem. I want to know what the solution is and believe it or not, somewhere deep down inside, clients really already have an idea about what the solution is. We just need them to feel confident enough to put it out there and say, this is what I want. Many times clients are so afraid of failing, they don't want to put that out there. They're afraid if they put it out there, people are going to laugh at them and go, there's no way you can do that. I want them to put it out there. I want to say what is it that you hope you can do? Where are we going? Encourage people to tell their own stories and talk about their experiences in their own words. You'll listen for the positives, you'll listen for their strengths and their resilience and all those different things. Listen for evidence of their values if they talk a lot about being a loyal friend or being a good employee or whatever it is. We want to listen to that and make a mental note of it. Evidence of their skills, what do they do? Because we can build on whether it's employment or interpersonal or coping or whatever it is. Their inner strengths, their cultural strengths, and family and community resources that they already have. If they talk about calling their sister when they get upset or maybe they just call their sister every week to talk to her or something, okay, great. So we know that CIS is probably a decent resource for this person to use and that's just one of those things we're going to put there. And I encourage them to think of it as a toolbox. And y'all know I have a weird fascination with index cards but it helps me keep things in order because you can sort through them and do a lot of things with index cards where if you make lists, not so easy. So I'll have clients as they identify strengths, write them on an index card and put them in a box. Now we can make a box out of one of those old pencil boxes we used to use in elementary school. You can make that when you're in art therapy. And this is their tools box. So they have a variety of resources that they can choose from. Some of my clients have gone to extended lengths and they've gotten the things you hang on a door to put your shoes in because they have like 18 different pockets. And each pocket they've labeled with a different type of strength like friends and coping skills and other things. And as they come up with a strength, they put it in the appropriate pocket. So then they have that visual representation of all the strengths that they have available to them. Listen for evidence of people's values. Okay, we did that one. Watch people's behaviors for signs of strength. So if they start talking about getting frustrated but then they get this really enthusiastic attitude about I am not going to let them get me down. All right, they are determined. So that's what I'm going to look at. I'm going to look for evidence of them sitting up straighter and indicating more of a dominant posture. Point out strengths and resources when you see them. Now, obviously you don't want to do it constantly through every single session because people be like, all right, you're enough of the cheerleading squad. I like to do it at the end when I'm kind of summarizing what we talked about in today's session, what strengths I saw and ask them if they feel like those strengths are actually there. I missed something. But it summarizes, it punctuates the end of the session with strengths and helps them become more aware. Ask clients about times and situations in which they've been at their best or things have been going well and help them identify strengths through those experiences. When you were at your best, what were you doing? What was different? Did you have friends you were relying on regularly? What was going on? We can also help them balance out their negative statements with questions designed to probe for strengths and resources. So negative statements that I'm stupid or there's no way I can achieve this. We can probe and say, in the past, when you've set goals that you've been concerned about not being able to achieve, tell me about one of those that you actually were able to follow through with. When we're talking about recovery, if they say, I'm a chronic relapser or there's no way I can stay clean and sober, I don't know why I'm even trying this, have you ever stayed clean and sober before for a day? Okay, you did it for a day. That's awesome. Let's build on that. Because a lot of times when people relapse, whether it's for mood or addictive disorders, it's because we missed something. The behavior, the addictive behavior, was more rewarding than staying clean. So we need to look at it and figure out why was that more rewarding at that point in time? Why did you make that choice? And then figure out how to make it so it's not so rewarding anymore. We want to reframe negative statements about themselves where reframing is appropriate. For example, I'm a chronic relapser. Okay, a person has gotten sober and relapsed multiple times, but they're determined. They have gotten sober several times, and they're back and willing to do it again. So I see three strengths in that statement. Help people learn to think and speak in terms of challenges and counterproductive choices rather than problems and negative character traits. Stupid, lazy, ineffective, whatever. What are your challenges in achieving this? You're not stupid. Maybe you don't have the knowledge you need in order to effectively deal with something. Okay, that's a challenge. So how do we deal with that? How do we get you the knowledge you need? Teach people the use of clinical tools that will take inventory of their strengths and resources. There's a lot of them. You can obviously make your own, but you can also go online and look for strengths inventory. You can go to the U.S. Department of Labor and look for the interest inventory. It used to be called the CGOE. I don't remember what it's called anymore. But it's a tool that we use in vocational rehab to help people identify what's called transferable skills. And we start with things like what were you good at? Topics were you good at in school? If you were good at biology, okay. Let's work with that. What were your interests? What are your hobbies? All those things can transfer. I have a friend of mine right now who is a firefighter and is getting ready to retire. He loves to dive. Well, that's a hobby of his, but it may end up becoming his third career, firefighting is his second. That's a strength he has. He enjoys it. He's good at it. And it also can help him make money in the future. And we want to help them remember that no one can empower another human being, but we can help them learn to empower themselves. We can, you know, give them, point them in the right direction. But empowerment means looking and going, yes, I can. So they have to believe that they can do it. Recognize and remember that clients are the experts in their own lives. I don't know what's worked for them or what hasn't in the past. So I need them to educate me. We want to seek to understand what they're saying rather than correct it. I hear what they're saying. And instead of saying, you know, there is no way you can find recovery if you're still doing X, Y and Z. What I may hear them saying instead, and instead of correcting them, saying what I hear you saying is the first step you want to take is to try to give up using cocaine. And then you'll consider other changes after that or you might consider other changes after that. So paraphrasing, but hearing what they're saying instead of saying you're wrong. Because as soon as we start correcting them and saying you're wrong, then we're setting goals for them, not letting them set their own goals. Work to understand what clients and families really want when they're trying to recover from substance abuse. What is it that they're hoping to have? What is their hoping is going to come out on the other end? Too often I have somebody come to treatment and they're hoping that if they get clean and sober, their marriage will be better. Okay, well, they're hoping their marriage is going to be better. And clean and sober is just kind of a step along the way that's a means to an end. So if they go through treatment and they get out of treatment and their marriage hasn't improved, then that's a huge relapse trigger. So we need to encourage them to really understand from the beginning what they want and how each choice they make is getting them closer to what they want and make sure they're setting appropriate goals. Help people see the full range of choices available to them. You know, there's a lot of different options if you're going to work on improving your marriage, for example, maybe the substance abuse needs to be addressed, but what other options and resources are available? What other choices are available out there to you? There's marriage counseling. There's counseling maybe through a spiritual organization. There's a lot of different options, not just residential. Teach people skills they can use in their own empowerment and use language, imagery, and metaphors that the individual client will find personally relevant. So I'm a country girl. A lot of times the references I make have to do with farming, cooking, those sorts of things. But if I'm working with an adult male from a metropolitan area, that might fall on deaf ears. So you want to try to use metaphors and imagery that works for the client. You know, I've tried to learn some football metaphors. I've tried to learn some mechanical metaphors. That way I can connect a little bit better with different people. Stay calm and consistent in setting limits and responding to any challenges of those limits. I'm willing to do this much for you. And I can do this much for you. I can't fix it for you. So we need to be willing to set these limits and go, this is what I can do. And, you know, this is where you have to pick up. Respect boundaries that promote people's psychological safety and trust in the therapeutic relationship. Yeah. See resistance is a sign that we, the provider, may be pushing too hard or in the wrong direction. If the clients start going, no. That means whatever you're suggesting is not as rewarding as the alternative. It's not getting the job done. So if we look at it like that, instead of them trying to be disrespectful or resistant or whatever you want to call it, it's a paradigm shift. And we can say, all right, why are they, why is this not rewarding? Why are they choosing to not do that? And we can say the same thing to ourselves. I mean, think about when you go on a diet and, you know, you have a bad day and you end up eating more than you should or going off your diet, whatever you want to say, you know, were you being resistant or were we pushing too, was I pushing too hard? Maybe I was, you know, reducing my calories too drastically or in the wrong direction. You know, maybe I need to exercise a little bit more or something. So we want to look at resistance as a learning opportunity. It's a chance to figure out why this particular course isn't rewarding. We need to seek and honor people's feedback about the relationship and our just, our words and our actions to improve the relationship. Regularly check in with your client. Now, some clients will take offense and, you know, I try not to go, well, how do you think I'm doing? Because that doesn't go over well with clients. What I want to elicit from them is how is this, how are you progressing? How do you feel that this relationship is working? Do you feel that we're making progress? And that's usually the phrase I use is, do you feel that we're making progress or what do you think we need to do in order to help you move closer to your goals in a better fashion or, or whatever. I use the word we a lot and I focus on the goals and helping them achieve their goals. You know, are we doing what we need to do or is there something else that might work better for you? Constantly check in and ask them. Community-based services, clients, lives, jobs, schools, family support systems, recovery groups and the businesses that they use are centered in the community. They are with us one hour a week or maybe three, you know, depending on your treatment center. But the rest of the time, they are out there. So we need to figure out what's out there that they can draw on. So the other, you know, 23 hours of the day plus, they have resources and they're not just flapping in the breeze. The true test of services takes place in the community where a host of triggers and stress factors awake. So what we do in that one hour in session, helping them reach out to resources helping them know where they can get help, providing education and helping them, you know, build their strengths in session, that one hour a week is really tested the other six and hours and however many days, 23, 24th of a day, where they're experiencing life on life's terms. You know, if they are talking about things and really saying all the right things in session, well, that's great, but session is safe. If they're in IOP, you know, that's nine to 20 hours a week, well, that's a safe place. What about the weekends? What about the times when they're not in with you? How are they doing? Families, communities and cultures are home to many strengths and resources, but many people need help identifying them because they're not aware of them. They may also be too foggy from the addictive process to recognize resources or separate them from the dangers that exist there. So what does that mean? Being foggy from the addictive process, if you've worked with anybody in early recovery, you know, their brain is rebalancing all the neurotransmitters. They're low on dopamine, motivation levels probably low. A lot of times mood is low. Sometimes anxiety is high, which makes it hard to concentrate. They're in a mini crisis state right now. So it's hard to really look around and go, okay, I know where to find all these resources. So we may need to help them recognize the types of resources that could be beneficial and figure out how to reach out to them. Now some of the resources, there may be dangers that exist there. For example, going to the health department for some clients is a huge trigger. It's a resource. It can help them stay healthy, but that also may be where people that they knew in their addiction are also going. So they may be running into their dealers and their old using buddies. So there are some dangers that exist there. So how can they still get the medical care they need without running into people that they know that may trigger them? They also may be so used to hearing negative things said about their families, communities, and cultures that they assume resources don't exist. How many times have you in your community and it varies between communities? Have you gone? You know, there is just nothing for people here. I mean, we just don't have any resources. I came from a place where we had resources coming out of our nose. I mean, we just had so many resources. It was an amazing community. And now I'm in a more rural community in a whole different state. And there are a lot fewer resources here. And I'm just sometimes I feel like I'm at my wit's end and I've had to go out and really try to figure out where I can find various resources and help the community build on what they've already got. Connection with community-based services helps clients build networks of resources they can call on as they face the challenges of recovery. As they get through recovery, if they realize that, you know what, I need help getting my medication or for whatever activity they need help with, they know what's out there. You know, they're not sitting there going, oh, golly, I need help with this. They know. Or they know where to look. And again, I always tell them the first place to start is United Way information and referral. Because if they don't know, they probably know someone who does know and can refer the person along. Through community-based services, clients begin to see themselves as stronger and more resourceful as they recognize the strengths and resources in their family, their community, and the cultures with which they identify. So application. I told you we were going to spend some time here. Five general guidelines for finding strengths. Look everywhere, under every nook and cranny, under every rock. No strength is too small. So if it only worked for an hour, well, that's still an hour that the person was not harming themselves in some way. No strength is too big. Well, that goes without saying. Look in the past. You know, what have you done in the past that in similar situations that helped you deal with this? Or in the past when things were going well, what was different? So that helps you identify things in the past. The present, you know, same questions. When you're having a good day, what's different? And when you've experienced cravings or depression, what have you done to help yourself deal with it, you know, today? So we're looking like right here, right now. The past can go way back. And the future, yeah, we can look there. We can say, how do you envision yourself dealing with this in the future? How do you hope to be able to deal with it? What strengths do you hope to be able to call on? Because that gives you an idea about where a person thinks they might be able to develop strengths. And look under flaws to find more strengths. I gave the example at the beginning of class. A lot of clients that I've worked with in early recovery have to change people's places and things. Because the people they've been hanging out with are still using. And it's not, they're not safe to be around one another. Right now, at least. Okay. So that's a flaw. That's potentially a relapse trigger. But there's a strength underneath. The person has been able to make friends. So they can make new friends. What, how did you form friendships with them? And how can you form new friendships with those same skills? And encourage them to, instead of looking at something as a waste or a flaw, what strength can you find in it? How did it help you survive? How was it a creative method of survival until now? So we're going to go through the nine life domains. While I'm talking, think about why this is important to recovery. What triggers might lurk here? What relapse warning signs could be found here? And what flaws might we be able to kind of dust off to find a strength? So life skills are concrete everyday survival skills and strengths that keep people's lives in order. Household skills such as cleaning, organizing, planning, managing, cooking, all those things are basic life skills. And some people don't have them. So they may not be able to budget very well, which means they may run out of money to buy their medication or to get healthy food. So those are relapse triggers that we need to look at. Interaction with the community. Do they read the news? Do they know how to use a computer? Do they stay kind of aware of what's going on? Well, that can be a good thing. It can also be a trigger for some people. Reading the news can trigger trauma memories, anger, anxiety. But if they're doing it, it shows that they want to take part. If they're doing it, it shows that they're active participants in their community. So we may need to look at how can they channel that energy instead of getting upset over something to empowerment, instead of feeling victimized, feel empowered to make a change. And transportation is another life skill. They need to be able to get from point A to point B whenever they need to. So do they know how to use public transportation? Do they know how to drive? Okay, they can drive. Can they find places? I can't find my way out of a paper bag. I'm the first person to say that and I own it. You know, I just, I know. I was thankful once GPS became a thing. And once Google Maps became a thing, it was wonderful. I can go anywhere now. But those are all things to be aware of. If somebody has a difficult time getting to their doctor's appointments, getting to their recovery meetings, getting to work, then those could all be relapsed triggers. If people start spending uncontrollably, they let their house kind of go into disarray. They quit managing their finances and taking care of things. They withdraw from the community. They're not really involved. They don't even know what's going on. They just kind of stay at home with the blinds drawn. And they're not getting out and getting to their appointments or making the arrangements they need to in order to get to their meetings and things. Those can all be relapsed warning signs saying, all those things a person needs to do to be, to work towards a rich and meaningful life, they're not doing right now. Why is that? That tells me that there's something's going on that is keeping them from having the energy, desire, ability to do this. So we want to look at that. Now, as far as flaws go, we can look at some things. I mean, I've known some people who were addicted. They could do this amazing juggling act with money. They could rob Peter to pay Paul so they could get their drugs. And then they were just constantly doing this shell game with money in order to make sure they always had enough money for their drugs. Well, they can do the same shell game to make sure they always have enough money to have a roof over their head and food and those sorts of things. When they were in their addiction, they planned out a lot of times how they would get their stuff, when they would use or what they would use, etc. Well, so they've got good planning skills. Now they need to use their planning skills for something different. So help them focus on some of that. Managing money, checking savings, using cash and money orders, re-establishing credit, paying bills, budgeting, setting priorities, and setting and working towards financial goals are all part of managing money. Especially in addiction, clients in early recovery, money can be a huge trigger, a huge, huge trigger. So there are things that they can do with their banks in order to make sure that they can't draw out large sums of money at once, encourage them to not have credit cards available to them, no, you can't buy crack cocaine with credit cards, but you can buy stuff with credit cards, hawk it and use that money to buy crack cocaine. So, you know, it's important that they understand that they don't want to have easy access to their checking account or a credit card, especially in early recovery. Help them learn how to use cash or money orders because some people don't register and they start running up debt on credit card and don't even think about it. It's like non-money, but if they have to pay with cash, they're much more cognizant of how much money they have and how much money they have left. Re-establishing credit is important for helping them move towards a rich and meaningful life. You know, you don't have to have an 800 credit score to do most things in life, but a lot of our clients, their credit is really bad. And if they want to buy a car, for example, to help them get to work, they're going to need to have decent enough credit. Otherwise, their car payments are going to be way, way higher. So, we want to help them figure out how to do that. Obviously, we're not experts on that, but we can refer them to financial consulting firms and places that can help them get back on their feet. Same thing with setting spending priorities, helping people decide. I had one client who used to get her state money at the beginning of the month, and I remember one day she was just so excited because she got her check and she was going to have surf and turf that night. And I was like, well, have you bought your medicine yet? No. Okay. Is that going to allow you to have enough money to feed yourself and your family for the rest of the week? I don't know. I'll worry about that when I get there. I'm having a surf and turf tonight. Okay. So, spending priorities was something that was a weakness of hers that she needed to end up looking at in order to make ends meet. And we want to encourage clients to have a consistent legal income. This is more true in addictions where people may engage in less than legal behaviors, working under the table, yada, yada, in order to get the money that they need. Leisure, excess stress can activate symptoms of post-acute withdrawal syndrome, including confusion, memory loss, mood swings, difficulty understanding feelings, and insomnia. When that HPA axis is activated, your stress response system, you know, you're in that crisis state and maybe a mini-crisis state, but you're on high alert, so you're not going to think as well. It can trigger a mood disorder. If you're already tired and exhausted and you start feeling stressed out, you may start feeling hopeless and helpless on top of it. It can trigger cravings and urges to drink or use. A lot of people use in response to stress, whether it's a behavioral addiction like pornography, internet gambling, eating whatever it is, or it's a chemical addiction. A lot of times it can be used in part as a response to stressors. And excess stress can plain and simple serve as a justification for returning to alcohol and or other drug use. The attitude is, well, if you were going through this, you'd drink too, wouldn't you? So we want to make sure that people are able to manage their stress, which means having some rest and recreation activities. Leisure helps people resolve the tension between what they need for leisure and the fear of leisure time. We say in early recovery that downtime is dangerous time, because when people don't have something to do, then they can start thinking and romanticizing the past and go, oh, I would really like to. That's not safe. Now, not everybody's going to want to stay scheduled from sun up to sun down every day. I know I don't. I need my downtime, but I need to make sure that I don't get bored. So making sure that people don't fear leisure time, that they feel they can handle it, they feel they can sit down and they can watch a football game without having to have a beer, that they can go to the beach without having to have a drink. It's a gradual process, but as they begin to recognize that it's fun, it's relaxing, and they can do it without their addiction, it becomes more enjoyable. A lot of our clients also have forgotten what they enjoy. You ask them, what do you do in your leisure time? And they're like, oh, use, it's about it. So we want to help them rediscover what it is that you like to do, and they may have been using for so long that they just don't know. Okay, so let's start experimenting. When I was in the residential program, we would have clients go out and they would play volleyball each day. We had a cornhole. We had all kinds of different things out in the recreation area that they could experience, and they learned how to laugh and be silly and just enjoy life sober. But it was a paradigm shift for them. It was a huge new thing, and it was really cool to watch people start to come out of their shell. Encourage clients to look at their talents and skills. Are they artistic, athletic, imaginative, creative? What is it they want to do? Heck, turn them loose on Pinterest for a little while and see what they can find that's in their ballpark. The cooperation skills they learn in group or team activities and the self-esteem they gain from identification with the group or the team can also benefit them in their recovery process. So leisure activities, which is why recreational therapy is a thing, it's a whole profession, because it's important to help people learn and it kind of gamifies a lot of social skills. The initiative and dedication developed by starting and completing projects also can become a strength. If they set a goal, they're going to... A couple of years ago, I crocheted a blanket for my best friend, and it was this patchwork blanket, and each night I would do one patch, and it took about three months in order to get all the patches done, and then I put it together, and I was very proud of myself at the end that I'd actually completed the whole quilt. I was like, I did that. So there's a certain amount of self-pride and self-efficacy that comes once they initiate and work all the way through a goal. It doesn't have to be recovery. It can be any goal, but as they start succeeding at goals, then they're going to start developing the belief that they can succeed at their recovery goals. If they're doing any physical activities for leisure, that will help with strengths, like physical strength. It can also help increase endorphins, increase serotonin, increase mood, and reduce pain. So there are a lot of benefits to leisure activities that actually make people move. There's physical and emotional resilience that can come from having enough rest. Not every leisure activity has to be volleyball. You can do things like crocheting or yoga, or even just stretching, and that can help people relax and recharge. And there's spiritual and emotional healing that can come from spending time in quiet reflection with nature and with people that the person has a sense of spiritual or emotional connection with. So there's a lot of different aspects, depending on the leisure activity, that can help a person in their recovery, and it can also help a person prevent relapse. Relationships are among the areas of life in which addiction does the most damage. Relationships with providers, recovery group members, members of faith communities can be a paramount importance in the recovery process. We want to make sure that people have resources they can call on 24-7-365. Somebody that's going to reach out and go, I got you. There are a couple of groups on Facebook that actually are very supportive and very awesome for people in recovery. Now I know there's like hundreds of recovery groups in Facebook. It's important to find the ones that are really helpful for people. So you may want to go and preview them before you refer somebody. And there's also in the rooms, I think it's .com, in the rooms .com, where people can reach out to other people who are in recovery. Relationships help clients develop interpersonal effectiveness. They develop their communication and listening skills. They learned how to develop trust with their selves as well as with others. A lot of our clients have made decisions before that have not been in their best interest or they've made poor decisions. So they could start questioning themselves. They start failing to trust themselves. So we need to help them learn that you know what, you can trust yourself. The first thing you need to do is look at head, heart, and gut honesty. You know, if your head says the logical thing to do, your heart says it would make you feel good and your gut's not going, oh, that's a bad idea, then it's probably good. And in the past, when you made unhelpful decisions, one of those was probably like screaming at you and you ignored it. So we want to look at poor decisions they made in the past and go, you know, was there any indication at that time that it might be a bad decision? So we want to learn, help them learn how to trust themselves and not talk themselves into or out of something. They develop respect for themselves and other people. They learn how to cooperate and be flexible because we don't always get our own way. No matter how much we want to, we don't. It helps them develop conflict resolution skills which can improve relationships as well as reduce their stress. So when they don't get their own way, they don't feel angry and hostile about it. It's an effective, amenable conflict resolution. It helps them develop interdependence and boundary setting and skills for handling difficult people. So if clients don't have these, we want to help them develop them. If they do have these, these are all strengths that they can work with. I mean, I've worked with some clients in early recovery who are super cooperative, some who have great conflict resolution skills, others who are excellent communicators. You know, especially the salesmen that I've worked with have always been really good at listening and hearing and in some cases manipulating. And one of the things I try to use, and that's another one of those flaws type things, a lot of the sales people I work with, they can convince you that they don't have a problem. And it's up to them to start using that power of persuasion to help them move along in their recovery instead of using it to hide their addiction. Relationships with friends, family relationships, and involvement in community groups can all provide that social support that people need. They need to have somebody they can call on. Recovery or support oriented relationships are very helpful. It can be a depression support group, a grief support group. It doesn't have to necessarily just be an addiction support group. I saw a article today about how AA is quote, this is the title, not my opinion, but the title of the article was that AA was struggling to be to remain relevant as people move towards secular support groups. It doesn't matter what the support group is. There are, they're smart recovery, they're celebrate recovery, there are 12 step programs, but encouraging people to reach out to other people who understand. Involvement in faith communities is a great way to get out there and get social support. It doesn't have to be just for recovery. Somebody they can hang out with and have a good afternoon. Caregiving skills such as parenting and nurturing can be really important because a lot of our clients didn't have great parents growing up, not that the parents tried to be bad. The parents just didn't have the skills to be effective. So we want to help clients identify how they can sort of reparent and nurture themselves and how they can nurture others in their life, in their relationships. Ask them, when is it easiest for you to be caring with others and with yourself? When is it hardest for you to be caring? I know when I'm sick and I'm tired, that's when I'm not the most caring. I'm like, yeah, no, that can wait. So I know when there are times when it's easier for me to be caring and giving and kind of all up in everybody's business. And other times when I have to think to myself, I got to do this. Ask them what makes it hard for them to be caring at those times. So for example, for me, when I'm tired, in the evening is one of those times when it's really hard for me to want to reach out and be caring. I get up at four in the morning. By eight o'clock, I'm done. So my son came down the other night at 8.30 and was telling me something was wrong with his cockatiel, not bad wrong. She, well, whatever. And I thought to myself, first thought was, this can wait till tomorrow. I don't feel like getting back up to deal with it. Then the second thought was, no, I need to get up and deal with this because I'll be devastated if anything goes wrong. So I got up and I cleaned the bird up and everything was fine. But it's, those types of things, it's important for people to be aware of when they can be caring and what makes it harder. That way, you know, when it's, they're having those times when it's harder to be caring, they can really check in with themselves and go, all right, this is not my ideal, but do I need to get up and do it anyway? Living arrangements, living in a place where children can live with them and it doesn't matter if it's a woman or a man. This can be a strength because people generally want to be with their offspring. Living in a place with physical and emotional safety obviously reduces stress, which reduces relapse triggers and is better for children and everything else. Having them make a house, a home, maybe people can't get into their own residence right away. They're staying in a shelter, but they have this one area, even in residential. We encouraged clients to make the area around their bunk as personal as possible. So it felt homey and it's not really easy to do with eight women in a room, but when you get into, even in domestic violence shelters and other places, making it as personal as possible so you feel comfortable and can relax. And that's a strength, if somebody can do that. I have difficulty. I'm not a good decorator. I mean, I walk in, I'm like, okay, fine, this is cool. And I can plop down. It takes me a long time to think, oh, I should probably put pictures on the walls. That's just not who I am. My daughter on the other hand is an interior decorator. Independence, you know, if somebody's living by themselves, they're independent. That is a strength that they can build on. They don't need other people. And housing assistance and resources, you know, this can be a strength if they're able to tap in to section eight housing or whatever to help them get a roof over their head where they can have physical safety and have their kids with them. So an example that I can give you, a client who's feeling that she's failed because she's staying in a recovery home might realize that she's physically safe there, that people there support her recovery and she's working towards plans for independent living in the future. So she hasn't failed. She just hasn't achieved her ultimate goal yet. She's in a great place that is supporting her ultimate goals. Occupationally, we want to help clients evaluate their job seeking skills, their work experience, work related training and transferable skills. Like I said, it doesn't have to be going from one to another. Like, you know, I'm a counselor. Okay, I'm a counselor. What can I do with that? You know, what skills do I have that can transfer? Or I'm a teacher or I'm a line cook or whatever it is, helping people figure out what skills they have, whether they learned it on the job or through a hobby or in school that can transfer and help them towards their recovery and achieving what they see as a rich and meaningful life. General employment skills, if they know how important it is to show up on time and dress appropriately and yada, yada, yada, that'll go a long way. Collaborative skills, work ethic, those kind of go hand in hand, being willing to play nice in the sandbox, as my old boss used to say, and know that you need to be there. You can't just call out whenever you feel like it. You need to think about it. By the same token, if you're like, snotting everywhere, you may not want to go in and get everybody else sick, but that's just a personal preference. But clients, we can look in these areas for helping them identify occupational strengths and having an occupation, having a job that puts food on the table and keeps a roof over the head and helps them be independent is a strength. The trigger here potentially, well, two triggers potentially, a stressful work environment. We need to help people figure out how to handle a job on the days that it's not going so good or a job that they don't really like, but they need to take in order to reestablish their work history and money. Payday can be a huge trigger. Direct deposit is one of those ways to handle it, but encourage them to talk with the financial advisor or their bank about ways to minimize their ability to withdraw their whole paycheck and which can be a huge trigger. And education, what training do they have? And it doesn't have to be formal school training. My husband's uncle, I think, used to be a plumber. And he doesn't do anything involved with plumbing now for a job, but whenever anything breaks around the house plumbing related, he can fix it. It's awesome. He has that education. He has that skill. Could he go back to school and become a plumber if he wanted to? Yeah, probably so, because that's a skill that he can build off of, but encourage in clients to think broader than just formal education. Women who have raised children and they've been mothers for the past 20 years, they have a whole bunch of skills that people may not recognize right away, but they have huge organizational skills, budgeting skills, the ability to work with small children, start looking through what did you learn and what types of jobs are similar to what you did taking care of your children as they were growing up. Look at types of intelligence. We're not all book smart. My husband likes to say for every year that I stayed in college, I lost a year of common sense and I don't think he's too far off, but we all have different types of intelligence. One of our neighbors from in Florida had wonderful language intelligence. I mean, she was fluent in English. She was a great writer, but she could pick up any language she tried to in like three months or less. I watched her. I watched her pick up three different languages before she was even out of high school. Logical and common sense. Some people have a ton of this and it's great because you need these kind of people on your team when you're doing any kind of project. Mathematical intelligence, spatial intelligence. My daughter has great spatial awareness and like I said, she does a lot of interior design and she's excellent at it. Not me. I look at it and I can't figure out if a sofa would fit in a room or not because it just all looks big to me. Musical intelligence, emotional intelligence, physical intelligence such as physical grace or the ability to touch and feel and notice different things. Interpersonal intelligence and wisdom. So you can define each of these for clients and talk about the different types of skills or things that might fall under each category and whether they have them. An assessment of strengths and skills and a variety of types of intelligence is important because society and the media tend to define smart or intelligent in terms of book learning, memory, academic achievement, job title or income. There are a lot of smart people who don't necessarily make six, seven figure salaries but they're really smart. Many intelligent people have been called stupid, slow or below average because they don't have stereotypical intelligence. So we want to make sure that we don't pigeonhole people. Many people who've made counterproductive choices in their lives tend to blame those decisions on a lack of intelligence, ignoring all the social and emotional forces that helped shape their decisions. So I reject the notion that people are stupid. You know, I look for how are they smart? They may be differently smart but how are they smart? And then when we look at counterproductive choices, I want to say, okay, what else went into it? Besides, you know, maybe you're not having all the knowledge that you needed in that area. What else contributed to you making that decision? Health. Many people have been conditioned to think of their own health as less important than that of others where we tend to caretake. So it's important that people take care of their own health and pay attention to their basic habits. Hopefully some of these are already good in your clients but, you know, look for strengths. Sleep habits, nutritional habits, exercise, stress management and relaxation. In a recovery lifestyle, we want people to have all five of these things. What do they already do now? What are they willing to start working on? Medically, have clients get regular checkups and take prescribed medications as prescribed and follow any other health measures necessary for any other existing conditions, including physical conditions such as HIV, diabetes, cancer, high blood pressure, high cholesterol. If they need to be taking certain medications to be healthy, you know, it's going to help them in their emotional health recovery and their addiction recovery if their body is healthy because their body can then manage the hormones and the neurotransmitters that are required for emotional management. Internal resources. They're hopes and dreams. What are they? What are their passions? What are their goal-setting skills? And hopes and dreams and passions are things that are fun to have people write on a little piece of paper and then put in a hat. And then you draw from the hat and you read off a hope or a dream or a passion and people try to guess whose hope or dream that was. So that can be a fun sharing ice-breaking activity. Goal-setting skills. Decision-making. Compassion. Confidence. Sense of humor. Responsibility. Reliability. Courage. Honesty. Humility. Faith. Willingness. Generosity. Any of these are internal resources that can help people deal with life on life's terms and work towards a rich and meaningful life despite any challenges that come their way. And you can have clients make a list of what characteristics does a person need to have not skills but characteristics does a person need to have that helps them be successful. And you can put it up on the whiteboard and you can talk about each one of them and then talk about how to develop them if they don't already have them. A strengths-based approach looks at and appreciates even small successes in all areas of life including recovery. So we're not just looking at what have you done to not relax. We're looking at what are you doing occupationally? What are you doing in your hobbies? Why is that important? Because life's recovery is a lifestyle. For somebody to be solidly in recovery they have to be healthy. They have to be happy. They have to have emotional support. They have to have independence and a roof over their head. They have to have Maslow's hierarchy kind of taken care of at least those lower levels. So it's important that we look at successes in each area of life because when people have successes that means they've set a goal and they've achieved it and likely they've overcome challenges. So we can learn from those. You know, what have you done in you know some people have this just rocking work life. They are CEOs whatever. Their home life is a disaster. So you want to look and go okay you can manage this Fortune 500 company and manage a team of 80 executives with no problem. But you're having difficulty communicating with your wife. Let's talk about what the difference is here. Let's talk about this strength and how can you use the strengths that you use at work to deal with a bunch of very different people in order to more effectively function at home. So we want to look at strengths in all areas of life and apply them to recovery and problem solving for the problems that they identify. Show appreciation for partial change. They may not completely change their behavior but if they're taking steps if they're trying if they're getting a little bit better that's awesome. Provide stage appropriate interventions to help people move to the next stage at their own pace. And this really refers to Prochaska and Declamentes stages of readiness for change pre-contemplation contemplation preparation action and maintenance. So people who are not in the action phase are not ready to start doing anything. People who are in the preparation phase are making a list of their strengths and resources and thinking about how they're going to make the change. And if you go to SAMHSA's website and look up tip 35 TIP 35 motivational interviewing you can learn about appropriate interventions for each stage of change. Through experiments with cutting down or controlling use people discover the limits of their ability to use addictive substances in a controlled way. So if they think they can control drink okay I'm not going to correct them and tell them they can't because they're not going to know until they try and it's going to keep haunting them sometimes. So if they're determined to do it well all right they're going to experiment let's take the information they glean from that and try to put it together to figure out can you control drink. Any drug including alcohol that's avoided even for a day means at least a small reduction in damage. So even if the person stayed clean for a day or a week and then relaxed well you know what you stayed clean for a day or a week that was you know a step in the right direction. What helped you stay clean during that period and how can we build on that so you can stay clean longer and what was it that changed or what happened that led to the relapse. People need to have an awareness of the effects of addictions on themselves their family their community a willingness to accept personal responsibility all of these are recovery strengths a belief that they can and do deserve to recover engagement in recovery support activities that's pretty broadly defined it doesn't have to be 12 step meetings active participation in treatment activities depending on the intensity of their addiction development of supportive recovery relationships and progress in recovery all of these are strengths and remind them that progress is not going to be linear there they may go two steps forward one step back and then a step to the side and then back in again you know it may look more like the time warp than running a marathon but they're going to get there so general strengths eliciting questions ask clients what do you think is your greatest strength what do you like most about yourself what do other people like most about you what do you what do other people find most exciting about you what values are most important to you you know you can see the rest of these questions here one thing you can do is get a big old beach ball and use permanent marker and write each one of these questions on the beach ball and then you toss it around the room and when somebody catches the beach ball they look at it and whatever question they see is the question they've got to answer so it makes it a little fun you can also do it with jenga blocks and write these write everything on the different jenga blocks and as somebody pulls out a block or adds a block depending on whether you're building up or tearing down whatever question is on that block they have to answer general strength questions also can include what is it that you want out of life right now what do you need to achieve what you want what are your hopes and dreams how do you think you need to get these things you know what do you think the process is what are some possible ways you'd like to see this situation turn out and the miracle question if you woke up tomorrow and you didn't have this addiction problem or whatever how would it look and feel so a strength-based approach helps people build on what's working for them what's worked in the past or what they think might work in the future it emphasizes client choice and self-direction in goal setting to increase empowerment investment and self-efficacy if you haven't already signed up please remember that addiction and mental health counseling and social work continuing education credits are accepted are available for this presentation and are accepted in most U.S. states Canadian provinces Great Britain Australia and South Africa go to allceus.com slash counselor toolbox and click on the link counselor toolbox CEU spreadsheet to easily locate the course based on this presentation Alrighty as promised are there any questions we went through a lot of stuff but from a strength based perspective I think we covered a lot of ground today and when I was going through and making this presentation it gave me a lot of food for thought for different ways to approach clients in answer to a question about experience working with recovery support specialists I've worked with recovery support specialists and peer recovery support specialists peer means they have to have experience in recovery other recovery support specialists not so much it's great you know some of the most effective clinicians that I've worked with and some of the best teachers that I ever had were in recovery and didn't have a formal counseling degree so you know I really shy away from putting too much emphasis on letters after your name and I and I want to hear what the person has to say so yeah I really think recovery support specialists are awesome for contributing information especially peers peers can say you know I've been there I've done that as long as they're able to separate the I've been there I've done that and not force people to try to walk in their footsteps and go you have to do it this way that doesn't work for everybody well if there are no other questions I appreciate you bearing with me and I will see you next Tuesday we're going to be talking about social justice and why helping clients understand their multiple identities is important in the recovery process