Counselling 101

REMINDER: Counseling 101 is at 1:30 on Thursday in the Barn.

New Eden Group Starting

The flyer is available here.

Contact Robin if you have questions.

Managing email

If you get a ton of email, you might find these helpful:

• Nice or short?
• 5 Sentences

Evidence-based practices and outcomes

From David Mee-Lee's latest newletter:

Recently there was a discussion on EBPs and the relative importance of the therapeutic relationship in treatment outcome. I am sharing excerpts from the posts of two people who know much more about this than me. Underlining is mine.

• "None of the approaches identified as evidence-based have been tested against and proven superior to any approach intended to help."

Listserv Posting #1
"Our group (www.talkingcure. com) treats all approaches that claim superior results the same way. Specifically, we repeat in print and on the web that there is no evidence that any approach achieves superior results to any other bona fide treatment approach-that is, a model that is intended to be therapeutic. Some readers may not know, but none of the approaches identified as evidence-based have been tested against and proven superior to any approach intended to help. None. It's staggering when you think about it, especially when you consider the massive amount of money and regulation going into the evidence-based practice movement. Of course, every model claims that fidelity to the approach is required. And, by the way, states like Oregon are in the process of establishing regulations to insure that clinicians not only say they are practicing a particular model but prove via paperwork, etc. that the particular model is being conducted according to the manual.

Admittedly, all of this would make sense if there was any evidence that the various evidence-based models contained specific ingredients that if left out would lead to poor outcomes. But the data say no. Indeed, in his massive review of the literature on the subject ("The Great Psychotherapy Debate"), Bruce Wampold states, "30 years of research has failed to provide a scintilla of evidence that any specific ingredient is necessary----" (p.204).

Instead of focusing on factors long known to affect treatment outcome-for example, the therapeutic alliance, the therapist, and the formal use of client feedback to guide service planning, delivery, and evaluation-the field continues to devote precious time and scarce resources to promulgating lists of approved treatment models-something which existing evidence shows contributes at most 1-2% to the variability in outcome. For the record, our team has never said that the therapeutic relationship is the only important variable in psychological treatments. It is, however, the most evidence-based finding in the literature, with over 1000 findings published to date. Study after study show that it contributes 4-8 times more to treatment outcome than treatment approach. As such, its absence in most professional discourse and the EBP movement is nothing short of stunning.

The standard applied to giving "evidence-based" status is the same as that used by the Food and Drug Administration (FDA) to approve new drugs; namely, to be identified as an EBP, a new treatment approach had to achieve outcomes equivalent or superior to an established treatment in two studies. Two studies. The problems associated with drawing conclusions from studies meeting this standard have been discussed in detail elsewhere and are too numerous to review here. Anyone interested, can click on the link (http://www.talkingcure.com/reference.asp? id=66) and download any of the articles we've written on the subject from our website (for starters, read Losing Faith, and then read the EBP talking points).

The APA has just officially changed the definition of EBP in response to critiques offered by our group and many others. The report, which appeared in the May- June 2006 issue of the American Psychologist, represents a major move forward and away from the overly simplistic and medicalized idea of "specific treatments for specific disorders" popular among proponents of EBP.

Instead, clinicians are encouraged to consider all the evidence in the context of client culture, preferences, and perceived benefit from services. To this, we say, "Bravo!" and "It's about time!" Indeed, for the last decade, we've been advocating that clinicians use the best evidence tempered by the preferences and response of the client. As clients and practitioners know, the real challenge in treatment is not figuring out what works for drug addicts or the borderline-diagnosed clients in general, but rather what will work for THIS person seated in this office on this day at this stage in their recovery. You know, we wrote an article about working this way called, "Making Treatment Count' which can be downloaded from the website.

Scott D. Miller, Ph.D.
Co-director, Institute for the Study of Therapeutic Change. Chicago, IL
Website: http://www.talkingcure.com.

Sticking with the winners

A Seth Godin post highlights the importance of sticking with the winners:

A study out today shows that obesity is contagious. If your best friend gets fat, your chances of gaining weight more than double.

Malcolm Gladwell fans will recall his reporting that suicide among teenagers can be contagious as well.

So is terrorism, of course. And spamming. And graffiti.

The most important thing you can do is choose who you're hanging out with....

Detox Counselor - Midnight Shift

Detox Counselor
Entry-Level
Midnight Shift
Part-Time Position, Thursday-Sunday, 12-8 a.m.

Must be compassionate, eager to learn and dependable. Basic computer skills are desired. Please fax resume to: 734.669.0728 or e-mail Brenda at: jobs@dawnfarm.org

Dawn Farm in the News - Part Deux

Jim's comments made Salon too:

The Detroit Free Press was among the few who put Lohan's rather spectacular relapse in the context of real-life recovery. For one thing, relapse is common to begin with, according to the National Institute on Drug Abuse. "It's tough enough to recover from an addiction. To have to do it in a fishbowl, it's daunting," said Jim Balmer, president of Dawn Farm, a treatment center in Ypsilanti, Mich. "Celebrity stints in rehab centers often seem to be little more than public relations stunts, more geared toward rehabbing a star's image than dealing with an addiction. That doesn't help with public understanding of addiction recovery," the Freep added. (Some people also question the effectiveness of resortlike rehab centers; L.A.'s ABC affiliate pointed out that fancy digs are usually the only way to prune away excuses and lure celebrities in. That way they can't say, "I can't go there because it's a dump," said one facility director.) The Freep also makes clear that people don't leave treatment centers "cured." Rather, that's when the process of learning to manage their problem in the real world begins.

[hat tip: Jo]

Dawn Farm in the News

From the Detroit Free Press:

Lohan relapse typical, says addiction expert

July 25, 2007

BY CECILIA OLECK

FREE PRESS STAFF WRITER

Troubled actress Lindsay Lohan's fresh-out-of-rehab relapse set tongues wagging and Internet message boards hopping Tuesday.

To many, the 21-year-old actress' arrest in Santa Monica, Calif., on suspicion of drunken driving and cocaine possession is yet another example of the shenanigans of the rich and famous. To others, it raises questions of the effectiveness of alcohol and drug treatment centers, as Lohan's recent woes come less than two weeks after the end of her second stint in a rehabilitation facility since January.

But those familiar with addiction and alcohol dependence say Lohan's troubles are similar to those of many others struggling with the diseases, including people in metro Detroit.

High-profile situations like Lohan's underscore how difficult dealing with an addiction can be, says Jim Balmer, president of Dawn Farm, a treatment center in Ypsilanti.

"It's tough enough to recover from an addiction. To have to do it in a fishbowl, it's daunting," he says.

Many of those recovering from addictions will relapse, according to the National Institute on Drug Abuse. Most effective treatment programs usually use medication or behavioral therapy, or sometimes a combination of both, to help with recovery.

"A good treatment center should shine a bright light on the dishonesty, on the incongruities," says Balmer.

Celebrity stints in rehab centers often seem to be little more than public relations stunts, more geared toward rehabbing a star's image than dealing with an addiction. That doesn't help with public understanding of addiction recovery.

People don't leave treatment centers cured of addiction or alcoholism, says Balmer, but they can learn how to deal with their disease, which is influenced by both genes and lifestyle.

"People have to learn to change the way their brain responds," says Balmer. "They learn how to cope in healthier ways."

Some will turn to exercise or endorphin-boosting spicy foods. Many immerse themselves in 12-step communities for support.

Balmer says he hopes Lohan will find hope and help.

"I think people in the recovering community by and large feel sad for her," says Balmer. "A lot of people feel like it's one of our brethren that's suffering."

Contact CECILIA OLECK at 313-223-4286 or coleck@freepress.com.

Copyright © 2007 Detroit Free Press Inc.

Cow(s)!

From Rick:

Hi everyone, just wanted to let you know that our Ushi replacement
will be arriving at the end of the week. He is a Holstein Bull (soon
to be steer)born on Friday the 20th of July and will be coming from a
local farm, he will be about 10 days old when he arrives. Yes I said
10 Days old and he will be needing to be bottle feed. A short time
after his arrival he may be joined by one or two more calves from the
same farm, also about 10 days old upon arrival here.

Also I have been in contact with the farmer that has Ushi, he tells me
Ushi is happy and heath and enjoying the company of all his new lady
Friends

Rick

Counseling 101

Our next counseling 101 will be on Thursday, August 2nd, 1:30 to 4:30 in the barn. The focus will be on clinical thinking skills and tuning into the client. Please let me know if you plan to attend. CAC credit will be available.

Photo contest

We're looking for some good photos of our sites for a couple uses. First, we're going to post virtual tours of our facilities on our website. Second, we're always looking for good photos for our website and printed materials.

The virtual tour photos might be pretty straight forward, but we'd also like some shots that are
visually interesting or communicate something unique to Dawn Farm. So play with perspective, lighting, etc. Bring your digital camera to work and have some fun.

The prize is to be determined. Pictures can be sent to me. Thanks.

Counseling 101

REMINDER -- I will be doing a series of counseling 101 workshops in the barn. The first one will be this Friday from 9am to noon. Part 2 will be on Thursday the 19th from 1pm to 4pm. The rest will be scheduled later. You do not have to commit to attending all of them.

If you would like to come on Friday and have not yet notified me, please do so. I just want to know how many copies I need.

Staff Training Schedule

Below are the dates for upcoming trainings at the Community Barn. All of you will receive an email and a hard copy of a letter with your current training status. All staff need to be up to date in all areas in that letter by September 30. Please contact me at akraemer@dawnfarm.org if you have any questions.

Wednesday, July 25: Annual Training, 5pm-9pm
Saturday, July 28 Annual Training, 10am-2pm
Wednesday, August 8 CPR /First Aid, 9am-12pm; Annual Training 12pm-4pm
Tuesday, August 14 Annual Training, 5pm-9pm
Saturday, August 18 CPR/First Aid, 10am-12pm
Thursday, August 23 Annual Training, 9am-1pm
Tuesday, September 11 CPR/First Aid, 5pm-7pm
Saturday, September 23 Annual Training, 10am-2pm

Another goodbye

Calvin Whitehead left outpatient for other pursuits on 6/28/07. Good luck Calvin!

Goodbyes

Linda Williams last day will be 7/13/07 she is moving to Arizona.

Tom Anderson's last day will be 7/29/07 he has received a scholarship to American University in D.C. and will be studying Political Science.

We'll miss both of you. Good luck and keep in touch.

International visits

Thanks to everyone who participated in last week''s Japanese visit. They had a great time and said that they learned a lot.

This week we have another international visitor - a psychologist from Kazakhstan. He speaks English and will be spending a day at each site. Please make him feel welcome. Thanks!

New residential info

We've got some updates info on residential treatment on the website here.

You'll find that we've added psych consultation fees for self/family pay clients. Click on the link for details.

You'll also find a new document explaining our approach to psychotropic meds. Please read it and encourage anyone considering residential treatment to read it.

Also, we've improved our donation page on the website. We are no longer using Paypal. Donations through the website will go directly to our merchant account via a secure connection.

Quote for the month

On surviving and thriving as an addiction counselor:

Go to Al-Anon. Or failing that, find clinicians who take care of themselves and learn from them. The greatest flaws I have seen in clinical work with addictions come not from "technical" issues but from "personal" ones. Therapists struggle with their boundaries, becoming either indulgent or authoritarian. Out of fear, they attempt to control their clients. The become hurt or angry. It's too easy to pass it off as poorly addressed countertransferance. I believe it comes down to fundamental issues of self care. To work with addicts, one must have good boundaries.

Therapists have god boundaries when they take care of themselves.

Jim Balmer, from Counselor Magazine's Addiction Professional's Reference Guide