January 2004 – Tips & Topics – january-2004

TIPS and TOPICS
Volume 1, No. 9
January 2004

In this issue
– SAVVY
– SKILLS
– SOUL
– STUMP the SHRINK
– SUCCESS STORIES
– Until next time

WELCOME!

It is already moving towards February. I know it is clichéd to say, but I can’t believe how fast the year is racing by. I hope you are as busy (in the productive sense) as I am. But I also hope you have more balance in your life than I have at present. I have already broken my New Year’s resolution for more balance. By declaring this here I am putting myself on notice to check the balance-meter more often and more effectively.

(more…)

January 2006

Volume 3, No.8
In this issue


SAVVY | SKILLS | SOUL

David Mee-Lee M.D.


 

SAVVY

Last month I attended the Second Annual Joint Commission National Conference on Behavioral Health Care: Focusing on Outcomes Research and Using Data. It got me thinking again about what is quality care that results in positive outcomes in addiction and mental health. Vijay Ganju, Ph.D., is the Director of the Center on Mental Health Quality and Accountability at the National Association of State Mental Health Program Directors Research Institute. In his keynote address he said something that caught my ear. He suggested that we must think beyond “person-centered care” to now focus more on “person-directed” care – emphasizing an even more active, stronger collaboration with clients, patients and consumers.

A second presentation by John Norcross, Ph.D., Professor of Psychology and Distinguished University Fellow at the University of Scranton, put into perspective the effective elements of a therapy relationship. He emphasized the alliance over the specific technique; goal consensus and collaboration over treatment method and model.

Tips:

  • Review the rules on patient-centered care that are considered central to improving the quality of care for mental and substance-use conditions.

In November 2005, the Institute of Medicine released a new report. This built upon a 2001 report titled “Crossing the Quality Chasm: A New Health System for the 21st Century” which puts forth a strategy for improving health care overall. The new 2005 report was titled “Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series.” The Quality Chasm framework is applicable to health care for mental and substance-use conditions, and describes a multifaceted and comprehensive strategy to do so.

Ten rules originally published as a guide to the redesign of health care in general were reiterated in the 2005 report on mental and substance use conditions. Of the 10, at least five are rules for “patient-centered care”:

–> Customization based on patient needs and values
The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.
–>The patient as the source of control
Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision- making.
–>Shared knowledge and the free-flow of information
Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.
–>The need for transparency
The health care system should make information available to patients and their families, information which allows them to make informed decisions when selecting a health plan, hospital, or clinical practice, or choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence-based practice, and patient satisfaction.
–>Anticipation of needs
The health system should anticipate patient needs, rather than simply reacting to events.

As you read each of these rules it may sound like you’ve heard it all before in Joint Commission and CARF accreditation standards etc. The clinical, administrative and programmatic implications of each rule are wide ranging and would indeed be a redesign challenge worth exploring.

Reference:
Crossing the Quality Chasm: A New Health System for the 21st Century (2001) Institute of Medicine, National Academy of Sciences. http ://www.iom.edu/CMS/8089/5432.aspx

Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series (2005) Institute of Medicine, National Academy of Sciences. http://www.iom.edu/CMS/3809/19405/30836.aspx

Tips:

  • Developing the alliance is the highest priority in the opening phases of therapy.

In the last 30 years there have been over 2,000 research publications and papers on the concept of the alliance. Here are some of the conclusions about developing the alliance which may help in your therapeutic practice with clients:

–> Develop a strong alliance early in treatment.
“Early” is relative to the length of therapy. But there is a convergence of evidence that points to sessions 3 to 5 as a critical window. In some ways this is not surprising if you have ever gone to therapy yourself. Would you likely go back to a therapist who you didn’t feel was helping, and whose methods and ‘fit’ with your style seemed ineffective? Would you really be interested in hanging in for five or more sessions? Of course if you have excellent retention rates, then you can ignore this point. You must be doing this well already.

–> A client’s experience of being understood, supported, and provided with a sense of hope is linked with the strength of the alliance in early stages of therapy.
Clinicians need to be curious about the client’s perception of what you are doing to generate empathy, support and hope. Their interpretation of what you do, especially early on in treatment, can be quite different from what you intended. Message sent may not be the same as message received. Simply because you think you are great at engaging people does not mean the client experiences it that way, at this point in time, with you. Restated: you may be a great clinician, but not necessarily for this particular individual at this time, doing the kind of work you do. This leads to the next concept.

–> Continue to improve and negotiate the quality of the relationship as an important and urgent challenge.
You can assume your initial assessment of the client’s relational capacities, style, preferences and quality of the alliance will probably differ from the client’s. It is the client’s perception of the alliance that is most influential, not yours. If they feel no hope or confidence in what you have to offer, they are the ones who stop coming to treatment – either physically and/or energetically (particularly if mandated or incarcerated). So it is important to specifically check out their perceptions on whether the relationship in treatment is working for them or not.

–> Techniques and models contribute less to outcome in early stages of treatment than the quality of the alliance.
The alliance should be forged first. This includes a collaborative agreement about the goals and strategies of treatment. Only then can various models and techniques be usefully implemented.

The bottom line:
Developing a good working alliance with the client is not just a nebulous, generic, nice thing to work on over weeks and months. It is a specific, early, clinical priority to evaluate and measure.

References:

“Psychotherapy Relationships That Work – Therapist Contributions and Responsiveness to Patients” (2002) Ed. John C. Norcross. Oxford University Press, New York. pp 11-14.

Horvath AO, Bedi RP (2002): “The Alliance” in “Psychotherapy Relationships That Work – Therapist Contributions and Responsiveness to Patients” (2002) Ed. John C. Norcross. Oxford University Press, New York. pp 37-69.

SKILLS

Words and terminology we use are often so ingrained, the meaning and implications so unconscious that it can be a surprise when someone actually raises your awareness. That’s what occurred as I was reading “Improving the Quality of Health Care for Mental and Substance-Use Conditions.” It happened a second time as I listened to this presentation: ” A White Paper by People who are New York State Consumers, Survivors, Patients and Ex-Patients” (NYS Office of Mental Health Bureau of Recipient Affairs).

Tips:

  • Notice and consider the terms we use and take for granted. You may want to change any that reinforce stigma and other unintended implications.

Not to make you a PC (politically-correct) freak, but chapter 3 of the Institute of Medicine’s 2005 report entitled “Supporting Patient’s Decision-Making Abilities and Preferences” raised some terminology points I had not considered before.

–> “Mental illness” often is used as a singular noun instead of plural “mental illnesses”. A one-size-fits-all label of “mental illness” could contribute to a perception that all mental illnesses have equal consequences, disabilities and handicaps. We do not typically refer to individuals as having “cancer” as if it is a single disease. Our more accurate terminology says an individual has leukemia, breast cancer, melanoma, or lung cancer. Similarly we don’t say an individual has “infectious disease”. We use specific terms – HIV, measles, or TB etc.

–> “Disorders” and emotional “disturbances” are used to describe mental illnesses, problems and symptoms. In non-mental illnesses, the terms “disorders”, “disordered” and “disturbance” are used less frequently. In general health care terms like “diseases,” “conditions,” “symptoms,” “problems,” and “complaints” are used for most health conditions. If these terms were also applied to mental illnesses, individuals might have an illness, condition, symptoms, or a problem that is amenable to a short-term intervention. Mental illnesses and problems ought to be regarded no differently from most general health illnesses, problems, and symptoms.

–> “Serious and persistent” has no counterpart in General Medicine. General illnesses use terms such as “severe,” “chronic,” “mild,” and “acute.” It is not common for example, to talk about “serious” cancers. The term “persistent” could connote a lack of belief in the ability to improve and recover. There is a less pejorative and clinically useful way to categorize individuals with mental illnesses where there are chronic, functional limitations. A way to refer to them could be: someone who has a mild, moderate, or severe disability associated with a mental illness symptom or diagnosis, rather than referring to them as the “seriously” mentally ill.

Tips:

  • Shift to terms which promote collaboration, empowerment and recovery.

Amy Colesante, Deputy Director of the NYS Office of Mental Health Bureau of Recipient Affairs, reminded us that “labels belong on jars, not people”. Here are terms she called “spirit-breaking” language:

–>“Non-compliant”
What attitudes and emotional reactions bubble up for you when you say this person is “non- compliant”? I would bet very few positive reactions come to mind. In the January 2004 edition of TIPS and TOPICS here’s what I stated about Treatment compliance versus treatment adherence: In the literature, much of healthcare has been using “adherence” long before the mental health and addiction treatment field became aware of the implications of using “compliance” versus “adherence” terminology. In this age of empowerment and collaborative service planning, it is not for the expert counselor and professional to develop a plan with which the client must comply. It isn’t for the physician to prescribe the medication with which the patient must demonstrate medication compliance.

Webster’s Dictionary defines “comply” as follows: to act in accordance with another’s wishes, or with rules and regulations. It defines “adhere”: to cling, cleave (to be steadfast, hold fast), stick fast. Do we really want people to “comply” with treatment? Or do we want them to be so invested in a collaborative endeavor together that they want to be steadfast and hang in with treatment – to “adhere”?

If your client, patient, consumer or family is “non- compliant” don’t look at the pathology of the individual. Look at the lousiness of your alliance and treatment plan. It is probably your treatment plan that you want them to comply with, rather than their treatment plan in which they are invested and desire to adhere to.

If you want to see more about terminology, read Volume 1, No. 9 January 2004 issue of Tips & Topics.

–> “Low-functioning”
When you use this term, do you face the person with optimism and confidence that much will be achieved? Is it easy to assume a more passive stance when you hold very low expectations for recovery or improved function? Wouldn’t it be more useful to identify a person’s struggles, and then develop a collaborative plan to address those areas most important to the client? For example with the use of money: Would your client like to have more control themselves rather than have a representative payee in charge of their money? With a living situation: Would your client like to live wherever they want, rather than remain homeless, be told where to live, what to do, and with whom to associate?

–> “Chronic”
If “chronic” is misused to mean a sense of hopelessness about poor outcomes, serious and persistent illness, repeated treatment failures, a non- compliant and low-functioning relapser, I suspect both your spirit and your client’s spirit will be broken. “He’s a chronic” or “She’s just chronic” do not exactly inspire hopeful recovery work. When used in contrast to “acute” illness in general healthcare, “chronic” is a more neutral term to denote the long-term nature of an illness needing committed treatment and continuous support.

An argument can probably be made for all these terms. It is not my intention to make us so self- conscious and PC-obsessed that we can hardly converse without offending someone. Let’s remember that behavioral health people are generally people of good will, trying to do the best we can with limited resources and huge challenges. See what you think of these suggestions/ perspectives. If there’s a way to use our terminology better so it positively reduces stigma, impacts recovery and increases resources, perhaps it’s worth tweaking our language.

SOUL

Recently I heard about the “Slow Cities” movement – whole towns deliberately committed to a slower pace of living in work, play and all activities. (If you want to read more about this, click Here)

That intrigued me, especially as I was driving at 70 miles per hour on the freeway to San Francisco on a conference call with a committee across three time zones. My cell phone (hands-free of course) communicated with their speaker phone and another committee member who was conferenced in on his cell phone. I was rushing to make it in time to register for a conference, trying to weave in and out of long traffic lines waiting to pay the toll across San Francisco Bay. Doing that, I might even gain ten feet and one minute!

What’s wrong with this picture?

Yet I don’t think I am the only crazy person who too often lives and works like this. You probably have your own pet story that captures our collective busy- ness.

As I paid the exorbitant speeding fine (after rushing to get home from another conference in San Francisco on another occasion) I felt a rekindling of my annoyance (almost incense) at the highway patrol woman who had stopped me. Didn’t she know I was a law-abiding citizen who hadn’t had a speeding ticket in years? Hadn’t I just helped the community by conducting a workshop on helping people with co- occurring mental and substance use problems? Didn’t she see I was just keeping up with the flow of traffic etc. etc.? You are not interested in my several other rationalizations, minimizations and projections of blame.

In case you haven’t had a speeding ticket lately, you can do traffic school over the Internet now and avoid getting bad driver points. I didn’t know that. My 20 year old, “spirited” daughter did know that—-from personal experience. She even offered to do the test for me – for a fee of course. Being the law-abiding citizen I am, I did the course myself. Did you know you should leave a three second space of time between you and the next car in front of you? Do you even know how to judge a three second lag time anyway?

Want to join me in the “slow living” recovery path?

Gotta run. I’m late getting TIPS and TOPICS published this month again, and I’ve got to hurry to get ready for a long training day. I’ll start tomorrow.

Until Next Time

Thanks for joining us this month. See you in February.
David

Vol. 11, No. 12

In This Issue
  • SAVVY, SKILLS & STUMP THE SHRINK : A combined “conversation” on working with mandated clients
  • SOUL : Changing the context to avoid droughts and storms in helping people

Welcome to all new readers to the March edition of Tips and Topics.  Thanks to all for reading this month.

David Mee-Lee M.D.

SAVVY, SKILLS & STUMP THE SHRINK

This month, I presented a webinar on The ASAM Criteria and DSM-5.  A participant wrote to me with some follow-up questions.  We ended up having an email “conversation” as we clarified questions and responses to the initial questions.

(If you want to hear the Addiction Technology Transfer Center (ATTC) Network webinar, you can access it at www.ASAMcriteria.org.  Click on News & Events and you’ll see it there).

So forMarch, here’s a combined SAVVY, SKILLS and STUMP THE SHRINK. I will share with you the “conversation”.

My Webinar Point- about “doing time”

I made a point that treatment providers, especially when working with mandated clients, are responsible for making sure that clients are “doing treatment” not “doing time” in the program – i.e. not just going through the motions.

Question #1:

Howcan you tell if a person is just “doing time, not treatment”?

Hi David,

What other specific criteria should providers gauge to determine whether a client is just “sitting in the program” or “doing time”?  For example, say the client just wants to get a job and maintains that attitude throughout treatment – in effect, turning treatment into a vocational training program. Would you consider this one example of merely “sitting in treatment?” What should be done, in “treatment” or not? 

Response #1:

Youcan turn “doing time” into active treatment.

“Doing time” is when a person is not taking responsibility for their treatment and their treatment plan.  If your client just wants a job but is in a treatment program, it is fine to make the goal of treatment: to get a job.  That’s what he wants and is a good place to start to engage him in treatment.  Presumably however, he has been referred to an addiction program or mental health because he has an addiction and/or MH problem. Say he doesn’t see that and thinks he just has a job problem, then the treatment plan focus would be: do motivational work around helping him get a job.  At the same time examine with him how has not had a job; or when he does get a job he loses it due to addiction and/or MH problems.

Even with the focus on getting a job, he is not just involved in a vocational training program, because he would be assessing why he doesn’t have a job or can’t keep one. Treatment will emphasize:

*      His examining how he is going to keep a job if he does not address the addiction/MH problems.

*      His sharing in group why he thinks he does not have a behavioral health problem, yet he has not had a job.  OR he shares how he lost his job because he was not showing up, or was hung-over.  OR he shares that due to mental health problems he got fired, or that he couldn’t make it through a job interview because he was so depressed or unstable.

*      Executing a “discovery” plan not a “recovery” plan – discovering any connections between addiction/MH problems that interfere with getting or keeping a job.

*      Active and meaningful participation and working on a collaborative plan. This is “doing treatment”, involving stages of change work to see if the client can connect the dots: that if he is to going to land a job, at some point he will need to address his addiction and/or MH problems.

Say your client just sits there and doesn’t participate in collaborative treatment planning. Then he is not doing treatment, he is “doing time.”  We shouldn’t continue treatment.  If he is not changing his treatment plan in a positive direction, he is essentially choosing not to do treatment, and has a right to leave.

My Webinar Point – DSM-5 SUD and Homelessness

In the new DSM-5 criteria for Substance Use Disorder (SUD), there are 11 criteria with a requirement for at least 2 of the 11 to diagnose SUD.   Some of these relate to how substance use interferes with meeting life expectations like work, family and social obligations.

Question #2:

Are the homeless exempt from certain SUD criteria?

 

In working with a homeless population it seems the degree of social isolation obscures the impact of their substance use disorder given the extent and degree of social isolation. In effect, the degree of social functioning required of them is much lower in light of the lack of role obligations that they must fulfill. Does this make them “exempt” from some of the DSM-5 substance use disorder criteria?

Response #2:

Many homeless will still meet sufficient criteria to qualify for an SUD.

As you suggest, a socially isolated homeless person may not have work, family or social obligations.  Thus they may not meet the social obligation criteria. However, such a homeless person could meet the other criteria – only 2-3 of 11 are needed to have mild SUD.

Here are the first 4 they could meet:
1. Substance is often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.

3. A great deal of time is spent in activities necessary to obtain substance, use, or recover from the substance’s effects.

4. Craving or a strong desire or urge to use the substance. (DSM-5, SUD, criteria 1-4 of 11)

I hope this helps,

David

 
My Webinar Point- about “Graduation”

When I discuss program-driven treatment rather than person-centered, outcomes-driven treatment, I encourage participants to move away from “graduation” as aconcept and practice in the treatment of addiction (and actually any illness).

Question #3:

What did you mean about ‘graduating’ from the program’s policies and procedures?

Yes, this helps! If ever there was a critical thinker, it’s you, David.  I enjoyed tracking your logic and appreciate your way of explaining.

 

One last thing – in response to the question of why its erroneous to use the term graduation in the realm of addiction, you said something about clients’ graduation, but only satisfying graduation of the program’s policies and procedures…or something along those lines. This point grabbed my attention. I was hoping you could articulate it once more and perhaps expand upon it. On that point, I read your piece on RCA Ceremonies and don’t recall coming across it. (March 2011 edition of Tips and Topics)

Thank you for responding to my e-mail and making yourself accessible.

Response #3:

Focus on functional improvement not program compliance.

Thanks for your nice feedback.  Take a look at Tips and Topic (TNT) – February 2013 edition.  I raised concerns that an overemphasis on compliance to program rules, norms and assignments overshadows a person-centered, assessment-based, outcomes-driven approach. Progress in a person’s function based on their individualized treatment plan determines when they transfer to another level of care, not compliance with the program’s policies and procedures, or phases.

I think this addresses what you want, but let me know if not.

Thanks,

David

Question #4:

How do you work with a client who says the “right things”?

OK,I have one more question in response to your answer in regards to “doing time” in treatment.  Say, the legally-mandated client takes a compliant-orientated stance and “gives in.” Or perhaps he feeds the treatment staff what they want to hear by apparently acknowledging the connection between drug use and employment within the first several week ofIntensive Outpatient (IOP) treatment.  It’s not a unique or peculiar situation to have this kind of mandated client then say they have a job problem and that their drug problem is now under control. They remain “dug in” to that position by posturing as if “everything’s all good” and “I got this” type of mentality with respect to all other aspects of “treatment.” Thus would the treatment plan still be a “discovery plan” focused on the client’s need to obtain employment?

 

Would you please tell me how you might work with such a client.

Response #4:

Give your client the chance to follow his plan first. Closely monitor outcomes.

Take a look at the following editions of Tips and Topics, especially the difference between “compliance” and “adherence”.  We don’t want any client to be “compliant” and say what we want them to say (“feeds the treatment staff what they want to hear or not”).  Webster’s Dictionary defines “comply” as follows: to act in accordance with another’s wishes, or with rules and regulations.  It defines “adhere” as: to cling, cleave (to be steadfast, hold fast), stick fast.

Perhaps your client believes he has it all under control (“everything’s all good” and “I got this”.)  At that point, we can share with the client anything we see in his behavior and/or thinking and/or relationships we think would threaten his getting or keeping a job.  What if he doesn’t agree?  Then you develop a plan to track how he is doing with his job or job hunting.  Help him identify what would be the first sign(s) to recognize that he is heading in a direction of losing the job, or not even getting the job. If you track this closely with him, he/you can discover if indeed he has everything under control, or whether his plan is starting to unravel.  Close monitoring is vital.  We don’t want to wait until it all blows up before he changes his treatment plan.

For example:
If he still wants to hangout with substance-using friends, not go to AA or other support groups, and still thinks he can get or keep a job, then agree to have him try his plan: i.e. the plan to “keep hanging out with using friends; not attending AA” ‘treatment plan.’ See if his plans work.  Keep close tabs with him on recognizing the first signs that his plan is not working.

Say his treatment plan is actually working- i.e. the  “keep hanging out with using friends; no AA” treatment plan.   Maybe he’s either getting a job or keeping one. Understandably from your experience, you doubt that he will be able to sustain that stance/decision.  So what do you say in your sessions with him?  You agree to keep going with his plan; but with him you carefully watch what happens. With humility, you express that you hope you are wrong but you think his plan is a risky one.  If his plan starts to unravel, then he will be more open to trying a plan that incorporates your ideas, because his plan didn’t work.  What you did give him is the chance to make his own discoveries and decisions.

November 2007:

January 2004:

December 2006:

Hope this helps.

David

Question #5:

When do you finally discharge a person?

Thanks! David that helps. So in developing a plan to track how she/he is doing toward job obtainment this might include listing jobs of interest; applying to X number of jobs per week; listing potential barriers to employment; practicing job interviewing skills, etc?  AND what if the client consistently fails to successfully follow through–at what point would it merit a discharge?

 

You’ve shared this excellent example of MOTIVATIONAL ENHANCEMENT technique and what comes to mind is the consent forms which used to state the purpose ofthe consent to Adult Client Services was to ‘monitor compliance’.   Ever since hearing the compliance vs. adherence story, I STOPPED using the word compliance in my consent forms.

 

In speaking with Probation Officers and Intake Workers from criminal justice services who ask if a client is being compliant, I ask them if they are sure that is what they want from a client.  I then offer the explanation of how temporary and superficial “compliance” is.

Response #5:

Discharge when the person is not making positive changes in the treatment plan.

Thanks for that interesting update on your use of “compliance” versus “adherence”.  A person could be in “compliance” with a court order to do treatment, with which the person agrees to do.  But once they get to treatment, you don’t want “compliance”, you want “adherence” with the collaborative treatment plan in which the person had an integral part in developing.

Regarding:

So in developing a plan to track how she/he is doing toward job obtainment this might include listing jobs of interest; applying to X amount of jobs per week; listing potential barriers to employment; practicing job interviewing skills, etc? 

Yes, correct, as these are strategies that are Specific, Measurable, Achievable, Realistic and Time limited (SMART).  If the person does whatever they agree to do, then treatment keeps going.

Regarding:

AND what if the client consistently fails to successfully follow through–at what point would it merit a discharge?

If the person does not do what they agreed to do, assess why not.  Perhaps they said ‘yes’ too quickly when they meant ‘maybe’.  Or they really want to follow through, but it was harder to do.  Or they found a better way to get to their goal and so did that instead.  Whatever is revealed when you assess the lack of follow-through, if your client agrees to change their treatment plan in a positive direction, then continue treatment.  There is no need to discharge.

For example:

If a person did not follow through with a job interview they thought would be easy, practice role-playing the job interview process.  If they now agree to practice role-playing to prepare better for a job interview, this is a positive direction. Keep going in treatment.  (You can tell the Probation Officer that your client is in “compliance” with the court order to do treatment and is “adherent” to the collaborative treatment plan.)

What if your client does not want to adjust the treatment plan in a positive direction using role-playing or another acceptable strategy?   At that point, the client is choosing no further treatment.  This is their right and they can leave treatment.  You are not kicking them out – they are not doing treatment.  If you let them stay, then you would be “enabling” – allowing them to “do time” not “do treatment”.  They would be non-adherent (not following through) to the treatment plan they created collaboratively. But they also would be out of compliance with the court order to do treatment.  Hope you see the distinction.

*******

The decision flow makes perfect sense, David.

Thanks again for taking the time to put forth a thorough response.

References:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Arlington, VA, American Psychiatric Association, 2013.

Mee-Lee D, Shulman GD, Fishman MJ, and Gastfriend DR, Miller MM eds. (2013).The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. Third Edition. Carson City,NV: The Change Companies.

SOUL

I am an avid reader of weather.com and the Weather page of the local newspapers.  This is not because I am finding the latest facts to have an intelligent weather conversation with the next person I meet.  It is because of two realities facing me at home and at work.

*      California had its driest year in history in 2013. This year we have so far received less than half the rain we should have by now.  We are in a drought. We have been doing our best to cut water use – collecting water in the shower while waiting for the water to warm up and using it to water the plants; not turning on garden sprinklers; and “if it’s yellow, let it mellow; if it’s brown, flush it down” (sorry for the bathroom talk).

*      At work, my commute is often an airplane ride into potentially snowy or stormy airports.  It is not good to be scheduled for a workshop or keynote presentation and be stuck at an airport in another state!  So I am always anticipating a Plan B if there is bad weather predicted en route or for my destination.

 

So this year there has been a strange phenomenon where I check every day hoping to see the weather prediction of either 100% precipitation or 0% precipitation – depending on whether I am home or on the road.

 

If I am at home, I rejoice to see 100% rain predicted because that means we are one step closer to breaking the drought.

 

If about to go on aroad trip, I want to see 0% rain or snow predicted, so I am not stressed about getting to the conference on time.

 

It’s funny how the context can totally change what we want by 100%. It’s a bit like when working with mandated clients.  You can either side with the victim-side of the client (“They made me come”) by saying something like: “Iknow you don’t want to be here, but you have to be, so suck it up and see if you can get something out of the program.”

 

Or, you can change the context and say: “Thank-you for choosing to work with me, so I can help you get people off your back and help you keep your job, or get your children back, or stay out of jail.”

 

I don’t want to be in an unproductive drought or a stressful storm.  By changing the context, you can avoid droughts and storms in your work with people too.

 

I hope it rains…well not next week when I’m traveling.

Until next time

See you again in late April.

David

November 2007 – Tips & Topics – november-2007

TIPS & TOPICS
Volume 5, No.7
November 2007

In this issue
— SAVVY
— SKILLS
— SOUL
— Until Next Time

Welcome to the November edition; and if you are in the USA, Happy Thanksgiving. We’re glad you join us every month. But if you find yourself with too much e-mail, and want to unsubscribe, you can do that at the links at the end of this newsletter.

(more…)

April 2007 – Tips & Topics – april-2007-2

TIPS & TOPICS
Volume 5, No.1
April 2007

In this issue
— SAVVY
— SKILLS
— SOUL
— STUMP THE SHRINK
— Until Next Time

Welcome to the start of the fifth year of publishing TIPS and TOPICS. The first edition hit cyberspace in April 2003. You can see all previous editions and print them out from the website.

(more…)

September 2005 – Tips & Topics – september-2005

TIPS & TOPICS
Volume 3, No.5
September 2005

In this issue
– SAVVY
– SKILLS
– SOUL
– STUMP THE SHRINK
– Until Next Time

A significant number of new readers are joining us this month, so welcome to you. Thanks too, to all of you who have been with TIPS and TOPICS for many months and even years. I appreciate the many comments and messages of appreciation you send me.

(more…)

March 2008 – Tips & Topics – march-2008

TIPS & TOPICS
Volume 5, No.11
March 2008

In this issue
— SAVVY
— SKILLS
— SOUL
— SHAMELESS SELLING
— As a RESULT of your FEEDBACK
— Until Next Time

Welcome to March’s Tips and Topics (TNT), especially to the many new subscribers. As usual we are running late, so this March edition will likely get to you in early April. It is after all, free, so I guess you get what you pay for!

(more…)