Welcome to the June edition.
In SAVVY, STUMP THE SHRINK and SKILLS, a reader asks about my thoughts on what stage of change people are who go into treatment. He somewhat disagrees with what he heard at a training: “Rarely will you see a person come into treatment in the Preparation or Action stage of change”.
In SOUL, at least one reader didn’t ‘get’ the message I was sending last month when I shared Tucker Carlson’s text messages. I believe the wisdom I highlighted is so important, that I’m giving it one more try to explicitly spell out what to do about the polarization in the USA.
David Mee-Lee, M.D.
DML Training and Consulting
SAVVY, STUMP THE SHRINK and SKILLS
Fred Mills asked a question last month that prompts several learning points. He draws on the Stages of Change in the Transtheoretical Model of Change (Prochaska and DiClemente) from Precontemplation (not interested in changing); Contemplation (ambivalent about changing); Preparation (getting ready to change within the next month); to Action (taking active steps to change).
Hi, Dr. Mee-Lee. I was in a training today and the trainer said, “Rarely will you see a person come into treatment in the Preparation or Action stage of change”. I tend to disagree. I know many people who come into treatment are still in Precontemplation or Contemplation stage but I think the majority of people who go through with entering treatment would be at Preparation or Action. Can you offer some thoughts to help me understand?
C. Fred Mills, LCADC, LPCC
Targeted Assessment Specialist
Opioid Use Disorders Project (TAP OUD)
UK Targeted Assessment Program
Prestonsburg, KY 41653
fred.mills@ky.gov
Tip 1
People who go to the trouble of getting into treatment are at Preparation or Action. But they may not be at Action for what we think they should be.
Hi Fred, my experience is that just because people go through the effort of coming to treatment, that doesn’t mean they are at Preparation or Action for Recovery. They may be at Action for getting their kids back; getting off probation; staying out of jail; keeping a job or relationship, but at Precontemplation or Contemplation for stopping drinking or drugging. They will say things like “I have to be here to get my kids back” or “I can stop anytime” or “I don’t think it’s a problem but my boss has it in for me”.
Tip 2
To assess if a client is at the stage of Preparation or Action and for what, listen to what they are actually saying about what they want.
If they really are at Preparation or Action for recovery, then they would say things like “I have a severe problem with alcohol or drugs and I want to stop and I’ll do whatever it takes.” If they really are at that stage, they may not need much formal treatment unless they need immediate withdrawal management or have co-occurring physical and/or mental disorders.
They could start with Alcoholics Anonymous or Narcotics Anonymous or SMART Recovery and some outpatient education about addiction and recovery.
Tip 3
To engage a person in a self-change process, start with what they are at Preparation or Action for, not what we think they should be at Action for.
In treatment we always welcome a person who comes, but we start with what they really want, what they are at Preparation or Action for, not what we want for them, what we are at Action for. In other words the assessment and treatment plan would focus on what they want (getting the children back) and how we can help then get their children back?
You will no doubt get to the concerns you may have about their drinking or drugging; or the partner they have at home. As you assess with the client what concerns Child Protection Services has about reunifying with their children, their drinking, drugging or companions will inevitably come up in the assessment conversation.
Tip 4
The collaborative treatment plan should focus on what the client is at Action for to help them get what they want.
If the client wants their children back, the treatment plan would focus on all the obstacles to reuniting with their children and what the client is willing to do or not do.
- If the client is at Action for reunification but at Contemplation (ambivalent) about stopping drinking, the “discovery” treatment plan would focus on how to prove there is not a drinking problem rather than just getting the client to comply with abstinence.
- If the client is at Precontemplation about separating from an abusive partner, the “discovery” treatment plan would focus on how to demonstrate that children would be safe in a home with such a partner living there.
- If the client is at Action for recovery, then treatment is easy. Just help them change friends, deal with urges to use, stay away from dangerous places, go to meetings etc. Such a client will happily adhere and work hard. If you get pushback, then they are not at Action for recovery.
SOUL
I don’t like all the polarization in our country....political, cultural, racial, religious and on and on. Being Asian, albeit born and raised an Australian Chinese person, I probably don’t like conflict anyway. It is only going to get worse as the election season heats up for the next year and a half.
So I will address this polarization only one more time for a while and give my message of SOUL last month one more try. The content of what I was trying to say about Tucker Carlson’s January 7, 2021 texts is so important that I am going to spell it out more clearly. This was prompted by a reader’s candid message to me as follows:
To quote a person (Tucker Carlson) who has done so much harm in spreading lies to his listeners is very disconcerting. There are so many professionals that are more knowledgeable about addiction issues that are well respected and trusted than this individual. It makes me start to question your judgment. Please remove me from your list of subscribers. (I didn’t hear back about permission to acknowledge her name, but she is a Licensed Clinical Social Worker. I am also not sure if she even read what I wrote as I wasn’t referencing his addiction knowledge. Maybe she only had time to read the email Subject Headline “Wisdom from Tucker Carlson”)
Here’s the message I was trying to send last month because for at least one reader, ‘Message Sent was not the Message Received’.
If you identify with Republicans and love Tucker Carlson:
To what degree do you agree with the insights on which Tucker reflects in his texts?
- “.....this isn't good for me. I'm becoming something I don't want to be.” - Is there hate, violence, a lack of compassion and empathy that is taking us over to become something we don’t want to be?
- “Much as I despise what he says and does, much as I'm sure I'd hate him personally if I knew him, I shouldn't gloat over his suffering.” – Have we become so divorced from our humanity that we can gloat over the suffering of someone with whom we disagree?
- “I should be bothered by it. I should remember that somewhere somebody probably loves this kid, and would be crushed if he was killed.” - To what extent have we so dehumanized those we disagree with that we wish them dead?
- “If I don't care about those things, if I reduce people to their politics, how am I better than he is?" – Have we so demonized the opposition that we have lost sight of our own humanity and compassion for others?
If you identify with Democrats and do not love Tucker Carlson:
Can you open your heart to see the wisdom that arises from a fellow human being whose words you usually despise?
- Can we find common ground and areas of agreement to bridge the polarization between the right and the left of the political divide?
- Can you embrace the self-reflection to take stock of whether hate, violence and lack of compassion and empathy are taking us over?
- Even the people we think the worst of for what they say and do, can be part of healing. Can we see that they too have a human heart that has the capacity for empathy and caring about those with whom they disagree?
- Who will reach out first to break down the dehumanizing and demonizing of others that pushes us all further apart?
Years ago, I heard a couples therapist give this great advice: The person who should reach out first to bridge the divide is the one who believes they are the most correct with God, Source, the Universe on their side.
Until Next Time
Thank-you for joining us this month. See you in late July.
David