Interpersonal Communications and Building Relationships: Recovery Coaching Training

Governors State UniversityRecovery Coaching Training Program(Illinois Department of Health & Human Services – Division of Substance Abuse Prevention & Recovery (SUPR) grant funded) Module 4 : Interpersonal Communications & Building Relationships GSU Recovery Coaching Training - Module 4 -

Agenda • Creating Initial Connection as a Recovery Coach • Attributes of a Person-Centered Relationship • Motivational Interviewing Overview • Role of ‘Concerned Significant Others’ in Recovery Process • Basic Communication Skills Overview GSU Recovery Coaching Training - Module 4 -

Initial Connection as aRecovery Coach GSU Recovery Coaching Training - Module 4 -

Review of Recovery Coach Roles (5) GSU Recovery Coaching Training - Module 1

The Recovery Coach is NOT a.. (6) GSU Recovery Coaching Training - Module 1

Initial Connection as a Recovery Coach Establishing RC Coach in the Organization, we must establish clear… • Organizational policies, processes, boundaries for RC role • Includes confidentiality, transportation, etc. • Physical space, workload, client processes, etc. • Services and professional interfaces • Coordination for specific resources • Reporting relationship(s) • Organizational meetings & events • Introduce role of RC as well as self GSU Recovery Coaching Training - Module 4 -

Initial Connection as a Recovery Coach Introduction to Client group… • Provide clients with an overall understanding of the RC role • Participate in groups or other forums to gain familiarity… perhaps lead groups over time • Communicate process for initiating contact… Assigned? Voluntary? GSU Recovery Coaching Training - Module 4 -

Initial Connection as a Recovery Coach Introduction to clients.. • Establish relationship, rapport, trust • Explain role of RC • Explain ‘rules of the road’… • Process and boundaries for relationship in terms of services, confidentiality, reporting, transportation, etc. • Introduce yourself, tell your story, purpose, goals • Invite client to relate their story, history, relationships, values, goals… now and over time GSU Recovery Coaching Training - Module 4 -

Initial Connection as a Recovery Coach Working with clients over time… • It’s all about the relationship… • Trusted ally, confidant, help to resolve obstacles • Build Recovery Wellness Plan • Mentoring and Coaching • Resource connection within organization, community • Build client relational connectedness in community GSU Recovery Coaching Training - Module 4 -

Initial Connection as a Recovery Coach …remember… Dimensions of Wellness Plan Focus on identifying and removing obstacles to recovery and overall wellness GSU Recovery Coaching Training - Module 4 -

Over time – Work as advocate within the community • Create awareness of RC role in recovery process and ROSC philosophy • Build partnerships with providers of community resources • Influence participation in recovery process for individuals and organizations GSU Recovery Coaching Training - Module 4 -

Person-Centered Relationship GSU Recovery Coaching Training - Module 4 -

Person-Centered Relationship (3) Carl Rogers core conditions: • helps clients to clarify their own internal processes in a non-judgmental atmosphere, one that does not arouse discord • a “challenging, sacrificial, and underrated way of being with people” • belief that client has what he needs to be well • Therapeutic empathy – predictor of successful outcome and change in therapy GSU Recovery Coaching Training - Module 4 -

Person-Centered Relationship (3) “Core Conditions” • Accurate empathy • Unconditional positive regard • Genuineness / Congruence • Learnable skills, foundational to many models of treatment • relevant video: https://www.youtube.com/watch?v=X6fidphMX38 GSU Recovery Coaching Training - Module 4 -

Person-Centered Relationship (3) Partnership is a critical foundation, and must be intentionally created, not assumed Disengagementelements… create distance • Assessment – focus on data gathering vs. attending to person • Expert – building toward practitioner ‘correct’ solution vs. acting in partnership • Premature Focus – failing to understand holistic or ‘big picture’ view of person’s life • Labeling – focus on diagnosis or presenting issue vs. individual • Chatting – engaging in small talk vs. meaningful work in session GSU Recovery Coaching Training - Module 4 -

Motivational Interviewing (MI) GSU Recovery Coaching Training - Module 4 -

Motivational Interviewing (MI) (4) Beginning Definition: MI is a collaborative conversational style for strengthening a person’s own motivation for commitment and change When is MI appropriate? Where there is ambivalence or lack of commitment about change GSU Recovery Coaching Training - Module 4 -

MI: Readiness to change: (4) GSU Recovery Coaching Training - Module 4 -

MI: Resist the ‘Righting Reflex’ (4) • Attempt to ‘fix’ another’s problems, • Actually reduces likelihood of change • Doesn’t consider ambivalence factors • Result is discord(AKA resistance) as client pushes back to behaviors like • convincing others they have a problem • arguing for benefits of change • telling others how to change, what they should do • warning of consequences of not changing GSU Recovery Coaching Training - Module 4 -

MI: Resist the ‘Righting Reflex’ (4) Discord is influenced by practitioner behavior… • Indicates the need for change in practitioner behavior • We must be sensitive and aware of this feedback • We minimize discord by not fighting against it. • Rather than say the client is resistant or in denial, we should acknowledge our role in creating discord. Practitioner definition: MI is a person-centered counseling style for addressing the common problem of ambivalence about change. GSU Recovery Coaching Training - Module 4 -

1st element: MI Spirit: 4 domains (7) • Partnership– respect for client’s expertise • Acceptance– clear Rogerian traditions • absolute worth – intrinsic value of each person, • autonomy – each controls their own behavior, • accurate empathy – appreciate person’s perspective, • affirmation – identify other’s strengths and resources • Compassion – caring and concern, commitment to other’s best interest • Evocation- draw out person’s issues, areas of ambivalence, reasons and methods for change.

2nd element: Core Skills: (7) OARS + I …universal foundational therapeutic skills • Open ended questions • Affirmations • Reflective listening • Summarization • + Information Exchange

OARS: Open-ended Questions (4) Critical for information gathering, and for setting non-judgmental tone. These create movement, which is then directed using reflective listening Contrast to ‘closed’ questions… establishes limited context and evokes less relevant information • Caution: questions can stop momentum and may set a tone like an investigation • “key question” – vision of future if change occurred

Examples… Open Question… Closed Question In what ways does substance use impact your life? If you did consider change, how would you like your life to be different? Does your substance use hurt your relationship with your family? Do you want to have steady employment? GSU Recovery Coaching Training - Module 4 -

Use of OARS: Affirmations (4) Affirmations – Clear and genuine statements of understanding and appreciation • Re-orient client • from demoralized view of self, build hope, • Appreciationfor positive actions / strengths, meeting prior challenges, as persistence, etc. • Can lead to questions – • “how did you maintain that resolution?” • Tend to be lease-used microskill

OARS: Affirmations (4) Advice in using affirmations • Avoid generalities and ‘hollow’ statements, such as ‘I know you can do this” • Focus on specific behaviors vs. goals, attitudes • Avoid using “I”, or value judgements • Focus on non-problem areas • Nurture competent vs. deficient view of client

Examples… Reasonable Affirmations… Poor Affirmations You’ve demonstrated some solid organizational skills in how you manage your time You’ve shown a lot of persistence in completing your education I can tell you’re a really great Mom… If you set your mind to it, I know you can do this GSU Recovery Coaching Training - Module 4 -

Use of OARS – Reflective Listening (4) Many types of reflections, requires various levels of skills. Also, type and depth of reflection should be appropriate for specific situation • Encouragers – acknowledges you are listening • Simple reflection – stays close to client meaning • Complex reflections – contain additional meaning and depth, may open new doors

OARS – Reflective Listening Examples GSU Recovery Coaching Training - Module 4 -

OARS – Reflective Listening (3) ‘Roadblocks’ • What reflective listening is not • generally will interfere with hearing what client has to say: advice, judgement, directives, interpreting, analyzing • may serve to increase or create discord, also called denial

OARS: Reflective Listening12 ‘Roadblocks’ (3) • Ordering, directing, commanding • Warning, threatening • Giving advice, making suggestions, providing solutions • Persuading with logic, arguing, lecturing • Moralizing, preaching, telling clients their ‘duty’ • Judging, criticizing, dis-agreeing, blaming • Agreeing, approving, sanctioning • Shaming, ridiculing, name-calling • Interpreting, analyzing • Reassuring, sympathizing, consoling • Questioning, probing • Withdrawing, distracting, humoring, changing the subject

OARS: Summaries (4) • Summaries – • helps clients organize their thoughts and experiences, note discrepancies and build upon them • Three types – in each we strategically decide what to include and exclude • Collecting – summarize to move forward • Linking - use ‘and’ (not ‘but”) to build discrepancy • Transitioning - perhaps between stages of MI from building motivation to action

3rd Element: Eliciting Change Talk (4) Unique to MI • Change talk – client comments that speak in favor of change • Want to evoke this language, • reinforce it when it occurs, • increase frequency of this talk to increase intention to change

Change Talk (4) Three types or categories of client talk here: • Change talk – that which supports a change, or possibility of change • Sustain talk – which supports the status quo, • Discord – support status quo in specific way, person feels pressured to change and is actively ‘pushing against’ this • Neutral talk Our intentional response to client talk… • Influences the future direction discussion will follow • Helps organize the client’s experience GSU Recovery Coaching Training - Module 4 -

Examples… Change talk… Sustain talk I’d like to quit smoking.. It might be easier to quit over the holiday break from school Smoking costs a lot, it taps my budget I’m coughing more and more, my doctor said I’m looking at a chronic condition All my friends smoke, so it doesn’t bother anyone Smoking helps me relax, especially during the stressful holiday season Smoking may cost a fair amount, but I see it as my one luxury I really enjoy smoking GSU Recovery Coaching Training - Module 4 -

Preparatory Language: Mobilizing Language: Desire to change Ability to change / optimism Reason for change / benefits Need for change / current problems Commitment – action words (I will, I intend…) Activation – (I’m ready, I’m willing to…) Taking steps – ( I did …) (4) GSU Recovery Coaching Training - Module 4 -

MI: Four Processesdescribes stages of interacting with the client (7)

Video: Introduction to Motivational Interviewing https://www.youtube.com/watch?v=s3MCJZ7OGRk&t=37s GSU Recovery Coaching Training - Module 4 -

Role of ‘Concerned Significant Others’ (CSO’s) in Recovery Process GSU Recovery Coaching Training - Module 4 -

‘Concerned Significant Others’ (8) • ‘silent majority’ in addictions, addiction occurs in families / social context • cope with stressors created by substance use • CSOs can influence use – positively or negatively • CSOs are a potential treatment and recovery resource, for everyone

Attitudes toward CSO’s…(3) Role in addiction? • Disturbed spouse or family structure …Codependence… Enabling.. .pathology reinforces use? • Family Adjustment Model… stress / coping hypothesis, ‘doing the best they can’

Attitude toward CSO’s…(3) Possible role in recovery? correspond to views on addiction • Al-Anon (12 Step)… attitude of loving detachment, support self • Johnson / Interventions… family confrontation to begin treatment • Community Reinforcement and Family Training (CRAFT) … CSOs as resources GSU Recovery Coaching Training - Module 4 -

What CSOs should know(3) • Many diverse presentations and causes – gain basic knowledge about addictions • Formal diagnostics may be limiting • Presentation is not black or white – there is a continuum • Consider – a majority of those harmed by alcohol are not dependent users • Most important: what is impact on person’s life? Level of dysfunction • Consideration of risk factors, promote early treatment and intervention for those considered high risk before symptoms have become serious… addiction treatment has typically been at acute level • Majority of substance abusers have one or more co-morbid conditions

CSO’s Role in Treatment & Recovery (9) • Involvement of CSOs is shown to be very effective in supporting treatment initiation and recovery… BUT • Barriers to this involvement are found • Lack of knowledge about addiction and recovery • Lack of access to treatment providers and environments / also logistical concerns • Wariness about acceptance of their support by patient and provider • Concern their own needs will be ignored – resentment, isolation, fatalism, fear, etc. (De Civita, Dobkin, & Robertson, 2000)

CSO’s Role in Treatment & Recovery (3) “Recovery can be hazardous to your relationship” • Existing roles, power, expectations in relationship are changed • Difficult to set aside resentments and frustrations built over time • Cycle of relational conflicts and substance use arise, coping by both parties • Behavioral Couple Therapy – high commitment • Increasing shared positive activities • Increasing communication skills, reducing painful interaction patterns

CSO’s Role in Treatment Initiation and Recovery Approaches to CSO involvement in engaging treatment-refusing users in treatment… Interventions – Johnson Institute Intervention Al-Anon (12 Step) Community Reinforcement and Family Training

Therapist Facilitated Interventions (10) • Confrontational or highly directive approach is common • Therapists assists family in process and facilitates intervention • 70% of families do not go through with intervention • For those who do, most patients will enter treatment • Approach is not designed to address needs of CSOs outside of encouraging loved one to enter treatment

Al-Anon / Nar-Anon (8) • Shares philosophy with 12-Step Programs as Alcoholics Anonymous: • User is powerless to stop substance use, abstinence is only answer • Must surrender to higher power, use fellowship and guidance of mutual-help program • Mutual support group intended to provide support for CSO, not loved one • Attitude of detachment from loved one, acceptance of inability to help • BUT …When education and facilitation training given with this program, 30% influenced loved one’s attendance of AA (Meyers, Miller, Smith, & Tonigan, 2002)

Community Reinforcement and Family Training (CRAFT) (8) • Comprehensive approach designed to help both CSO and loved one cope with treatment and recovery processes • Based on philosophy that community plays a significant role in supporting use and recovery – goal to make sobriety more reinforcing than using • CRA addressed needs of patient / CRAFT addresses needs of CSO • Strong empirical support 60-75% effectiveness in engaging treatment

Interpersonal Communications and Building Relationships: Recovery Coaching Training