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Lorraine Pirro, M.A., LMSW Marion Riedel, PhD, LCSW-r Harm Reduction Conference 2010

Lorraine Pirro, M.A., LMSW Marion Riedel, PhD, LCSW-r Harm Reduction Conference 2010. The Daredevils of Mental Health: An Emerging Model of Harm Reduction Clinical Supervision. Overview Of Session :. In this session we will:

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Lorraine Pirro, M.A., LMSW Marion Riedel, PhD, LCSW-r Harm Reduction Conference 2010

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  1. Lorraine Pirro, M.A., LMSW Marion Riedel, PhD, LCSW-r Harm Reduction Conference 2010 The Daredevils of Mental Health: An Emerging Model of Harm Reduction Clinical Supervision

  2. Overview Of Session: In this session we will: Review the essential characteristics of supervisor/supervisee relationship Learn how to model the spirit of HR psychotherapy Compare HR supervision with more traditional models Nurture resilience in the supervisee Practice self-Care Deconstruct power, privilege, oppression and culture Deal with transference and countertransference Challenge dominant clinical training paradigms

  3. Harm Reduction Psychotherapy One Definition A way of being with a client in a collaborative approach to psychotherapy that identifies and marshals client strengthsin the service of positive change.

  4. And Harm Reduction Psychotherapy… • Reduces harm and suffering. • Increases self-esteem and self-efficacy. • Inspires trust, safety, and an overall sense of well-being.

  5. Increasing Consciousness and Reducing Chaos Consciousness Chaos

  6. Nurturing Great Therapists So how to model the spirit of harm reduction psychotherapy in supervision?

  7. Nurturing Resilience in the Supervisee • Parallel processes of resilience as protective factor—mirrors the clinical work • Supporting strengths “what are the 3 fabulous things you did this week?” • “Strengths armor” • Find all the positives in each situation • Invite supervisee to find better solutions when challenges arise • Notice positive growth whenever it occurs

  8. The Successful Supervisor/supervisory Relationship Some of the essential characteristics are: • Creating a safe, collaborative and affirming experience • Transparency • You can’t just say it’s transparent—it has to be transparent • It is a relationship—nurture, feed and weed • Trust intentions

  9. Key Tasks to Facilitate Growth • Increase skills to: • Cope with ambiguity • Tolerate risk • Protect against vicarious trauma • Support autonomy and creativity • Facilitate decision-making • Allow time for consideration of options (don’t move too fast to problem resolution) • Challenge with love and respect • Model good psychotherapy skills in the supervision room

  10. Dealing with Transference and Counter transference • Challenges traditional notions of boundaries. • Power dynamics. • No clear blueprints for this emerging model. • Hypothesis: Transference and counter transference are simply another way of “seeing”. Fluid, Informative, Invaluable.

  11. The Supervisor/Supervisee Relationship Dare We Aim for Brilliant ? • Peerless alliance with total transparency = unsurpassed case formulation. • Expert therapist providing transformative therapy = inspired partner outcomes.

  12. The Successful Supervisor/Supervisee Relationship What Is a Peerless Alliance? • Safe, affirming, and collaborative. • Transparent: You can’t just say it’s transparent—it has to be transparent.

  13. Non-judgmental Affirmative not just accepting Competent and confident Engage in mutual accountability Willing to admit mistakes Attuned to fluctuations of the depth and affective tone of the relational bond Deep affection and respect for one another Consistently able to explore difficult material Can We Be Both Noble and Stalwart? The Daredevils’ Code

  14. What are qualities of a good supervisor?

  15. Supervision in HR Psychotherapy: An enduring link between a supervisor and supervisee in order to: 1) advance the supervisee in the cognitive, emotional, ethical, and behavioral areas; 2) help her/him work independently based on professional decision-making; and 3) help develop a personal style of work.

  16. Can We Talk About Us for a Moment? • Because in this work… • We care… • Therefore we hurt... • For those who suffer… • It comes with the territory.

  17. Values and Supervision? How do your world view and personal demographics affect your ability to supervise? To be supervised? • Gender • Race/ethnicity • Sexual orientation • SES • Age • Class • Others?

  18. Self-Care Can You Listen From the Inside Out?

  19. Setting limits Self-advocacy Restorative relationships Alone time Vacation Loving Spirituality Perspective Music, Writing, Art Creative expression Mentoring/Teaching Exercise Laughing… Lots of laughing Some IdeasWhat Do You Think?

  20. Deconstruct Power, Privilege, and Oppression • Impact of structural inequities at the therapeutic table and in the supervisory relationship • How equalizing power serves our partners best in the journey to healing and health • Better supervision occurs with power equalized as well • Constant monitoring of imposing power and privilege is necessary. • Good supervision helps the supervisee • How does the supervisor keep him or herself in check?

  21. HR Clinical Supervision Requires: • Engaging in challenging dialogues • Asserting needs and wants • Inviting and resolving conflict • Working effectively with the manifold traumas facing our work partners • Use of narratives

  22. Limitations of TraditionalTraining • Limits of traditional training may contradict the application of HR principles and approach. • Examples: Notions of certain traditional boundaries, “patient/therapist” roles, and disease model of treatment (DSMIV).

  23. What’s in Common (WE HOPE) Both reference didactic material. Representations of supervisory dialogue impact practice. (Potential to facilitate or debilitate). The relationship is the currency. Where We Differ (HURRAH!) Power and control are equalized. Supervisor is a mentor and guardian of shared values and ideals vs. gatekeeper to the profession. Traditional and HRP Supervision

  24. What’s in Common (WE HOPE) Case formulation is evidenced based. Fosters the evolution of the professional self. Increases therapist agency and self-efficacy. Respects interpersonal boundaries. Where We Differ (HURRAH!) Lifelong learning and support in the “impossible profession” versus developmental continuum ending in “self supervision”. Traditional and HRP Supervision

  25. Wise and Cautionary Tales • Context is vital. Trust and safety reign. • The therapist holds sacred the integrity of the partner’s narrative. • And the supervisor safeguards the context of the therapist’s narrative with identical passion. • In the words of a great supervisory sage and the Daredevils’ Code: “I’d eat my notes before I would allow harmful disclosure.”

  26. Discussion and Examples • Boundaries, Advocacy, Counter-transference: How they are the same and different in HRP. • Transference/Modeling a healing relationship: “What if my therapist is in a bad mood today?” • HRP Case formulation With Couples. Declining A Ceiling. • Integrated care: (Legal) drugs are not always bad.

  27. What’s Next? • Be generous with colleagues. Utilize social work models of “mentoring”, sharing knowledge and skill. Advocate fo • r HRP principles in healthcare (Examples: Substance use treatment, inpatient psychiatric care.) • Continue to address structural inequities and deficits in cultural competency that permeate all.

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