Promoting Strengths-based Treatment at Your College Counseling Service

1. Promoting Strengths-based Treatment at Your College Counseling Service SuEllen Hamkins, M.D. Josh Relin, Psy.D. ACHA 2013

2. Today’s Talk • Roots of strengths-based, collaborative treatment • Initial consultations • Cultivating stories of strength and meaning • Strengths-based documentation • Promoting it to your center • Demonstration interview

3. Converging streams of strengths- and values-based, collaborative mental health treatments • “Positive psychiatry” • Recovery model • Trauma-Informed Care • Motivational Interviewing • ACT – Acceptance and Commitment Therapy • Narrative Therapy/ Narrative psychiatry • Mental Health Activism • Active Minds

4. Common principles • a focus on strengths and values • a collaborative therapeutic stance • an honoring of personal preferences, cultural values and indigenous communities • an awareness of cultural discourses that can be supporting or marginalizing • the fostering of well-being • attention to how our practices support these principles

5. Key Concepts of Narrative Therapy/Psychiatry • We experience our lives and our identities through the stories we tell about ourselves and the world. • The meanings we give our experiences and feelings and the the stories we tell about our lives arise in relationships. • We can cultivate narratives of strength and meaning that contribute to positive identity development and open up new possibilities for recovery and well-being. SuEllen Hamkins, MD, 2013

6. Leo Tolstoy: Happy families are all alike; every unhappy family is unhappy in its own way. SuEllen Hamkins: Happy families are all different; every happy family is happy in its own way. SuEllen Hamkins, MD, 2013

7. Today’s Talk • Roots of strengths-based, collaborative treatment • Initial consultations • Cultivating stories of strength and meaning • Strengths-based documentation • Promoting it to your center • Demonstration interview

8. Goals of Initial Consultation • Gather biographical information • Assess problems, strengths, and goals • The externalized problem, hx of the problem, the person w/o the problem, relationship with the problem • Determine preliminary course of treatment • Describe treatment options; collaborate balancing student’s and my own opinion • Collaboratively establish DSM-IV diagnostic description (if necessary) • Therapeutic conversation • Locate hope, find contexts for experiences, contain and define the problem, identify aspects of resilience, strengths, and values

9. “Emily Bennett”

10. Questions That Were Useful While Gathering Biographical Information about Emily • Was there anyone in middle and high school who knew how bright you are? Who knew you beyond the presence of depression and anxiety in your life? • What did you do to prepare yourself to “pull yourself together” once you got to college?

11. Externalizing and Characterizing the Problem • How do you know when anxiety/depression is present? • How does your body feel when anxiety/depression is present; do you feel it in any particular areas of your body? • What kinds of messages are emphasized and supported by depression/anxiety?

12. Identifying and Evaluating the Effects of the Problem • What are the effects of anxiety/depression on your life? • How do you feel about these effects?

13. Collaborative Treatment Planning • What were you hoping for from today’s appointment? What are your longer-term goals for therapy? • What did you imagine therapy to be like? What kind of therapy might be really useful at this point in your life? • How do you feel about me providing a diagnosis in order for you to access Disability Services? • How accurate do you feel these diagnoses are? • If there are more than one, should we use one? Both?

14. Today’s Talk • Roots of strengths-based, collaborative treatment • Initial consultations • Cultivating stories of strength and meaning • Strengths-based documentation • Promoting it to your center • Demonstration interview

15. Case Study: “Jimmy Newman” • 18 years old, European-American • First semester at the university • Athlete • Academically successful in high school • LSD • Severe manic episode • Five day hospitalization, lithium, aripiprazole • Three week partial program • One week later arrives at college

16. Focus on compassionate connection • Get to know the person without the problem • Understand the student’s experience of the problem • Develop stories of strength and meaning and dismantle harmful stories • Collaboratively consider next steps in light of the student’s values and vision

17. Cultivating stories of strength and meaning

18. Therapy-as-usual: Why are you having this problem? What are the roots of that problem in your childhood? Strengths-based therapy: Why are you able to resist or overcome this problem? What are the roots of that strength or value in your childhood?

19. Questions to cultivate stories of strength and meaning • When do you feel best? • With whom? Doing what? • What are you drawing on to help you get through this difficult time? • How did you develop that skill? • What do you care most about? • How are you staying true to what you care most about despite how hard things are right now?

20. A map for cultivating storiesof strengths and values • Identify a small positive event or intention • Have the client name a value or strength that the event or intention exemplifies • Seek other examples of the value or strength recently and in the past • Seek additional meanings or intentions the client gives those examples • Find out who supports this value or strength in their life

21. A map for cultivating storiesof strengths and values Remote Recent Past Past Present Future Events Meaning

22. SH: Getting hospitalized and doing the partial hospitalization program in August, and then coming to your first semester of college in September---I just want to pause and notice that it takes something to be able to do that. • JN: (shrugs.) • SH:  Overcoming a challenge like the one you faced and continuing right on with your plan to come to college, I imagine that takes determination, would you agree? • JN:  I guess. • SH:   Is that a good word for it, determination? • JN:   Yes.

23. SH: Getting hospitalized and doing the partial hospitalization program in August, and then coming to your first semester of college in September---I just want to pause and notice that it takes something to be able to do that. • JN: (shrugs.) • SH:  Overcoming a challenge like the one you faced and continuing right on with your plan to come to college, I imagine that takes determination, would you agree? • JN:  I guess. • SH:   Is that a good word for it, determination? • JN:   Yes.

24. SH:   And do you have a sense of where this determination comes from?  Is it something new, or have you had determination in the past? • JN:   Ummm, well, I would say I developed it in wrestling. • SH:   You wrestled all through high school, is that right? • JN:   Yeah. • SH:   And did you use determination like, within a match, to win it, or was it determination to practice hard? • JN:   It was both.  I worked hard toward what I wanted to achieve, in practices and in matches.

25. SH:   And do you have a sense of where this determination comes from?  Is it something new, or have you had determination in the past? • JN:   Ummm, well, I would say I developed it in wrestling. • SH:   You wrestled all through high school, is that right? • JN:   Yeah. • SH:   And did you use determination like, within a match, to win it, or was it determination to practice hard? • JN:   It was both.  I worked hard toward what I wanted to achieve, in practices and in matches.

26. SH:   And do you have a sense of where this determination comes from?  Is it something new, or have you had determination in the past? • JN:   Ummm, well, I would say I developed it in wrestling. • SH:   You wrestled all through high school, is that right? • JN:   Yeah. • SH:   And did you use determination like, within a match, to win it, or was it determination to practice hard? • JN:   It was both. I worked hard toward what I wanted to achieve, in practices and in matches.

27. SH:   And would you say that that kind of determination, to work hard toward what you want to achieve, helped you overcome the symptoms you faced in August and be able to come to college? • JN: Yes, I would say it did. • SH: And how is college going? • JN: (Shrugs.) It’s hard. My classes are really challenging.  The concepts are harder; it's not like high school. • SH:   No, it's not like high school.  How's it going doing the homework?

28. JN: I'm getting it done.  I wrote an essay for a class and I went to the writing center to get help on it, which is not something I have usually done.  But I'll do whatever it takes. • SH:   So academically, you're using determination and doing whatever it takes to succeed, like going to the writing center and doing your homework.

29. JN: I'm getting it done.  I wrote an essay for a class and I went to the writing center to get help on it, which is not something I have usually done.  But I'll do whatever it takes. • SH:   So academically, you're using determination and doing whatever it takes to succeed, like going to the writing center and doing your homework.  

30. JN: I'm getting it done.  I wrote an essay for a class and I went to the writing center to get help on it, which is not something I have usually done.  But I'll do whatever it takes. • SH:   So academically, you're using determination and doing whatever it takes to succeed, like going to the writing center and doing your homework.  

31. SH: And how is the other part of college going, making connections? • JN: Good.  I've made some new friends, and I hang out with some old friends too. • SH:   Now, you said that you have stopped doing drugs so that you can stay well, but I imagine perhaps some of your old friends still are using. • JN: Yes, but I'm not going to.  I turned down free marijuana for the first time last week. • SH:   Wow, I imagine that took a kind of determination. • JN: Yes it did, but I am committed to not using drugs.

32. SH: And how is the other part of college going, making connections? • JN: Good.  I've made some new friends, and I hang out with some old friends too. • SH:   Now, you said that you have stopped doing drugs so that you can stay well, but I imagine perhaps some of your old friends still are using. • JN: Yes, but I'm not going to.  I turned down free marijuana for the first time last week. • SH:   Wow, I imagine that took a kind of determination. • JN: Yes it did, but I am committed to not using drugs.

33. SH: And how is the other part of college going, making connections? • JN: Good.  I've made some new friends, and I hang out with some old friends too. • SH:   Now, you said that you have stopped doing drugs so that you can stay well, but I imagine perhaps some of your old friends still are using. • JN: Yes, but I'm not going to.  I turned down free marijuana for the first time last week. • SH:   Wow, I imagine that took a kind of determination. • JN: Yes it did, but I am committed to not using drugs.

34. SH:   This commitment of yours, to work hard to achieve your goals, to do whatever it takes, are there roots of that in your family, would you say? •  JN:    I dunno. • SH:   Do your parents have determination?  Have they ever had to work hard to overcome difficulty? • JN: Yes.  They are both very hardworking. • SH:   So, would you say you got some of your determination from them? • JN: Yes, I guess it's genetic.  (Smiles).

35. SH:   This commitment of yours, to work hard to achieve your goals, to do whatever it takes, are there roots of that in your family, would you say? •  JN:    I dunno. • SH:   Do your parents have determination?  Have they ever had to work hard to overcome difficulty? • JN: Yes.  They are both very hardworking. • SH:   So, would you say you got some of your determination from them? • JN: Yes, I guess it's genetic.  (Smiles).

36. SH:   This commitment of yours, to work hard to achieve your goals, to do whatever it takes, are there roots of that in your family, would you say? •  JN:    I dunno. • SH:   Do your parents have determination?  Have they ever had to work hard to overcome difficulty? • JN: Yes.  They are both very hardworking. • SH:   So, would you say you got some of your determination from them? • JN: Yes, I guess it's genetic.  (Smiles).

37. Strengths: • Abilities • Resources SuEllen Hamkins, MD, 2013

38. Sample questions to elicit stories about a person’s strengths • What did you draw on to be able to succeed in that way? • What name might you give to this ability of yours? • What would you say it took to be able to overcome that problem?

39. Meaning: • Intentions • Values • Vision • Hopes • Dreams • Commitments SuEllen Hamkins, MD, 2013

40. Sample questions to elicit stories about intentions and values : • What vision for your life are you hoping to achieve? • What does your effort to succeed in that way say about your intentions for your life? • Is what you did evidence of commitments you have for how you live your life?

41. “Jimmy Newman”

42. Practices of strengths-based, collaborative therapy: • Focus on emotional attunement and collaborative connection • Start with stories of strength and success • Understand the student’s experience of the problem • Develop stories of strength and meaning • Collaboratively consider treatment resources in light of the student’s values

43. Principles of strengths-based, collaborative therapy • Collaborative stance • The student’s values are at the center • Awareness of social and cultural influences • Externalization of the problem • The problem is separate from the person • Cultivation of strengths and values • Intentionality • Preferred identity development • Connection to people who are supportive • Support for steps toward wellbeing

44. Today’s Talk • Roots of strengths-based, collaborative treatment • Initial consultations • Cultivating stories of strength and meaning • Strengths-based documentation • Promoting it to your center • Demonstration interview

45. Strengths-based documentation: initial consultation • Introduction to the person without the problem (Include passions, interests, values, skills, accomplishments and sources of inspiration): • The student’s goals for treatment and vision of well-being: • Chief concern: • History of the problem and efforts and successes in overcoming it :

46. Strengths-based documentation: initial consultation • Family history (Include family values, skills, and resources, what family members admire about the student and the problems that family members have faced and/or overcome): • Medical wellbeing and problems: • Observations/Mental Status:

47. Strengths-based documentation: initial consultation • Summary (Include strengths, skills, relationships, supports, values, successes in achieving wellbeing, and problems that are a focus of treatment): • Risk assessment (Include risks for harm to self or others and protective factors):

48. Strengths-based documentation: initial consultation • (Diagnoses, discussed with student:) • Collaborative treatment plan:

49. Today’s Talk • Roots of strengths-based, collaborative treatment • Initial consultations • Cultivating stories of strength and meaning • Strengths-based documentation • Promoting it at your center • Demonstration interview

50. Promoting Collaborative Strengths-Based Treatment At Your Agency • Find or cultivate allies • Converse with the director • Invite curiosity about the focus of intake procedures and paperwork • Invite mindfulness about language used in meetings and consultations • Offer trainings on narrative therapy, trauma-informed therapy, or other collaborative approaches to treatment • Invite students to collaborate • Invite and/or support ActiveMinds onto your campus • Be patient and sensitive to shame and guilt