Counselor Toolbox Podcast

Addressing Treatment Noncompliance Instructor: Dr. Dawn-Elise Snipes CEUs for this presentation can be found at https://www.allceus.com/member/cart/index/search?q=noncompliance Objectives ~ Examine some of the reasons for treatment noncompliance including ~ Learning vs. Performance ~ Low motivation ~ Not feeling heard / White-Coat Syndrome ~ Roll with Resistance ~ Tipping the Scales Questions ~ In what ways are your clients noncompliant? ~ What things are your clients often resistant about? Noncompliance ~ Is NOT a respect issue ~ Can result from ~ Lack of knowledge ~ Lack of ability ~ Lack of effective skills for that person ~ Lack of motivation ~ No buy-in to new skill or behavior ~ New skill or behavior less effective than old skill or behavior Types of Resistance ~ Issue resistance ~ Related to a specific issue such as smoking cessation, changing a dietary pattern, physical activity, etc. ~ Relational resistance ~ Has to do with the relationship between you and the client. ~ There is discord in the interactions. ~ Comments may include ~ You don’t understand ~ You can’t help me Learning vs. Performance ~ Client is motivated but not following through ~ Do they know it? ~ Can they do it? ~ Do they have confidence that they can do it? ~ How do you teach adult learners: ABCD ~ Acquisition: Auditory, Visual, Kinesthetic ~ Buy In (Why do I care?) ~ Connected to current/prior situations ~ Divided into manageable parts Learning vs. Performance ~ How do you teach performance? ~ Role play ~ Hypothesizing ~ Systematic exposure/experience ~ Example: Distress Tolerance for Anxiety ~ Have client develop distress tolerance plan ~ Remember a time last week when you were distressed and explain how you could have applied the plan ~ Role play a situation that often causes you distress and use the new skills ~ Envision yourself successfully navigating a stressful situation using new skills Learning vs. Performance ~ Systematic exposure/experience ~ Example: Distress Tolerance for Anxiety ~ IRL: Practice using the skill at least once a day on things that cause you anxiety. ~ Identify how successful it was ~ Identify what parts worked ~ Identify what you could do differently next time Tipping The Scales of Motivation ~ Stages of Readiness for Change ~ Precontemplation ~ Contemplation ~ Preparation ~ Action ~ Pain  Withdrawal  Romanticize/minimize drawbacks to old behavior ~ Motivation ~ Stages are NOT linear Motivation ~ Why is the new behavior less motivating? ~ Benefits of old behavior (Drinking, Eating, Cutting, Screaming, Sleeping) ~ How can you meet those needs now ~ Drawbacks to new behavior (Less immediately effective, less enjoyable, hard to remember to use them) ~ How can you minimize those ~ Benefits of the new behavior ~ How can you maximize those ~ Drawbacks to the old behavior ~ How can you magnify/remember these Motivation ~ What about the new behavior is less motivating ~ No buy in ~ Too hard/complicated/theoretical ~ Assumes skills not available (i.e. need to pause before DT; Need self awareness before communicating needs) ~ Not individualized ~ Meditation/PTSD/ADHD ~ Writing and reading for Extroverts ~ Support group and social gatherings for Introverts, cultures that prefer privacy ~ Tried and failed   Motivation Maintenance ~ Regularly review and add to the ~ Benefits of change ~ Drawbacks to st

Jungian Archetypes A CEU course for this podcast can be found at https://www.allceus.com/member/cart/index/search?q=jungian ~ Define Archetypes ~ Explore where they come from ~ Learn about each archetype and how to best serve them in counseling ~ Explore the type/archetype connection ~ Define each personality type and potential “stuck points” Collective Unconscious & Archetypes ~ Archetypes are innate, universal, and hereditary and function to organize how we experience certain things. ~ The collective unconscious, Jung believed, was where these archetypes exist. ~ Jung rejected the concept of tabula rasa ~ He believed that the human mind retains fundamental, unconscious, biological aspects of our ancestors which serve as a basic foundation of how to be human. Archetypes ~ Archetypes symbolize basic human motivations, values, and personalities. ~ The Persona ~ The Shadow ~ The Self ~ Anima/Animus ~ Each archetype played a role in personality, but felt that most people were dominated by one specific archetype. ~ The actual way in which an archetype is expressed or realized depends upon an individual's cultural influences and unique personal experiences. Persona ~ The persona, derived from the Latin word for “mask” is how we present ourselves to the world. ~ Represents all of the different social masks that we wear among various groups and situations. ~ This social mask to contains all of the primitive urges, impulses, and emotions that are not considered socially acceptable in each social situation. ~ Becoming too closely identified with this archetype can lead people to lose sight of their true selves. Shadow ~ The shadow is an archetype that consists of the sex and life instincts, composed of repressed ideas, weaknesses, desires, instincts, and shortcomings. (Dark side) ~ The shadow forms out of our attempts to adapt to cultural norms and expectations. ~ It is this archetype that contains all of the things that are unacceptable not only to society, but also to one's own personal morals and values. Anima/Animus ~ The anima is a feminine image in the male psyche ~ The animus is a male image in the female psyche. ~ The anima/animus represents the “true self” rather than the image we present to others ~ The collective unconscious may contain notions about how women should behave while personal experience contribute to more personal images of women. ~ Jung suggested that this discouragement of men exploring their feminine aspects and women exploring their masculine aspects served to undermine psychological development. The Self ~ The self is an archetype that represents the unified unconsciousness and consciousness of an individual. ~ Creating the self occurs through a process known as individuation, in which the various aspects of personality are integrated. ~ Who you “should be” the persona ~ Your repressed “dark side,” the shadow ~ Your masculine and feminine identity, anima/animus ~ Creating the self occurs through a process known as individuation, in which the various aspects of personality are integrated. Jung and Personality ~ Jung proposed three fundamental, innate, dichotomous ways by which individuals take in information and make decisions, in order to achieve individuation ~ An individual can use either “side” of each of the following dichotomies, but will prefer and tend to use one “pole” over the other. ~ Carl G. Jung (1875-1961) wrote that what appears to be random behavior is actually the result of differences in the way people prefer to use their mental capacities. Type and Archetype ~ Type is more descriptive of how we beh

Acronyms for Mental Health Recovery Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Continuing Education Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery CEUs are available for this presentation at  https://www.allceus.com/member/cart/index/search?q=acronyms Objectives ~ Review some quick tips and tools to help people better manage their emotions ~ Explore why each concept is necessary in recovery ~ Identify ways to use each acronym to form the foundation for a group (or homework) Fear FEAR ~ False ~ Expectations ~ Appearing ~ Real FEAR ~ Face ~ Everything ~ And ~ Recover ~ Emotional vs. Factual Reasoning ~ Facts for and against   Halt HALT ~ Hungry ~ Angry ~ Lonely ~ Tired HALT ~ Honesty (Mindfulness) ~ Acceptance ~ Loving (Compassion) ~ Tolerance FINE FINE ~ Freaked out ~ Insecure ~ Neurotic ~ Empty FINE ~ Faithful ~ Involved ~ Nimble ~ Experienced Ego-Driven vs. Purpose Driven EGO ~ Edging ~ God (Good Orderly Direction) ~ Out PURPOSE ~ Present-Focus ~ Understand what you need ~ Review your goals ~ Purposeful action (choose) ~ Observe the effects ~ Seek support ~ Evaluate Handling Urges URGE ~ Unpleasant ~ Reactive ~ Gravitate ~ Extreme THINK ~ Thoughtful ~ Honest ~ Intelligent ~ Necessary ~ Kind Mindfulness: RAID & SCAN ~ Recognize ~ Allow/Accept ~ Investigate ~ Decide how to improve the next moment   ~ Survey ~ Compassion ~ Awareness ~ Needs Distress Tolerance: ACCEPTS ~ Activities ~ Contributing ~ Comparisons ~ Emotions (Opposite) ~ Pushing Away ~ Thoughts (Happy) ~ Sensations Distress Tolerance: IMPROVE ~ Imagery ~ Meaning ~ Prayer ~ Relaxation ~ One thing at a time ~ Vacation ~ Encouragement Sleep: SHADES ~ Sleep routine ~ Hydration ~ Alcohol & Antihistamines (eliminate) ~ Darkness ~ Ergonomics ~ Stimulants (eliminate) Relaxation: RELAX ~ Recreate ~ Exercise ~ Laugh ~ Attitude adjustment ~ eXplore new hobbies, interests and places Self-Esteem: SELF ~ Strengths ~ Encouragement ~ Love ~ Friendship Relationships: FAVOR ~ Fair ~ Aware of each person’s perspectives and needs ~ Validate ~ Opportunity (Compromise) ~ Respect Communication: LOUD ~ Listen ~ Observe ~ Understand ~ Describe   Summary ~ Each of these acronyms can be used to increase awareness, trigger the use of new skills and reduce stress ~ To use these in group ~ Choose an acronym ~ Explore why that concept is important in recovery ~ Have clients identify how they operationalize or define each term ~ Create an infographic for each

Acceptance Tools Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Continuing Education Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Counseling CEUs for this presentation can be earned at https://www.allceus.com/member/cart/index/search?q=acceptance+tools Objectives ~ Accepting Failure ~ Accepting Isolation & Rejection ~ Accepting Loss of Control ~ Accepting Loss & Death Warm Up Practice ~ The Weather ~ The News ~ You wake up sick ~ Answer the following questions ~ What are the positives ~ What are the negatives ~ What is within your control ~ The situation ~ Your reaction to the situation Failure ~ When you try to do something but do not succeed ~ Identify what caused the failure: ~ Lack of realistic planning ~ Lack of knowledge ~ Lack of skills ~ Lack of focus ~ Actions of someone or something else ~ Identify what went well ~ Identify what you can learn ~ Explore the failure in terms of the big picture ~ Walk the middle path ~ I did not succeed AND I am going to be okay Failure ~ What does failure mean to you? ~ Failure is a loss ~ In what ways does failure cause you to feel ~ Angry ~ Hopeless and helpless ~ How can you integrate this loss into your life narrative? Isolation and Rejection ~ We all need to feel loved ~ By ourselves ~ By others ~ When you feel rejected ~ Who is rejecting you? ~ Other people ~ Yourself ~ Someone from your past ~ What are they rejecting? ~ You as a person ~ A particular behavior? (What is your part)   Isolation and Rejection ~ Combat Isolation ~ Define what it looks like to not feel isolated and make a plan ~ Tear down the walls / Allow other people in ~ Find common ground ~ Synergize ~ Combat Rejection ~ Know your worth ~ Separate rejection of ideas or behaviors from rejection of you as a person   Isolation and Rejection ~ When you feel rejected or isolated ~ Accept the feeling ~ Observe the facts ~ Appreciate differences ~ Remember that many times it has to do with the other person Loss of Control ~ You cannot control everything nor would you want to ~ Acceptance doesn’t mean you like it, just that you recognize you cannot control it ~ When you have a problem, you have 4 options ~ Change the situation ~ Change your response to the situation ~ Accept and tolerate the problem ~ Stay miserable Loss of Control ~ Make a list of all of the things that aggravate you because you cannot control them. ~ Circle each thing that is the results because of someone else’s thoughts or actions (Traffic, poor group performance at work, rude people…) ~ Highlight each thing that is an “act of God” (time passing, holidays, weather…) ~ Identify how you can radically accept or mitigate these things Loss and Death ~ With each loss comes some element of denial, anger, depression and acceptance. ~ All of these are normal emotions to feel, acknowledge and let go. ~ Losses come in all forms: Loss of childhood, loss of optimism/hope, loss of possessions, loss of/change in friendships (even after a move), and deaths ~ Some losses are voluntary, like moving or changing jobs. ~ Some are involuntary like death, graduation, divorce, layoffs ~ Think of losses as end-of-season cliffhangers when an actor leaves. How is the next season going to play out? Loss ~ Addressing Loss: Anger ~ Anger is a response to a perceived threat. ~ Identify what

7 Habits for Effective Recovery Counseling CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/710/c/ Objectives ~ Review the 7-Habits of Highly Effective People and how they apply to recovery from mental health and addiction issues Be Proactive ~ Be response-able ~ Your life (Vehicle) ~ What people things and activities are important to your life? What is your destination / Good Orderly Direction? ~ What thoughts, attitudes and self talk will help you move toward that destination? (Empowering, accepting, compassionate) ~ What actions will help you move toward that destination? (self-care, building support, therapy, new job…) ~ What challenges or adversities can you plan for and mitigate? (Illness, financial stresses, bad days, deaths, holidays…) Be Proactive ~ Be response-able ~ Your recovery (Engine) ~ What people things and activities are important to your recovery? What do you need to do to maintain your happiness? ~ How is your recovery important to your overall life goal or destination? In what ways does it impact the people and things that are important to you? ~ What challenges or adversities can you plan for and mitigate? Be Proactive ~ Focus on what is within your control ~ Imagine a blizzard or hurricane is coming ~ What is and is not within your control? ~ How can you minimize the distress ~ How can you maximize the happy and build your reserves ~ Make a list of things (including positive things) that are within your control Be Proactive ~ Develop skills to help you regulate your emotions, urges and actions and choose those that help you move toward happiness. ~ Admit and learn from mistakes ~ Practice the 3 finger rule ACT ~ Action ~ Changes ~ Things ~ What action can you take right now to start changing things for the better? Begin with the End in Mind ~ Most failures result from failure to envision/plan (within reason) ~ Going to the gym ~ Going to the grocery without a list ~ Going on vacation without a destination ~ Starting a project without a plan Begin with the End in Mind ~ Envision in your mind what you cannot at present see ~ If you were happy, what would be same and different? ~ What is your personal mission statement (revisable)? ~ What do you do? ~ How do you do it? ~ Why do you do it? ~ What do I really want out of life? ~ What am I uniquely put on earth to achieve? ~ What do I believe my purpose or mission is in life? Begin with the End in Mind ~ Envision in your mind what you cannot at present see ~ If you were happy, what would be same and different? ~ What is your personal mission statement (revisable)? ~ What do you do? ~ How do you do it? ~ Why do you do it? Begin with the End in Mind ~ Plan ahead and set goals ~ Specific ~ Measurable ~ Achievable ~ Time Limited ~ Realistic ~ Rewarding ~ Envision reaching your destination daily. ~ Keep track of progress toward your destination. Put First Things First (Purposeful Action) ~ Recognize that not doing everything is okay. ~ Prioritize by practicing mindful discipline ~ Remind yourself why you do the things you do ~ For new opportunities, ask “Does X get you closer to the things that are most important to you?” ~ Organization reduces stress and energy expenditure ~ Do you have energy and time to do it over if you don’t do it right the first time? (Outlining) ~ It's all right to say no or ask for help when necessary to focus on your highest priorities. Put First Things First (Purposeful Actio

Building Resilience Counseling CEs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/709/c/ The Art of Resilience ~ Resilience is a process or lifestyle that enables people to bounce back in the face of adversity ~ “a dynamic process encompassing positive adaptation within the context of significant adversity” (Luthar, Cicchetti, & Becker, 2000) ~ Resilience develops over time as people are exposed to, and successfully navigate, stressors Resiliency Theory ~ The central principles of the theory include ~ Risk factors/mechanisms ~ Vulnerability factors ~ Protective factors/mechanisms. ~ Risk factors and mechanisms are the events or conditions of adversity that cause distress in early life ~ Poverty ~ Prematurity ~ Residential mobility / lack of family or community ties ~ Addicted or dysfunctional family environment ~ Illness (cancer, M.S., chron’s disease) The Art of Resilience ~ Vulnerability factors are traits, genetic predispositions, or environmental and biological deficits which may cause heightened response, sensitivity, or reaction to stressors. ~ Cognitive impairment (FASD) ~ Lack of social support ~ Emotional dysregulation ~ Ineffective coping skills ~ Mood or addictive disorders in the person ~ Poor physical health (pain, nutrition, hormones, sleep) The Art of Resilience ~ Protective factors and mechanisms are things which enhance or promote resistance, or which may moderate the effect of risk factors. ~ Rutter (1987) suggests that protective mechanisms may operate in one of four ways to allow overcoming adversity: ~ Reducing risk impact ~ Reducing negative chain reactions to risk factors ~ Promoting resiliency traits ~ Setting up new opportunities for success. The Art of Resilience ~ Fergus and Zimmerman (2005) identified two types of protective factors. ~ Assets are positive factors that reside within individuals, such as: ~ Self-efficacy and self-esteem ~ Social competence and communication skills ~ Resources refer to factors outside individuals, such as: ~ Social support ~ Opportunities to learn and practice skills ~ Wellness programs that support biological health 6-Cs of Resilience ~ 6-Cs ~ Coping ~ Control ~ Character ~ Confidence ~ Competence ~ Connection (resource)   Characteristics “Assets” of Resilient People ~ Coping: Can effectively balance negative and positive emotions and manage strong impulses. ~ Emotion Regulation / Prevent or mitigate vulnerabilities ~ Distress Tolerance ~ Problem Solving Skills ~ Control/Autonomy: A sense of personal identity and ability to act independently to exert some control over one’s situation ~ Who are you, and who and what is important to you? ~ What things can you change in this situation? ~ The situation? ~ Your reaction to the situation? Characteristics “Assets” of Resilient People ~ Character and a sense of purpose and future: ~ Purposeful Action: Make realistic plans for a meaningful life based on what is important to you ~ Take the steps necessary to achieve goals ~ Notice positive, forward moving thoughts and behaviors in yourself and others ~ Confidence in one’s strengths and abilities ~ What are your strengths? ~ In what ways does your response [to this stressor] make sense? ~ How did you get through similar situations? ~ What helpful or self-defeating thoughts are you telling yourself? Characteristics “Assets” of Resilient People ~ Competence ~ Ability to mitigate emotions and successfully problem solve ~

PTSD Prevention in First Responders Presenter: Dr. Dawn-Elise Snipes Counseling CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/378/c/ Objectives ~ What is PTSD and Cumulative PTSD? ~ Prevention: Why and When? ~ HPA-Axis AKA Threat Response System ~ Prevention: How? ~ Destination ~ Mindfulness ~ Vulnerabilities ~ Cognitions ~ Interventions ~ Specific Interventions   PTSD ~ Exposure to a traumatic event that involved actual or the potential for death or serious injury in which there was a sense of helplessness and horror. ~ 3 Types ~ Single Exposure (The straw that broke the camel’s back) ~ Chronic Exposure ~ Secondary Exposure (Think… Spouses of people working Twin towers) ~ Spouses – When Mama ain’t happy… ~ Children Introduction ~ For the vast majority of the population, the psychological trauma is limited to an acute, transient disturbance. ~ The signs and symptoms of PTSD reflect a persistent, abnormal adaptation of neurobiological systems to the witnessed trauma. ~ For more information (psychobabble) about the exact brain changes that take place in people with PTSD, view the video on our YouTube Channel: Neurobiological Impact of Psychological Trauma on the HPA-Axis PTSD Symptoms & Functions ~ Re-Experieincing: Flashbacks, nightmares ~ Avoidance: Avoiding any triggers for re-experiencing ~ Sight, Smell, Sound, Taste, Touch, Place, Time, Objects… ~ Arousal or Reactivity ~ Hypervigilance /Easy startle ~ Difficulty Sleeping ~ Angry outbursts ~ Cognition/Mood ~ Trouble remembering key features of the traumatic event ~ Negative thoughts about oneself or the world (Us-Them) ~ Distorted feelings like guilt or blame ~ Loss of interest in enjoyable activities Burnout –Not Quite PTSD, but Just as Bad ~ Physical, Mental, Emotional Exhaustion: Rookie ~ Frustration, Guilt, Loss of a sense of purpose ~ Nothing I do makes a difference. ~ There’s just too many of them ~ Self-consciousness about their sense of vulnerability, emotional reactions ~ Cynicism and callousness: In response to prolonged feelings of helplessness some people put on heavy armor hey develop an ~ “Look out for # 1.” “Cover your ass.” “Not a Social Worker.” ~ Failure, helplessness and crisis: R.O.D Deputy Risk Factors ~ The response of an individual to trauma depends not only on stressor characteristics, but also on factors specific to the individual. ~ Perception of stressor ~ Proximity to safe zones ~ Similarity to victim ~ Degree of helplessness ~ Prior traumatic experiences (1+1=5) ~ Amount of stress in the preceding months (Including family, personal and organizational) ~ Current mental health or addiction issues ~ Availability of social support 4/24 Prevention Whys ~ It is easier (and cheaper) to intervene early ~ Activity—identify someone who has developed burnout. What are the impacts ~ Emotionally (anger, anxiety, moodiness, withdrawn, depressed) ~ Mentally (outlook, concentration, hope, screw it attitude, gets behind on paperwork) ~ Physically (illness, exhaustion, weight gain, increased drinking) ~ Socially (relationships with family, friends, ability to get along with team, draws complaints, “lost puppies”) Prevention Whens ~ NOW! ~ Prevention mitigates vulnerabilities and strengthens the force ~ A vulnerable officer is more likely to: ~ Draw a complaint ~ Make a mistake ~ Get hurt ~ Develop stress related illnesses and mood issues The HPA Axis: Threat Response Sy

Cognitive Processing Therapy with Anxiety, Trauma and Chronic Conditions Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Counselor Continuing Education Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Counseling CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/336/c/ Objectives ~ Learn the goals of CPT ~ Discuss how CPT can be applied to people with chronic conditions, anxiety or trauma issues ~ Identify some of the common tools used in CPT which can be helpful with many clients Introduction ~ CPT is based on a social cognitive theory that focuses on how the event or symptoms are construed and coped with by a person who is trying to regain a sense of mastery and control in his/her life (chronic illness dx, trauma, GAD) ~ Emotions such as fear, anger, or sadness may emanate directly from the trauma or condition (primary emotions), because the situation is interpreted as dangerous, and/or resulting in losses. ~ Secondary, or manufactured, emotions also result from faulty interpretations made by the patient. Social-Cognitive Theory ~ Social-cognitive theories focus more on the content of cognitions and the effect that distorted cognitions have upon emotional responses and behavior. ~ In order to reconcile the information about the current situation with prior schemas, people tend to do one or more of 3 things: ~ Assimilation is altering the information to match prior beliefs (“Because a bad thing happened to me, I must deserve punishment”). ~ Accommodation is altering beliefs enough to incorporate the new information (“Although I didn’t use good judgment in that situation, most of the time I make good decisions”). ~ Over-accommodation is altering ones beliefs about oneself and the world to the extreme in order to feel safer and more in control (“I can’t ever trust my judgment again”). Dimensions of Disruption ~ 5 major dimensions that may be disrupted by traumatic events: ~ Safety ~ Trust ~ Power and Control ~ Esteem ~ Intimacy 12-Session Protocol ~ Introduction ~ Meaning of the event ~ Identification of Thoughts and Feelings ~ Remembering the Event ~ Identifying “Stuck” Points ~ Challenging Questions ~ Problematic Thinking ~ Safety ~ Trust ~ Power and Control ~ Esteem ~ Intimacy and Meaning Natural and Manufactured Feelings ~ 2 kinds of emotions that follow traumatic events. ~ Natural/universal: fear when in real danger, anger when being intentionally harmed, joy or happiness with positive events, or sadness with losses. ~ Natural emotions have a natural course. They will not continue on forever unless there is something that you do to feed them ~ Manufactured feelings, result not directly in response to the event, but based on how you interpret the event. Goals ~ Help clients recognize and modify what they are saying to themselves “stuck points” ~ Help clients identify: ~ How the condition or event impacted on your views of yourself, other people, and the world. ~ Why this event happened to you ~ How has it changed or strengthened your views about yourself, other people and the world in general? ~ Address the content of the meaning derived from the traumatic memory. ~ Help clients accommodate, or accept that the traumatic event occurred and discovering ways to successfully integrate the experience into the one’s life Goals cont… ~ Determine the impact of the traumatic event or condition on beliefs about self and others ~ Begin to normalize the grief process and differentiate it from PTSD, anxiety or depressive symptoms ~ Ident

Treatment for People with Borderline Parents Instructor: Dr. Dawn-Elise Snipes Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Counseling CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/375/c/ Objectives ~ Review the characteristics of BPD ~ Compare and contrast BPD with addictive behaviors ~ Examine ways to implement the activities presented in the book in a group format Characteristics of BPD ~ Poorly developed, or unstable self-image, often associated with excessive self-criticism ~ Difficulty recognizing the feelings & needs of others ~ Interpersonal hypersensitivity (i.e., prone to feel slighted or insulted) ~ Perceptions of others tend to focus on negative attributes or vulnerabilities. Characteristics of BPD ~ Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and fear of abandonment ~ Close relationships ~ Viewed in extremes of idealization and devaluation ~ Alternating between over involvement and withdrawal. Effects on Others ~ Feeling inadequate despite best efforts to appease ~ Lack of emotional boundaries ~ Responsible for the parent’s happiness ~ Guilt for personal happiness ~ Difficulty trusting people due to alternations between feeling appreciated and condemned ~ Anxiety because the parent was unpredictable ~ Hypervigilance I Never Knew It Had A Name ~ Group Activity 1 ~ Discuss the function of each symptom for the parent ~ Have participants identify any behaviors they have which may also resemble that symptom ~ Review and refute the take-aways providing practical cognitive and interpersonal skills ~ Group Activity 2 ~ Stop & Think: The Lessons are Clear—Review and Refute All Grown Up ~ Examines the effects of the borderline personality on the living conditions ~ Chaos ~ Abuse and Neglect ~ Boundary Violations ~ Invalidation ~ Role Reversals ~ Looks are Everything ~ Keen Perception All Grown Up ~ 6 Seeds to Grow a Healthy Child ~ Support ~ Respect and Acceptance ~ Voice ~ Unconditional Love and Affection ~ Consistency ~ Security All Grown Up ~ Group Activity 1 ~ Examine each effect of the Borderline Personality ~ Discuss how each was present in the family of origin ~ Discuss how each is manifested in the client’s current life ~ Identify methods to eliminate those dysfunctional patterns All Grown Up ~ Group Activity 2 ~ 6 Seeds: Discuss how to use those 6 principles to ~ Reparent/nurture self ~ Nurture healthy relationships ~ Group Activity 3 ~ Stop and Think: Resiliency Builders Grieving a Lost Childhood ~ Understand the grieving process ~ Review messages received in childhood about dealing with losses ~ Identif losses and feelings associated with the dysfunctional childhood ~ Identify continuing issues with the borderline/addicted parent Grieving a Lost Childhood ~ Group Activity ~ Describe what you would have liked your childhood to be like ~ As a group, identify ways to translate that to present day. Guilt, Responsibility & Forgiveness ~ Identify potential guilt-triggers for the adult child ~ Discuss how guilt works, and what the benefits/motivations for guilt may be ~ Identify and discusses different origins of guilt ~ Encourage identification of what can & cannot be controlled ~ Explore the issues of guilt and responsibility ~ Encourage participants to examine their beliefs related to forgiveness Guilt, Responsibility &

Love Me Don’t Leave Me Addressing Fears of Abandonment Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs *Based in part on Love Me Don’t Leave Me by Michelle Skeen, PsyD.   Counseling CEUs can be earned for this presentation at https://www.allceus.com/member/cart/index/product/id/517/c/ Objectives ~ Help clients increase awareness of their story including beliefs about and behavioral reactions to situations that trigger your fear of abandonment ~ Learn about fear of abandonment ~ Explore the concept of schemas or core beliefs ~ Examine common traps in thinking, reacting and relationships ~ Learn skills necessary to ~ Accept their past as part of their story ~ Acknowledge that their past does not have to continue to negatively impact them in the present How It Impacts Recovery ~ Connection is a basic human need ~ As infants and children, survival was dependent upon the relationship with the primary caregiver ~ People’s beliefs about other people and relationships was formed largely based on their interactions with their caregivers ~ Healthy relationships serve as a buffer against stress How It Impacts Recovery ~ Addressing beliefs that formed as a result of these relationships will help people: ~ Create a new understanding of these events ~ Better understand themselves and their reactions ~ Help them make more conscious, healthy decisions in their current relationships Abandonment Experience ~ In childhood, survival depends on caregivers. ~ Fear of abandonment is a natural survival response ~ Meeting biological needs and safety are key triggers for anxiety at any age. ~ When focused on survival people cannot focus elsewhere ~ Every stressful situation becomes a crisis in the insecurely attached child Abandonment Experience ~ In infancy/early childhood, caregivers were: ~ Away for long periods (Work, military, jail, choice, death) ~ Been inconsistently or unpredictably physically or emotionally present. (emotional distress, addiction, ill equipped to deal with a child) ~ In later childhood ~ Poor family fit/black-sheep ~ Trauma that ruptures the relationship with the primary caregiver ~ Introduction of a new, less emotionally or physically safe caregiver   Reactions to Fears of Abandonment ~ Fight or flight ~ Anger toward someone who is unavailable ~ Sadness (helplessness) when someone goes away ~ Shame (Self anger) about feeling needy ~ Fear ~ Rejection/isolation ~ Loss of control/the unknown ~ Failure ~ Questions for clients ~ What caused these fears as a child? How were they reasonable/helpful. ~ What causes these fears now? How are they unhelpful? Temperament ~ Based on their temperament, children need different types and amounts of caregiver interaction ~ Wide open and easily overstimulated ~ The energizer bunny ~ The introvert ~ The extrovert ~ If abandonment fears are triggered in early childhood, it can be addressed. *It is important to pay attention to the behaviors that are being reinforced Schemas ~ Based on their needs and caregivers reactions, children form schemas or core beliefs about the world and others ~ Important points about children under 7: (ages 8-12 children are developing alternate cognitive skills) ~ Children think dichotomously ~ Children are egocentric ~ Children can only focus on one aspect at a time ~ Children cannot think abstractly (consider other “possible” options) Schemas ~ A broad way of perceiving things based upon memories, feelings, thoughts ~ Schemas that trig

Strengths Based Biopsychosocial Approach to Recovery from Addictions and Personality Disorders Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Earn Counseling CEUs for this presentation is at https://www.allceus.com/member/cart/index/product/id/507/c/ Objectives ~ Define Personality Disorders ~ Examine the similarities between the behaviors of certain personality disorders and addictions ~ Identify ways to address these behaviors and thought patterns ~ Encourage clinicians to critically examine behaviors in patients with addiction in order to effectively differentially diagnose Why I Care/How It Impacts Recovery ~ When personality disorders are viewed as pervasive & perpetual, it ~ Provides an “excuse for relapse” ~ Often derails treatment because patterns of behavior thought to be due to the PD are essentially ignored ~ Personality Disordered & Addictive Behavior often look the same ~ Goals for recovery from both: ~ Honesty with self & others about thoughts/feelings/needs/wants (Mindfulness) ~ Distress tolerance and the ability to self-soothe ~ Hope and faith in self/future/others through addressing cognitive errors ~ Development of self esteem to eliminate need for external validation ~ Development of healthy, supportive relationships Personality Disorders ~ Represent a cluster of behaviors that is pervasive beginning before the age of 15. ~ Addictive behaviors also often begin before 15 ~ Due to immature cognitive development, children tend to be more egocentric, overgeneralize and think in terms of dichotomies ~ From a survival perspective, most of these behaviors make perfect sense when viewed through the eyes of a child Personality Disordered/Addictive Behaviors ~ Treatment ~ Since these behaviors formed the foundation for further development patients must: ~ Understand their function in the past ~ Identify how these behaviors and beliefs are faulty in the present ~ Develop alternative skills ~ Be empowered to interface with the world with the strengths, knowledge and tools of the adult Addictions & Personality Disorders ~ Cluster A (Paranoid, Schizoid, Schizotypal) ~ Characterized by social awkwardness and withdrawal ~ Often co-occur with addictions ~ Cluster C (Obsessive-Compulsive; Dependent) ~ Characterized as anxious and fearful ~ May co-occur with addiction ~ Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) ~ Characterized by dramatic, emotional, erratic behavior ~ Behavioral patterns overlap with addiction Addictions & Personality Disorders ~ Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) ~ Characterized by ~ Dramatic, emotional, erratic behavior ~ All or Nothing thinking ~ Hostility and Aggression ~ Hypersensitivity ~ Manipulative ~ Low Self-Esteem / Weak Self-Concept What environment might perpetuate these behaviors? What about those with decent childhoods? Addictions & Personality Disorders ~ Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) ~ Antisocial: ~ Disregard for the rights of other people ~ Impulsivity ~ Hostility and/or aggression ~ Deceit and manipulation ~ Seem to lack empathy What environment might perpetuate these behaviors? What about those with decent childhoods? Addictions & Personality Disorders ~ Cluster B ~ Histrionic ~ Excessive emotionality and attention seeking ~ May become enraged at perceived rejection ~ Need to be the center of attention ~ Inability to engage in au

A Strengths Based Biopsychosocial Approach to PTSD Instructor: Dr. Dawn-Elise Snipes Ph.D., LMHC Objectives – Highlight the functional nature of most behaviors and reactions – Define PTSD – Examine the function and meaning of PTSD symptoms – Develop an understanding of why some people develop PTSD and others do not – Explore useful interventions for persons with PTSD Reward and Survival – Humans and animals experience reactions to prompt behavior – Anger/Fight – Fear/Flight – Reactions are responses designed to – Protect life – Achieve a reward/avoid punishment PTSD and Gradual Onset PTSD – PTSD: Traditional exposure to an event or multiple events – Military – Crime Victims – Gradual Onset PTSD: repeated exposure to horrific or threatening events causing a sense of helplessness – Law Enforcement – Military – Child Abuse/Neglect Definition – Exposure to a horrifying event in which there was a sense of helplessness – For each symptom that follows, we will identify – The function – What triggers that symptom or exacerbates it – How the person deals with/mitigates that symptom – Other things he or she could do Symptoms – Re-experiencing the traumatic event – Intrusive, upsetting memories of the event – Flashbacks (acting/feeling like the event is happening again) – Nightmares – Feelings of intense distress when reminded – Intense physical (panic) reactions to reminders Symptoms – PTSD symptoms of avoidance and emotional numbing – Avoiding reminders of the trauma – Inability to remember important aspects of the trauma – Loss of interest in activities and life in general – Feeling detached from others or emotionally numb – Sense of a limited future Symptoms – PTSD symptoms of increased arousal – Difficulty falling or staying asleep – Irritability or outbursts of anger – Difficulty concentrating – Hypervigilance (on constant “red alert”) – Feeling jumpy and easily startled Other common symptoms of PTSD – Anger and irritability – Guilt, shame, or self-blame – Substance abuse – Depression and hopelessness – Suicidal thoughts and feelings – Feeling alienated and alone – Feelings of mistrust and betrayal – Headaches, stomach problems, chest pain Triage – Similarity to the victim (or being the victim) – Proximity to your safe zones (home, work) – Social support after the trauma – History of mental health problems – Number of stressors in the past 6 months Assessment – If you were not the victim, how were you similar to the victim- – How are people around you similar to the perpetrators- – What was (or would have been) helpful for people to do after the trauma- – Who can you rely on to do those things now- Creating Safety – What can you do to take back your “safe zones” – How can your protect yourself from this in the future- – How did the experience change – How you view things- – What is important to you- – How you will live your life now- Sleep – Function – Balances neurochemicals – Helps reduce cortisol – May improve adrenal fatigue – Safety – Environmental (Feng Shui) – Common sense Sleep

Using a Strengths-Based Biopsychosocial Approach to Addressing Anxiety Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Define a strengths based approach ~ Define a biopsychosocial approach ~ Explore the symptoms of anxiety ~ Identify potential causes of and biological, psychological and social interventios for those symptoms Why I Care/How It Impacts Recovery ~ Anxiety can be debilitating ~ Low-grade chronic stress/anxiety erodes your energy and ability to concentrate ~ Anxiety is a major trigger for: ~ Addiction relapse ~ Increased physical pain ~ Sleep problems What Does Strengths Based Mean ~ It is easier (and more effective) to build upon something that already works to some extent. ~ Strengths-based approach helps people identify how they are already trying to cope and builds on that ~ There are two types of strengths ~ Prevention/Resilience Strengths ~ What you do on a daily basis to stay healthy and happy ~ Intervention/Coping Strengths ~ In the past when you have felt this way, what helped? ~ What made it worse? What is a Biopsychosocial Approach ~ Bio-logical ~ Neurochemicals ~ Nutrition ~ Sleep ~ Sunlight & Circadian Rhythms ~ Psycho-logical ~ Mindfulness ~ Distress Tolerance ~ Coping Skills ~ Cognitive Restructuring ~ Social ~ Improving self-esteem and your relationship with self ~ Improving relationships with healthy, supportive others What is Anxiety ~ Anxiety is half of the “Fight or Flight Response” ~ It is an excitatory response ~ It’s function is to protect you from danger ~ It can become a problem when it is ~ Overgeneralized ~ Overly intense/uncontrollable ~ Constant due to brain injury ~ Like depression, it can be caused by excess serotonin Serotonin: A Common Neurobiologic Substrate in Anxiety and Depression. EISON, MICHAEL S. PhD Symptoms of Generalized Anxiety ~ Generalized anxiety disorder symptoms can vary. They may include: ~ Persistent worrying or obsession about small or large concerns that's out of proportion to the impact of the event ~ Inability to set aside or let go of a worry ~ Inability to relax, restlessness, and feeling keyed up or on edge ~ Difficulty concentrating, or the feeling that your mind “goes blank” ~ Distress about making decisions for fear of making the wrong decision ~ Carrying every option in a situation all the way out to its possible negative conclusion ~ Difficulty handling uncertainty or indecisiveness Symptoms of Generalized Anxiety ~ Generalized anxiety disorder symptoms can vary. They may include: ~ Physical signs and symptoms may include: ~ Fatigue ~ Irritability ~ Muscle tension or muscle aches ~ Trembling, feeling twitchy ~ Being easily startled ~ Trouble sleeping ~ Sweating ~ Nausea, diarrhea or irritable bowel syndrome ~ Headaches Symptoms of Generalized Anxiety (Kids) ~ Excessive worry about: ~ Performance at school or sporting events ~ Being on time (punctuality) ~ Earthquakes, nuclear war or other catastrophic events ~ A child or teen with GAD may also: ~ Feel overly anxious to fit in ~ Be a perfectionist ~ Lack confidence ~ Strive for approval ~ Require a lot of reassurance about performance Biological Interventions ~ Your body thinks there is a threat. Figure out why ~ Supportive Care ~ Create a sleep routine ~ Helps the brain and body rebalance ~ Can help repair adrenal fatigue ~ Improves energy level ~ Nutrition ~ Minimize caffeine and other stimulants ~ Try to prev

ACT and the Matrix What Every Counselor Should Know with Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox & Happiness Isn’t Brain Surgery CEUs based on this video are available at https://www.allceus.com/member/cart/index/product/id/519/c/ Objectives ~ Review the main points of Acceptance and Commitment Therapy ~ Review how to apply the matrix ~ Identify the shortcut question The Main Principles of ACT ~ The goals are to: ~ Create a rich and meaningful life, while accepting the pain that inevitably goes with it. ~ Learn to perceive difficult thoughts and feelings as harmless, even if uncomfortable, transient psychological events. ~ Take effective action guided by your deepest values and in which you are fully present and engaged. (No autopilot) Control is the Problem, Not the Solution ~ Clean Discomfort: When emotions and reactions are accepted, it leads to a natural level of physical and emotional discomfort ~ Dirty Discomfort: Once you start struggling with it, your “struggle switch is turned on” and discomfort increases rapidly. ~ Struggle switch is like an emotional amplifier—switch it on, and you can have anger about your anxiety, anxiety about your anger, depression about your depression, or guilt about our guilt. Experiential Avoidance ~ The more time and energy spent trying to avoid or get rid of unwanted feelings in general, the more we are likely to suffer “Quicksand” ~ Anxiety (Fear things won’t get better) ~ Anger (Frustration things aren’t getting better) ~ Depression (Hopelessness and helplessness—resignation that things can’t get better) Changeable Variables in Context ~ Emotions are a natural way your body prompts you to act. ~ Focus on changeable variables in the context in which the issue occurs ~ Physical vulnerabilities (sleep, nutrition, pain) ~ Relationships (boundaries and communication) ~ Thoughts (Distress Tolerant) ~ Behaviors (DBT/CBT)   Six Core Principles of ACT ~ Values Awareness ~ Contact with the Present Moment ~ The Observing Self ~ Acceptance ~ Diffusion ~ Committed Action Clarifying the Destination Values & Goals Awareness ~ A lack of clarity about values can underlie much of people’s distress or keep them “stuck.” ~ Like going on a road trip without a destination ~ They can get caught up spinning their wheels trying to fight against something or use that same energy to work toward something. ~ “What is the most effective use of your limited energy and time to help you achieve your goals?” Clarifying the Destination Values & Goals ~ Clarifying ~ Relationships: Who is most important to you? ~ Which people? ~ What do you want those relationships to be like? ~ What events, things, experiences are meaningful to you? ~ Work ~ Health ~ Personal Growth Clarifying cont… ~ Values ~ What values do you want to embody (Choose 5)? ACT Matrix: Destination Identification • Values Awareness • Contact with the Present Moment • The Observing Self • Acceptance • Diffusion • Committed Action The Observing Self The Audience ~ Fly on the Wall /Scientist/Nurse doing bed check ~ Curious ~ Objective ~ Nonjudgmental Mindfulness in the Present Moment Awareness of What Is ~ Contact with the Present Moment/Bringing full awareness to your here-and-now experience ~ How do I feel? ~ What are my thoughts, wants and urges? ~ What physical sensations am I experiencing? ~ Describe the environment—smell, temperature, colors, objects, people, sounds, etc…

Medical Error Prevention in Comprehensive Integrated Systems of Care 2017 Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery CEUs are available on demand for this video at https://www.allceus.com/member/cart/index/product/id/698/c/ Objectives ~ Identify medical errors common in a comprehensive integrated system of care including pain management ~ Discuss how pain influences the comprehensive treatment process ~ Identify causes of errors ~ Describe effects of medical errors on the patient and family ~ Identify common documentation and communication errors in multidisciplinary teams ~ Define “medical error” ~ Identify the factors in a credible root cause analysis ~ Identify major signs and symptoms of a medical emergency ~ Describe other interventions designed to prevent harm and to protect patient safety commonly utilized by therapists Definition of “medical error” (NIM) ~ Diagnostic errors ~ Error or delay in diagnosis ~ Failure to use indicated tests ~ Use of outdated therapy ~ Failure to act on results of monitoring or testing     ~ Treatment ~ Error in the performance of procedure, test ~ Avoidable delay in treatment or in responding to an abnormal test ~ Inappropriate (not indicated) care ~ Type ~ Intensity ~ Breadth/Diversity ~ Duration Medical Errors in Counseling ~ Counselors often work with teams of specialists and support personnel ~ Psychiatrists & Psychologists, Mental health professionals ~ Physicians, Physician’s assistants & Nurse practitioners ~ Nutritionists ~ Physical and occupational therapists ~ Pain management specialists ~ Certified addiction professionals ~ Pastor/ religion/faith leaders ~ Relatives More Medical Errors ~ Prevention ~ Failure to consider multiple causes of symptoms ~ Failure to provide preventative treatment ~ Inadequate monitoring or follow-up of treatment ~ Other ~ Failure of communication ~ Equipment failure ~ Other system failure Documentation & Communication Errors ~ Short hand ~ Poor communication between teams ~ Documentation quality ~ Content ~ Lack of a single point of contact ~ HIPAA Violations ~ Making assumptions without clarification or confirmation ~ Reasons for medications the patient is taking ~ Causes of pain or distress   Error Causes ~ Multiple professional involvement. (Too many cooks without a Chef) ~ Misdiagnosis or assignment of a false diagnosis ~ Intimidation ~ Over-treatment ~ Relay false client/patient or their own personal information ~ Inappropriately share or distort information ~ Attempt to treat out of the realm of expertise ~ Do not consult with medical professionals Error Causes ~ Do not thoroughly collect background histories or complete assessments ~ Provide inadequate safety or security of physical environment ~ Recommend inappropriate or dangerous treatment protocol Medical Error Effects ~ Loss of trust  drop-out, relapse or symptom worsening ~ Loss of trust that accurate, complete information will be passed ~ Reversal or relapse of mental health and other physical conditions ~ Take incompatible medications due to a lack of communication by the patient’s various providers ~ Abuse medications or take inappropriate medications when multiple causes for emotional or physical pain are not considered Medical Error Effects ~ Lose important wraparound