Missouri Rehabilitation Association
Presents
Beyond Resistance
Generating Strengths, Hope, & Possibilities
with Challenging People
Bob Bertolino, Ph.D.
Associate Professor, Maryville University-St. Louis
Sr. Clinical Advisor, Youth In Need, Inc.
Sr. Associate, International Center for Clinical Excellence
Tidbits
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•
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•
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Contact: bertolinob@cs.com; 314.852.7274
bobbertolino.com
Overview
1. Understanding Characteristics of Unresponsive
Clients
2. Three Challenges with Unresponsive Clients: The
Data
3. Personal Philosophy in the Service of Change
4. Evidence-Based Practice (EBP)
5. A Strengths-Based Approach: Principles and
Strategies
Characteristics of Unresponsive
Clients
Characteristics of Unresponsive Clients
• What kind of clients are most challenging for you?
• What specifically do these clients do that is
frustrating or discouraging or difficult or __________
to mitigate?
• What effect(s) do/does these behaviors have on
you?
• How about on your ability to help such clients?
• How have you successfully mitigated past
challenges with clients?
Three Challenges with
Unresponsive Clients:
The Data
Challenge #1
Psychotherapy works but primarily with a subset of clients. Despite a
substantial increase in diagnostic categories and a proliferation of treatment
approaches and specialized techniques, the effect size of psychotherapy has
not improved since the first meta-analytic studies in 1977 (Bertolino,
Bargmann, & Miller, 2012). Further, 30% to 50% of clients do not benefit from
therapy (Lambert, 2010) with deterioration rates among adult clients
between 5%-10% (Hansen, Lambert, & Forman, 2002; Lambert & Ogles,
2004)
Bertolino, B., Bargmann, S., & Miller, S. D. (2013). Manual 1: What works in therapy: A primer. The ICCE manuals of feedback
informed treatment. Chicago, IL: International Center for .Clinical Excellence.
Hansen, N., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implication for treatment
delivery services. Clinical Psychology: Science and Practice, 9(3), 329–343.
Lambert, M. J. (2010). Prevention of treatment failure: The use of measuring, monitoring, and feedback in clinical practice.
Washington, DC: American Psychological Association.
Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. New Jersey: Lawrence Erlbaum.
Challenge #2
Clients who are not improving and/or deteriorating dropout of services
at a higher rate. Dropout: the unilateral decision by clients to end therapy—
averages are between 20% to 47% (Swift et al., 2012; Wierzbicki & Pekarik,
1993). In addition, it is estimated that the clients who do not benefit or
deteriorate while in psychotherapy are responsible for 60-70% of the total
expenditures in the health care system (Miller, 2010).
Miller, S. D. (2010). Psychometrics of the ORS and SRS. Results from RCT’s and Meta-analyses of Routine Outcome Monitoring
& Feedback. The Available Evidence. Chicago, IL. http://www.slideshare.net/scottdmiller/measures-and-feedback-january2011.
Swift, J. K., Greenberg, R. P., Whipple, J. L., & Kominiak, N. (2012). Practice recommendations for reducing premature termination
in therapy. Professional Psychology: Research and Practice, 43(4), 379-387.
Wierzbicki, M., & Pekarik, G. (2002). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice,
24(2), 190-195.
Challenge #3
There is substantial variation in outcomes between providers with
similar training and experience.
• Some therapists consistently have better outcomes, regardless of the
diagnoses, age, developmental stage, medication status, or severity of their
clients. (Wampold & Brown, 2005)
• Clients of the most effective therapists improve at a rate at least 50% higher and
drop out at a rate at least 50% lower than those of less effective therapists.
(Wampold & Brown, 2005)
• 97% of the difference in outcome between therapists is attributable to
differences in their ability to form alliances with clients. (Anderson et al., 2009;
Baldwin, Wampold, & Imel, 2007)
Anderson, T. Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal
skills as a predictor of therapist effects. Journal of Clinical Psychology, 65(7), 755-768.
Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of
therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852.
Wampold, B. E., & Brown, G. S. (2005). Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes
in managed care. Journal of Consulting and Clinical Psychology, 73(5), 914–923.
Personal Philosophy in the
Service of Change
PRACTICES
“What we do”
↑
THEORY/MODELS
“How we think”
↑
PERSONAL PHILOSOPHIES
“Who we are”
What is My Philosophy?
1. What are my core beliefs, ideas, or assumptions about the
clients with whom I work?
2. How did I arrive at those beliefs?
3. What has most significantly influenced my beliefs, ideas,
and assumptions as they relate to my clients?
4. How have my beliefs, ideas, and assumptions affected my
work with clients? With colleagues/peers? With larger
communities?
What is My Philosophy (cont.)?
4.
5.
6.
7.
How do I believe that change occurs?
Do I believe that some degree of change is possible with
every client? (If you answered “yes” then end here.)(If you
answered “no,” proceed to the next question.)
How do I work with clients whom I believe cannot (or do
not want to or are resistant to) change? What do I do?
If I do not believe that every client (and/or family) can
experience some degree of change, what keeps me in
doing this kind of work?
The Costs of Negativity
• A recent study shows that extensive discussions of problems and
encouragement of ‘‘problem talk,’’ rehashing the details of problems,
speculating about problems, and dwelling on negative affect in particular,
leads to a significant increase in the stress hormone cortisol, which
predicts increased depression and anxiety over time.
• People who are in a more positive mood are better liked by others and
more open to new ideas and experiences.
Byrd-Craven, J., Geary, D. C., Rose, A. J., & Ponzi, D. (2008). Co-ruminating increase stress hormone levels in women.
Hormones and Behavior, 53, 489–492.
Fredrickson, B. (1998). What good are positive emotions? Review of General Psychology, 2, 300-319.
Bertolino, B. (2015). The residential youth care worker in action: A collaborative, strengths-based approach.
New York: Routledge.
Evidence-Based Practice (EBP)
Evidence-Based Practice (EBP)
“The integration of the best available research with
clinical expertise in the context of patient
characteristics, culture, and preferences.” (p. 273)
APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American
Psychologist, 61(4), 271–285.
Clinical Expertise
The APA Task Force on EBP
“Clinical expertise… entails the monitoring of patient progress (and of changes in the
patient’s circumstances—e.g., job loss, major illness) that may suggest the need to
adjust treatment… If progress is not proceeding adequately, the psychologist alters or
addresses problematic aspects of the treatment (e.g., problems in the therapeutic
relationship or in the implementation of the goals of the treatment) as appropriate”
(2006, pp. 280, 276-277).
APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist,
61(4), 271–285.
Lambert, M. J., Bergin, A. E., & Garfield, S. L. (2004). Introduction and overview. In M. J. Lambert (Ed.), Bergin & Garfield’s
handbook of psychotherapy & behavior change (5th
ed.)(pp. 3-15). New York: Wiley.
Warren, J. S., Nelson, P. L., Mondragon, S. A., Baldwin, S. A., & Burlingame, G. A. (2010). Youth psychotherapy change trajectories
and outcomes in usual care: Community mental health versus managed care settings. Journal of Consulting and Clinical
Psychology, 78(2), 144-155.
Patient (Client) Characteristics,
Culture, and Preferences
•
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Client characteristics (i.e., age, gender, gender identity,
ethnicity, race, social class, disability status, sexual
orientation, developmental status, life stage, etc.).
Strengths, resources, beliefs, and factors that can
influence change.
Understanding of the local knowledge and culture.
Personal preferences, values, and preferences related to
treatment (e.g., goals, beliefs, worldviews, treatment
expectations).
A Strengths-Based Approach:
Principles and Strategies
The Pathology Bias
•
Freud thought the best we could hope for in life was
“ordinary misery.”
•
Behavioral health has historically focused on
pathology.
•
Until recently, psychological publications and studies
dealing with negative states outnumber those
examining positive states by a ratio of 21 to 1.
•
A bias in behavioral health has been to get people
back to zero; a result of which is the “empty person.”
•
We can help individuals to better leverage strengths
and resources, a result of which is a reduction in
negative symptoms and an increase in well-being.
From Pathology to Strengths
“What we have learned over 50 years is that the disease model does not
move us closer to the prevention of these serious problems. Indeed the
major strides in prevention have largely come from a perspective focused
on systematically building competency, not correcting weakness.
Prevention researchers have discovered that there are human strengths
that act as buffers against mental illness: courage, future-mindedness,
optimism, interpersonal skill, faith, work ethic, hope, honesty, perseverance,
the capacity for flow and insight, to name several… We need now to call for
massive research on human strength and virtue. We need to ask
practitioners to recognize that much of the best work they already do in the
consulting room is to amplify strengths rather than repair the weaknesses of
their clients.” (p. 6-7)
Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1),
5–14.
Strengths-Based Defined
A strengths-based perspective emphasizes the abilities and resources people
have within themselves and their support systems to more effectively cope with life
challenges. When combined with new experiences, understandings and skills,
those abilities and resources contribute to improved well-being, which is
comprised of three areas of functioning: individual, interpersonal relationships, and
social role. Strengths-based practitioners value relationships convey this through
respectful, culturally-sensitive, collaborative, practices that support, encourage
and empower. Routine and ongoing real-time feedback is used to maintain a
responsive, consumer-driven climate to ensure the greatest benefit of services.
Bertolino, B. (2014). Thriving on the front lines: Strengths-based youth care work. New York: Routledge.
1
Expectancy and Hope are
Catalysts of Change
Key Competency
Demonstrate faith in the restorative effects of services
• Evidence shows that client pretreatment expectations affect
engagement, retention, and outcome.
• Have faith in clients and the restorative effects of services.
• Believe and demonstrate faith in the procedures/practices.
• Show interest in the results of the procedure or orientation.
• Ensure that the procedure or orientation is credible from the client’s
frame of reference and is connected with or elicits previous
successes.
2
Clients are the Most Significant
Contributors to Service Success
Key Competency
Maximize client contributions to change
• The client and factors in the client’s life account for more variance (8087%) in the outcome than any other factor.
• Focus on client ratings of distress and change.
• Recognize clients as competent and capable of change.
• Identify and utilize client contributions including internal strengths (i.e.,
abilities, coping skills, resiliencies) and external resources (i.e.,
relationships, social support systems).
The Variance in Treatment Outcome
• Client/Extratherapeutic Factors = 80-87%
• Treatment Effects = 13-20%
• Therapist Effects = 4-9%
• The Alliance = 5-8%
• Expectancy, Placebo, and Allegiance = 4%
• Model/Technique = 1%
Bertolino, B., Bargmann, S., & Miller, S. D. (2013). Manual 1: What works in therapy: A primer. The ICCE manuals of feedback informed
treatment. Chicago, IL: International Center for .Clinical Excellence.
Wampold, B. E., & Brown, G. S. (2005). Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in
managed care. Journal of Consulting and Clinical Psychology, 73(5), 914-923.
Client Contributions
• Use assessments as opportunities to
explore both risks and strengths.
• Identify and assist with developing
supportive social systems, resources,
and networks.
• Explore client stories by using
questions that elicit past solutions and
successes:
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Utilization
Exceptions
Difference
Influence (Problem or Person over)
Coping
Splitting
Linking
2
Family
3
Friends/
Social
Relationships
8
Other
1
Client
7
Work/
Employment
6
School/
Education
4
Community
5
Outside
Helpers
3
The Therapeutic Relationship Makes Substantial
and Consistent Contributions to Outcome
Key Competency
Engage clients through the working alliance
• The quality of the client’s participation (engagement) in services the most
important process determinant in outcome.
• Clients who are more engaged and involved in services are likely to receive
greater benefit.
• The client’s rating of the alliance is more highly correlated with outcome
than provider ratings.
• Work with clients to establish goals and methods to achieve those goals.
What is the Therapeutic Alliance?
The therapeutic alliance refers to the quality
and strength of the collaborative relationship
between the client and therapist and is
comprised of four empirically established
components:
1) agreement on the goals, meaning or purpose
of the treatment;
Consumer
Preferences
Goals,
Meaning or
Purpose
Means or
Methods
2) agreement on the means and methods used;
3) the client’s view of the relationship (including
the therapist being perceived as warm,
empathic, and genuine); and,
4) accommodating the client’s preferences.
Client’s View of the
Therapeutic
Relationship
Possibility Language
Dissolving Impossibility Talk
1.
Reflect client statements in the past tense.
From: “It’s always that way.”
To: “It’s been that way.”
2.
Move from global (“everybody,” nobody,” “always,” “never”) to partial
(“recently,” “somewhat more,” “a lot”).
From: “I’m always in trouble.”
To: “You’ve been in trouble a lot.”
3.
Move from truth/reality to perception (“It seems to you,” “You’ve gotten
the idea”).
From: “Things will never get better.”
To: “It really seems to you that it will never get better.”
Possibility Language
Future Talk: Acknowledgment and a Vision for the Future
1.
Assume the possibility of future change and/or solutions by using words
such as “yet” and “so far.”
From: “It’s always going to be this way.”
To: “So far you haven’t found any evidence that things will be different than the way they are
now.”
2.
Recast the problem statement into a statement about a preferred future
or goal.
From: “I’ll never be able to have the life I really want.”
To: “So you’d like to be able to move toward the life you really want.”
3.
Presuppose that changes and progress toward goals will occur by using
words such as “when” and “will.”
From: “No one wants to be around me.”
To: “So when you begin to notice that there are people who enjoy your company and want
to be around you what will be different for you?”
Possibility Language
Giving Permission
•
Give permission “to,” “not to have to,” and both
From: “I shouldn’t be angry.”
To: “It’s okay to be angry.”
From: “People keep saying that it really should make me angry.”
To: “It’s okay to not be angry about it.”
From: “Sometimes I’m angry and sometimes I’m not. I must be crazy!”
To: “It’s okay to be angry and you don’t have to be angry and you’re not
crazy.”
Say it in Another Way
• “He doesn’t want to change.”
• “She is manipulative.”
• “He’s oppositional.”
• “She’s resistant.”
• “He’s got an anger management issues.”
• “She’s too dependent.”
• “He has poor judgment.”
• “She’s out of control.”
Using Action-Talk
• Non-Action Talk
• Cab driver talk
• Opinions, evaluations, assessments, judgments
• Politician talk
• Vague, general, not specific as to person, place, time, thing, or
action
• “Someday” talk
• Vague as to time or frequency
Using Action-Talk (cont.)
• Action-Talk/Videotalk
• Move from vague, non-sensory-based descriptions to clear,
observable, behaviors
• Using Action-Talk to Clarify Meanings
• Action complaints – specifics about what one doesn’t like or one wants
to have change
• Action requests – specifics about what one would like to have happen
• Action appreciation – specifics about what has liked about something
and would like more of
• Specific to person, place, time, thing, action, or result
• Who is to do what by when?
• Who did what, when?
3-Point Strategy
1. Problem Description: What needs to change?
• Scaling questions
2. Vision of the Future: How will we know that change has
been achieved?
• Miracle question, crystal ball, time machine, etc.
• General future-oriented questions
• Scaling questions (revisited)
3. Movement: How will we know that progress is being
made?
• Scaling questions (revisited)
Session Rating Scale (SRS)
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A 40 point measure with 4 subscales
Two versions that can be scored: SRS & CSRS
Complete near the end of session (last 5-10 minutes)
Overall scores below 36 or any subscale below 8 should be
discussed with clients
Lower scores at the beginning of services can mean very different
things
Lower scores as services progress are 4x likely to contribute to
dropout
Takes less than 1 minute to administer
Paper/pencil and electronic scoring systems
Can plot personal data on Excel spreadsheet
4
Culture Influences and Shapes All
Aspects of Clients’ Lives
Key Competency
Convey respect for clients and their cultures
• Provide services with respect to client culture and preferences.
• Maintain self-awareness of one’s heritage, background, and experiences
and their influence on attitude, values, and biases.
• Emphasize a multi-level understanding, encompassing the client, family,
community, helping systems, etc.
• Recognize limits of multicultural competency and expertise; consult others
who share cultural similarities and expertise with clients being served.
• Acknowledge clients as teachers and experts on their own lives.
3
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•
•
•
•
Culture Influences and Shapes All
Aspects of Clients’ Lives (cont.)
Create culturally meaningful experiences and activities.
Use person-first language.
Individualize services (avoid “one-size-fits-all” approaches).
Create plans of action that are culturally sensitive.
Exercise care in matching methods (i.e., techniques, interventions)
with clients.
• Use culturally sensitive methods of research and evaluation.
• Conduct ongoing cultural self-assessments.
5
Effective Services Promote Growth,
Development, and Well-Being
Key Competency
Utilize strategies that empower clients and improve their lives
• Early response to services is strong indicator of eventual outcome.
• The longer clients go without experiencing positive change the greater the
likelihood they will have a negative or null outcome and/or drop out.
• View problems as challenges instead of fixed pathology.
• Maintain a future focus.
• Use language as a vehicle for change.
• Explore exceptions—how change is already happening.
• Focus on small changes.
• Focus on maximizing the impact of each interaction.
• Monitor change from the outset through feedback.
Strategies to Neutralize Resistance
and Facilitate Change
•
Relationship to problems: Learn how clients situate
themselves in relation to concerns and problems.
Listen for “I,” “Me,” “Myself,” or “We” statements as
opposed “You,” “He,” “She,” “Him,” “Her,” “They,”
“Them” statements (Note: Be aware of cultural
differences in language)
•
Explore coping style
•
Explore preparation for change
•
Search for exceptions
Strategies to Neutralize Resistance
and Facilitate Change (cont.)
•
Externalize the problem
•
Identify and alter repetitive patterns (depattern or
repattern)
•
Life Witnesses as Supports
•
Find a vision for the future
•
Focus on language
Well-Being Contributors
Sales
Life Circumstances
10%
Set
Point/Temperment
50%
Intentional Activities
40%
Lyubomirsky, S. (2007).
The how of Intentional
happiness:
A scientific
approach to getting the life you
Life Circumstances
Activities
Set Point/Temperment
want. New York: Penguin.
Intentional Activities
“Circumstances happen to people, and activities are ways that people act on their
circumstance.” (Lyubomirsky et al., 2005, p. 118)
• Intentional activities involve engaging in new actions, activities,
and behaviors which form new habits, routines, and patterns.
• These new routines—which are forms of “mental flossing—
increase well-being.
• The result is improved well-being, which is correlated with
higher life satisfaction, better learning and retention, more
creativity, and greater resiliency.
Lyubomirsky, S., Sheldon, K. M., Schkade, D. (2005). Pursuing happiness: The architecture of sustainable change.
Review of General Psychology, 9, 111-131.
Considerations for Activities
1. Focus on fundamental skills such as listening, attending, and eliciting
client feedback and respond to that feedback immediately as a
means of strengthening the therapeutic relationship.
2. Collaborate with clients on determining which exercises provide the
best fit.
3. Consider cultural and contextual factors with positive interventions.
4. Encourage clients to try agreed-upon exercises in a routine and
ongoing manner, continue those exercises that have proven
beneficial, and experiment with new ones as needed.
5. Package exercises to increase the likelihood of benefit.
Five Pillars of Well-Being (PERMA)
(Intentional Activities)
1. Positive Emotion: Happiness (and lastingly happier); Joy; Life
Satisfaction
2. Engagement: “Being at one” with some absorbing activity (Flow)
3. Relationships: Building positive relationships and social
connections
4. Meaning: Using what is best inside you to belong to and serve
something bigger than you are (the “larger” world and society)
5. Accomplishments: Achievement, Competence, Mastery,
Development of New Skills over life span
Seligman, M. E. P. (2011). Flourish: A visionary new understanding of happiness and well-being. New York: The Free Press.
Past, Present, and Future
1. Think of an event, situation, or experience from the past that
you have good memories about.
2. Take a deep breath or two and immerse yourself as much as
possible on the event.
3. Focus on your sensations. What you can see, hear, taste,
smell, and/or feel in your body. Also notice your emotions.
4. Stay with and savor those pleasant sensations and emotions
and develop them as much as you can.
5. Try to remain in the experience for 3-5 minutes.
6. Repeat the exercise by focusing on the present, and more
recent or current experiences. Then do the same with future
and “hoped-for” experiences.
What Went Well?
1. For one week, identify and write down three good things
that went well each day;
2. Write down what influenced those things;
3. At the end of the week reflect on the collection of good
things and if comfortable, share your experience with
another person.
VIA Signature Strengths
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www.authentichappiness.org
VIA Signature Strengths (cont.)
1. Wisdom and Knowledge: Cognitive strengths that entail the acquisition
and use of knowledge
2. Courage: Emotional strengths that involve the exercise of will to
accomplish goals in the face of opposition, external or internal
3. Humanity: Interpersonal strengths that involve “tending and
befriending” others
4. Justice: Civic strengths that underlie healthy community life
5. Temperance: Strengths that protect against excess
6. Transcendence: Strengths that forge connections to the larger universe
and thereby provide meaning
Signature Strengths Exercise
• Take one signature strength and for the following
week use that strength in a new way, every day.
Peterson, C. (2006). A primer in positive psychology. New York: Oxford University Press.
Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of
Interventions. American Psychologist, 60(5), 410-421.
Character Strengths and Posttraumatic Growth
•
Character Strengths found to predict Posttraumatic Growth:
•
•
•
•
•
•
Bravery
Gratitude
Hope
Kindness
Religiousness
Character Strengths found to be important mediators of success in situations
characterized by significant cognitive, emotional, and physical challenges:
•
•
•
•
•
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Courage
Honesty
Leadership
Optimism
Self-regulation
Teamwork
Mathews, M. D. (2008). Positive psychology: Adaptation, leadership, and performance in exceptional circumstances. In P. A. Hancock & J. L. Szalma
(Eds.), Performance under stress (pp. 163-180). Aldershot, England: Ashgate.
Character Strengths and Common Concerns
Presenting Problem
Potential Character Strength Utilized
Effective prevention of depression relapse
Perspective, Curiosity, Judgment, Spirituality
Residual depressive symptoms
Curiosity, Perseverance
Anxiety
Self-Regulation, Bravery, Fairness, Curiosity
Body-image issues
Gratitude, Kindness
Drug Use
Self-Regulation, Bravery
Trauma
Perseverance, Bravery, Hope
Improved attention and working memory
Self-Regulation, Love of Learning
Reduced anxiety; adaptive learning dealing with
threat
Self-Regulation, Curiosity, Perspective
Improved romantic relationships
Love, Kindness, Social Intelligence
Decreased negative self-focused attention
Zest, Humor
Decreased negative affect
Zest, Hope
Rashid, T. (2009). Positive interventions in clinical practice. Journal of Clinical Psychology: In Session, 65(5), 461-466.
Finding Life Purpose or Direction
Four signals or life energies:
1.
2.
3.
4.
Blissed
Blessed
Pissed
Dissed
Adapted from the work of Bill O’Hanlon
61
Blissed
Steve Jobs
“You’ve got to find what you love. And that is true for your work as it is for your
lovers. Your work is going to fill a large part of your life, and the only way to be
satisfied is to do what you believe is great work. And the only way to do great
work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle.
As with all matters of the heart, you’ll know it when you find it.”
Your time is limited, so don’t waste it living someone’s life. Don’t be trapped by
dogma–which is living with the results of other people’s thinking. Don’t let the
noise of others’ opinions drown out your own inner voice. And most important,
have the courage to follow your heart and intuition. They somehow already know
what you truly want to become. Everything else is secondary.”
Blessed
• Identify people who believed in you, encouraged
you or told you you were good at something or
could do something.
• Consider talents, developed or natural, that you
have.
• Reflect on incidents of good luck (being in the right
place at the right time-and taking advantage of that
luck).
Pissed (Righteous Indignation)
The Key: Transform the “negative” energy of anger and hurts
into positive energy
• What would you talk about if given an hour of prime time
television to influence the nation or the world?
• What pisses you off that you would like to correct in the
world or other people?
• What can’t you sit still for?
Dissed (Wounded)
The Key: Transform the “negative” energy of anger and hurts into
positive energy
•
•
Ann Rice’s daughter who died of leukemia at 5. Rice wrote a novel
that featured a 5-year-old who could never die. (Interview with a
Vampire)
U2 singer Bono’s mother died when he was 14. He has written a
series of songs to help transform his hurt. In reference to the most
recent one, “Iris,” Bono has said that although the song came from
wound it represents his mom’s positive energy.
The Outcome Rating Scale (ORS)
•
A 40 point measure with 4 subscales
•
Two versions that can be scored: ORS & CORS
•
Higher score indicate lower levels of distress; lower scores indicate
higher levels of distress
•
Clinical Cutoffs: 25 (> Age 19); 28 (Ages 13-19); 32 (≤ Age 12)
•
Reliable Change Index (RCI): 5
•
Complete at the beginning of session
•
Takes less than 1 minute to administer
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Paper/pencil and electronic scoring systems
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Can plot personal data on Excel spreadsheet
ORS – Individual
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Self-esteem
Self-perception
Sense of Self
Internal Strengths
Healthy activities and behaviors
Coping Skills
Safety
Anxiety
Depression
Substance Abuse
Somatic problems (i.e., sleep, headaches, etc.)
ORS – Interpersonal
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Close Relationships
Romantic Relationships
Family
Close Friends
Stable Living Environment
Conflict Resolution
Safety
Violence
Mystification
Disconnection
ORS – Social Role
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Other Friends and Supports
Community Connections (to individuals, groups, and the
community at-large)
Education (School, GED, Job Skills Programs)
Employment
Volunteering
Feeling Valued and Empowered as a Member of a Community
(there can be more than one)
Safety
Feeling Isolated (disconnection)
Lack of Acceptance
Lack of Opportunity