Category: Family Dynamics

  • How can you heal the trauma within?

    manhattan_bridgeTrauma changes you. You might not necessarily like that change. How can you heal the trauma within? You have the ability to transform yourself into a healthier person. You have enormous healing potential; the goal is learning to access it—and then to use that potential to heal the trauma, release the addiction(s), and obtain a glorious new life.

    Without your consent, trauma can change you, often into a person you’d rather not be.                                                -Michele Rosenthal

    Working through trauma can be scary, painful, and sometimes retraumatizing. Because of the risk of retraumatization, this healing work is best done with the help of an experienced trauma specialist. The clinical term for a therapist that has experience in treating trauma  is a trauma informed therapist. The therapist will be able to answer questions as to his/her experience in trauma informed care over the phone. You want to ask if they are experienced in EMDR, Light Entrainment or Somatic Experiencing.

    Treatment for Trauma

    When you are triggered by a trauma memory, your nervous system gets stuck in overdrive. Successful trauma treatment revisits these traumatic memories, and allows you observe the trauma and your “fight-flight-freeze” response. The therapist will establish a sense of safety and help you resolve the past traumas. The following therapies are commonly used in the treatment of PTSD, emotional and psychological trauma:

      • Somatic Experiencing:  Somatic processing of trauma takes advantage of the body’s unique ability to heal itself. The focus of therapy is on bodily sensations or movements (like excessive leg movement, wringing of your hands or profuse perspiration) rather than thoughts and memories about the traumatic event. By concentrating on what’s happening in your body, you gradually get in touch with trauma-related energy and tension. The therapist will encourage you to safely release this pent-up energy through shaking, crying, and other forms of physical release.
      • EMDR (Eye Movement Desensitization and Reprocessing): This practice incorporates two paddles that when held in your hands vibrate, and a headset that sends a low tone alternating from one ear and then to the other ear. The tones and the vibration of the paddles distract the conscience mind, allowing for the unconscious or sub-conscience memories to arise. The therapist and you explore these memories and discuss them to attempt to resolve the feelings around the trauma.
      • CLEAR Therapy (Colored Light Entrainment and Re-patterning) Clear Therapy is a method of releasing unresolved core emotional issues using colored light. When a flashing light is emitted into the eyes, the brain adopts the rhythm of the strobe. In the initial intake session, you will look at 11 different colors of flashing light and the therapist is able to pinpoint issues based on what you see in each color. In the following sessions, the feedback from your perception of the colors enables the therapist to uncover core beliefs that drive your thinking, feelings or behavior. CLEAR is coordinated with eye movement (see EMDR), breath work and meridian-based therapies (see EFT) to facilitate rapid resolution of the problem.
      • LST (Light Stimulation Therapy) LST enhances learning abilities and performance by stimulating the eye and brain with light. A LST session has you sitting comfortably in a darkened room, looking at a waveband of colored light which is focused directly on your eyes. It is advised to have 3 to 5 sessions per week until a total of 20 sessions is completed. At the end of the 20-sessions, there is a reevaluation to determine the necessity of further treatment.
      • The Brain and Brainwave Entrainment-The DAVID Device: The senses of sight and hearing, by their very nature, provide a favorable environment for affecting brainwaves. By presenting pulsed audio and visual stimulation to the brain, the brain begins to vibrate at the same frequency as the pulsed audio from the DAVID Device. The device sends flashes of lights into a pair of glasses, and pulsed tones through a pair of headphones to gently guide the brain into altered states of consciousness.
      • The Green Wave Therapy: The Green Wave Therapy is a technique that combines green laser light, micro current energy, and some of the principles of EMDR [Eye Movement Desensitization and Re-patterning], and EFT [The Emotional Freedom Acupressure Technique]. You will rest on a massage table, and a micro current device focuses on the region between your eyebrows. You hold the EMDR paddles in your hands as they pulse rhythmically. You also wear a headset that delivers audio tones in unison with the paddle’s vibrations. The practitioner stands back about 4-5 feet and circles the entire body with green laser light. With every 1-2 minute pass, the clinician checks the level of distress you are experiencing while thinking about the trauma.
      • Emotional Freedom Technique (EFT): Based on impressive new discoveries involving the body’s energies, EFT has been reported to be 80% clinically effective in relieving Trauma. The EFT procedure involves tapping with the fingers on points on the body that are associated with acupuncture pressure points. While doing the tapping sequence, distressful thoughts and/or events are targeted and healing statements are repeated out loud. EFT often works where nothing else will. It is rapid, long lasting and gentle. No drugs or equipment are involved. It is easily learned by anyone in less than an hour. EFT techniques can be taught and be self-administered.

    Trauma Recovery Tips

    Recovering from emotional and psychological trauma takes time. Give yourself time to heal and to mourn the losses you’ve experienced. During your trauma therapy here are some self-help strategies to keep you healthy and continue the healing between your therapeutic sessions:

               1: Don’t isolate

               2: Stay grounded

               3: Take care of your health

    Don’t try to force the healing process. Be patient with your pace of recovery. Finally, be prepared for difficult and volatile emotions. Allow yourself to feel whatever you’re feeling without judgment or guilt.

     

  • Addiction is a Symptom of Untreated Trauma

    manhattan_bridgeI am a recovery coach. A recovery coach or sober companion is often called in to work with the most difficult addict, the chronic relapser. A chronic relapser is an individual that has been to several rehabs, often 7, 8 or 9 visits in less than five years. Who has not been able to put together 90 sober days, except in treatment. Whose family, spouse or children have given up on them. In reality, a chronic relapser is an addict that is acting out compulsively in their addiction. The chronic relapsing in their addiction is a sign or a symptom of an unresolved traumatic occurrence in their youth. Their addiction is a symptom of untreated trauma.

    Often, calling a recovery coach is the last resort.

    My first job, of course, is to make sure this person doesn’t drink, use or act out. And to find some redeeming qualities of this addicted person so I can approach healing the behaviors driving the addiction. This is the key point that brought me to the understanding that many of my clients have experienced some form of trauma, early in their childhood or adolescent lives.

    “What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood.”    — Alice Miller, author of Breaking down the Wall of Silence

    I always ask the client for their story. I provide all of my clients the ACE study questions. ACE means Adverse Childhood Experiences. The ACE study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego. It started in 1976 with the purpose of finding more about childhood trauma, and the later-life health and well-being of participants. (For more information on ACE, see my blog post dated August 20, 2015). The ACE study poses such questions as: Did you move a lot? Did you ever go hungry? Did you experience a childhood that was less than nurturing? Did you ever have a moment that overwhelmed you? Did you live through an ordeal that changed how you think about people, places or things? The results of the ACE questions, and the addict’s story that comes after it, always profoundly moves me. I get a much more honest story than most clinicians, mainly because of these questions.

    The reason it’s significant for me to identify and acknowledge trauma, is because research proves that trauma can activate behaviors that lead to addiction. My clients are using a drug or alcohol as a way of self-protection, of calming down, as life preservation. Everyone in the rooms (AA, NA meetings) knows addicts “use” in order to “numb out.” Well, let’s rethink that, turning it a bit to say: victims of trauma are really using a drug or drink to:

    • Stay safe: After trauma the addict’s own mind can feel like a danger zone, which makes being “out of it” feel safer than being in it.
    • Escape memories: Unwanted and unresolved memories have a way of popping up incessantly after trauma; addictions offer the mind a different area of, or reduced capacity for focus that helps suppress reminiscing.
    • Soothe pain: Substances or the adrenalin rush of self-destructive behaviors change the addict’s body chemistry, releasing endorphins and other mood enhancers that reduce discomfort.
    • Be in control: Sometimes, engaging in addictive behaviors can lead an addict to feel strong, resilient and courageous, an experience that is tremendously alluring when trauma from the past intrudes on the present.
    • Create a world the addict can tolerate: The intense feelings brought on by fear, memories and anxiety can make any moment seem overwhelming. The release of tension brought on by addiction-oriented behavior helps facilitate a manageable experience.
    • Treat yourself the way you feel you deserve: Trauma can leave an addict feeling less-than, worthless, hopeless, and damaged. The more self-destructive the addict behaves, the more it can feel like he or she is living in alignment with who they truly are. While this is false, it can help reduce feelings of otherness and disconnection.
    • Redefine who the addict really is: Trauma changes an addict’s identity all the way down to the core of their beliefs and self-definition. It can seem as if no one understands them. Engaging in addictions can help create a sense of community by connecting the addict to others who feel, see, think and behave as they do. Addictions can help the addict revise their self-perception by allowing them to engage in and act out behaviors that allow them to feel stronger, more courageous, capable, etc., than trauma has left them feeling.[1]

    This puts the addiction-trauma link into perfect perspective for me, and I hope it opens some eyes for other addicts, alcoholics, and clinicians that are reading this post. Next week’s post will go on to explain the scientific research that backs up this discovery that addiction is just a symptom of untreated trauma.


    Research used in this blog:

    Centers for Disease Control and Prevention, http://www.cdc.gov/violenceprevention/acestudy/about.html

    Adverse Childhood Experiences Study, Posted on August 20, 2015 by Melissa Killeen, http://www.mkrecoverycoaching.com

    [1] Trauma and Addiction: 7 Reasons Your Habit Makes Perfect Sense, by Michele Rosenthal. Published on March 30, 2015 in Behavioral Health, Living in Recovery, Living with Addiction and at http://www.recovery.org


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  • What kind of credential do I need to be a Professional Recovery Coach?

    What kind of credential do I need to be a Professional Recovery Coach?

    manhattan_bridge_post_versionWhen I published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013, the term professional recovery coach or professional recovery life coach was not in frequent use.

    A professional recovery coach is trained in professional coaching techniques, which means he or she has been educated in group dynamics (how people act in a group), how to develop high performing individuals (leadership) or how to facilitate change. Additionally, they have training in the addiction recovery models, motivational interviewing and Harm Reduction. They may use their experiential knowledge of their own recovery to augment their professional recovery coaching faculties. Professional coaches work in many fields: executive coaching, business coaching, finance coaching, wellness coaching or life coaching. Recovery coaching fits nicely into the life coaching model.

    International Coaching Federation (ICF)

    There is one worldwide organization that is recognized as issuing professional coaching credentials, the International Coaching Federation (ICF), http://coachfederation.org. There are three levels of ICF coaching credentials. The Associate Certified Coach (ACC) Credential is for the coach who is just beginning in the field, and is the first credential that can be completed with ICF. The Professional Certified Coach Credential (PCC) is for the more experienced coach and the Master Certified Coach (MCC) Credential is for the expert coach.

    When seeking to be credentialed as an Associate Certified Coach (ACC), the coach has to have completed an entire ICF Accredited Coach Training Program (ACTP). On the ICF website is a list of all of the accepted training programs from which the ICF will accept training credentials. The ICF does not offer a unique recovery coaching credential, nor a peer recovery-support credential.

    There is one organization, Family Recovery Resources, listed in the ICF Accredited Coach Training Program that offers a family-in-recovery coaching course for a family recovery coach certificate. There are no other recommended organizations that offer any recovery coach orientated courses. If a recovery coach has received training from any organization specializing in recovery coaching training, it is likely that the training would not be credited toward an ICF certificate. There is a very interesting selection of courses in the ICF Accredited Coach Training Program, such as executive coaching, end-of-life coaching, divorce coaching, Neuro-Linguistic Programming, wellness coaching, conflict coaching and several other excellent learning opportunities, on the ICF web site.

    The ACC applicants must work while they learn, and complete 100 hours of client-to-coach experience during their coach-specific training program. In addition the applicants are required to receive 10 hours of Mentor Coaching, and 100 hours (75 hours to be paid) of coaching experience with at least 8 clients, post training. There is a performance evaluation (audio recording and written transcript of coaching session) and a Coaching Knowledge Assessment (CKA) to complete the ACC credentialing application. The ACC credentialing process costs are dependent on the types of training courses a coach must take to complete the requirements for the certificate. The ACC credentialing process can take from 18 months to two years complete.

    It is my hope that the information transmitted in the past few posts will help a person interested in recovery coaching see the path to certification a bit more clearly. Please feel free to contact me with any questions you have about the path you should take in seeking your recovery coaching training and credentialing.

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  • What training and certificate do you need to be a peer recovery support specialist ?

    What training and certificate do you need to be a peer recovery support specialist ?

    manhattan_bridge_post_versionI published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013. Since then, recovery coach or peer recovery support specialist training has become one of the fastest growing aspects of the coaching field. So, what kind of training and certificate do you need to be a peer recovery support specialist ?

    In 2013, the organizations that offered recovery coach or peer recovery specialist training numbered around 50. Today, the number has grown to 250. Many state certification boards have established recovery coach and peer recovery support specialist certifications.

    The definition of a recovery coach, and a peer recovery support specialist has changed significantly, as well. Now, the term peer-to-peer recovery support specialist defines a coach that works with people in mental health recovery and/or people that are in co-occurring recovery (co-occurring describes when a person has an addiction and a mental health diagnosis). Commonly the coach in this job is called a “peer.”

    Even though most of the state certification boards issue a certificate with the same “title,” (such as certified peer recovery support-specialist) the agencies that are looking for coaches to work with addicts advertise for recovery coaches and the agencies that are looking for coaches to work with people with behavioral or mental health disorders advertise for peers.

    In the treatment field it is common to have states use different terminology and acronyms for a certificate of the same job description. For example, the terminology for a certified recovery coach or peer in New Jersey is Certified Peer Support Practitioner (CRSP).The Alcohol and Drug Abuse Certification Board of Georgia calls this credential a Certified Peer Recovery Coach (CPRC). The Minnesota Certification Board offers a Certified Peer Recovery Specialist (CPRS) credential. There are several different terms for certificates for the same job description throughout the United States.

    As of March 2014, 38 states and the District of Columbia have established programs to train and certify peer-to-peer recovery support specialist working with people in mental health recovery. Eight states are in the process of developing and/or implementing a peer program. For information on locating these agencies go to the International Association of Peer Specialists at: http://inaops.org/training-and-certification/.

    The International Association of Peer Specialists web site features a PDF document that is downloadable, with a list of all of the peer training organizations. This document is entitled: Peer Specialist Training and Certification Programs: A National Overview, and was compiled by the Texas Institute for Excellence in Mental Health, in the School of Social Work at the University of Texas at Austin. This PDF breaks down the peer certifications for every state, gives a web site and email contact for the training organizations as well as the required domains to master, in order to receive the certification. As an adjunct to this PDF, an additional list of recognized peer support training providers is available. The link is: http://inaops.org/training-providers/. If your area is not served by training organizations featured in these two documents, email: training@naops.org to find training in your area.

    What are the peer recovery support specialist guidelines for receiving certification?

    The peer recovery support-specialist application for certification will vary from state to state but essentially the guidelines are similar. Individuals can qualify to become certified peer-to-peer recovery support specialist by meeting the following guidelines:

    • Have a minimum of one year demonstrated recovery time from a significant mental health and/or substance use disorder at the date of application.
    • Be at least 18 years of age.
    • Must have a minimum of at least a high school diploma or GED.
    • Have attended and successfully completed a recognized training curriculum (face to face in a classroom setting or on-line) that totals 40 hours at a minimum and have a valid certificate of completion from that training.
    • Have completed an additional 20 hours of training and have valid certificates verifying attendance and participation in the following training categories: Wellness Recovery Action Planning (WRAP), Person Centered Thinking, Personal Assistance in Community Existence (PACE), Crisis Prevention, Veteran supports and interventions. Applicants can also use other college coursework, if related to the work of a Certified Peer Support-Specialist, if it will enhance the ability to provide services to people with mental health and/or substance use disorders. The applicant must submit an official transcript for review with the application.
    • Acknowledge the peer will follow the ethical guidelines of a peer recovery support-specialist by signing a form stating they have read and comprehend the guidelines
    • Submit two (2) personal reference letters

    What are the costs of Certified Peer Recovery Support-Specialist Training?

    Costs for Certified Peer Specialist training range from $400-$1,000. There are several ways to pay for Certified Peer Specialist (CPS) training. There are a number of programs and organizations that sponsor free Peer Recovery Support-Specialists certification training, continuing education classes, and supervisor training classes. As follows, are some suggestions:

    Offices of Vocational Rehabilitation (OVR) help people with disabilities prepare for and achieve an employment goal. OVR has many offices located throughout United States. If you qualify for OVR services, OVR may pay up to $900 for you to receive certification training.

    County Mental Health and Developmental Services is another source of possible funding. Some county MH/DS offices contract with training vendors to provide a Certified Peer Specialist class in that county. When this happens, a county purchases an entire class (20 seats) from a training vendor. The county then accepts applications from people who want to attend the training. In these cases, the training is usually only open to people who reside in that county.

    The Mental Health Associations of your state may provide low cost Certified Peer Specialist training.

    Review the document, Peer Specialist Training and Certification Programs—A National Overview (http://www.dbsalliance.org/pdfs/training/Peer-Specialist-Training-and-Certification-Programs-A-National-Overview%20UT%202013.pdf ). There are many states, Alabama, Ohio, New Jersey and North Carolina, to name a few that offer free training and are listed in this document.

    Next week’s blog post will review what certification is required to be a professional recovery coach working as a coach that has a variety of coaching credentials.

  • What kind of training do I need to be a recovery coach?

    What kind of training do I need to be a recovery coach?

    manhattan_bridgeI published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013. Since then, recovery coach or peer recovery specialist training has become one of the fastest growing aspects of the coaching field. So what kind of training do I need to be a recovery coach?

    In 2013, the organizations that offer recovery coach or peer recovery-specialist training numbered around 50. Today, the number has grown to 250. Many state certification boards have established recovery coach and peer recovery support specialist certifications.

    Many of the organizations that offer addictions recovery coach training or peer recovery support specialist training are listed on my web site: http://www.mkrecoverycoaching.com/recovery-coach-training-organizations/. For many people interested in being a recovery coach, the training costs, deciding on the best training organization and the training necessary to fulfill the certification requirements can be confusing. So I would like to attempt to clear up this confusion and will answer these questions in this post:

    • What are the guidelines I must meet to apply for recovery coaching training?
    • What kind of training do I need to be a recovery coach?

    What are the guidelines to apply for recovery coaching training?

    Applicants must meet the following guidelines to apply for a training course in order to be a recovery coach or a peer recovery support-specialist. These guidelines are shared by many training organizations and certification boards across the nation as a standard for what a potential recovery coach must have before applying for recovery coaching training:

    • High school diploma, GED or higher
    • Minimum of one year of direct knowledge of sponsorship and 12-step programs
    • Minimum one year of sobriety from substance use or one year sobriety in co-occurring mental health and substance use disorders (self-attestation)

    What kind of training should I look for?

    Certification boards require the coach to receive outside training that fulfills the requirements mandated by the state board. These requirements are often a certain amount of hours training in topics such as addiction recovery theory and models, coaching ethics, motivational interviewing, relapse prevention, nicotine cessation, suicide prevention and HIV-AIDS education. Each state and organization has different requirements. So first check with your state to ensure the course you take will be accepted by the state credentialing board.

    There are trainings offered that can give a coach more information that may not be on the state certification board list, but are very helpful. The kinds of training I found helpful as a new recovery coach were: conflict management, anger management, intervention training, co-occurring disorders, behavioral addictions, the pharmacology of addiction, and psycho-pharmacology as well as knowledge about coaching families in relationships with addicted persons. There are also training organizations that offer three different levels of recovery coaching training: novice, intermediate and master-level coaching certificates.

    The places in which you receive this training are quite diverse. In the links section of this web site, I list over 250 organizations offering recovery coach training. The courses can be online, or in a classroom. The costs for this training is diverse as well, from free (in Ohio) up to $4,000 per course. The length of the course could be three days or four months.

    At no time does taking a recovery coaching course give you an immediate state certification board recovery-coaching credential. It gives you a document (called a certificate) that says you completed the training. There are many coaches who do not seek state board certification, and use this document or certificate from a training organization as adequate proof they are knowledgeable in performing the duties of a recovery coach.

    There is one international credentialing organization, the International Certification and Reciprocity Consortium, commonly known as the IC & RC(http://internationalcredentialing.org/) that runs many state credentialing boards and has developed an exam for a Peer Recovery (PR) Certification. The IC & RC suggests applicants check with their state credentialing board for specific test taking guidelines.

    Are there any additional requirements for recovery coaching certification?

    NAADAC, the Association for Addiction Professionals, and the National Certification Commission for Addiction Professionals (NCC AP) http://www.naadac.org/NCPRSS offer the Peer Recovery Support-Specialist Certification. Similar to the requirements of the IC & RC, the NCC AP recommends, in order to receive certification, a coach read and sign a statement on the application affirming adherence to the Peer Recovery Support-Specialist Code of Ethics. Credentialing boards require supervisors of the coaches-in-training to sign a document verifying they have supervised the coach during the period of the coach’s training. Letters of recommendation are also items required by some credentialing boards. Other state boards require a recent photograph. As always, check with the state credentialing board for specific requirements for credentialing.

    Next week’s post will review what certification is required to be a peer-to-peer support-specialist working with people in mental health recovery.

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

  • What kind of certification do I need to be a recovery coach?

    What kind of certification do I need to be a recovery coach?

    manhattan_bridge_post_versionI published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013. Since then, recovery coach or peer-recovery specialist certification training has become one of the fastest growing aspects of the coaching field. So what kind of certification do I need to be a recovery coach?

    In 2013, the organizations that offer recovery coach or peer-recovery specialist training numbered around 50. Today, the number has grown to 250. Many state certification boards have established recovery coach and peer-recovery support specialist certifications. Yet, for many people that seek to be a recovery coach the qualifications, the training, the requirements for certification, or credentialing seem baffling. So I would like to attempt to clear up this confusion and will answer these questions in this post:

    • What is the process for certification as a recovery coach or peer recovery specialist?
    • What kind of certification should I be focusing on?

    What is the process of being qualified, getting training and then credentialed as a recovery coach or peer-recovery support specialist?

    If you are investigating becoming a recovery coach, I suggest you follow these steps:

    1. Research the training organizations that offer recovery coach training you can afford. Go to http://www.mkrecoverycoaching.com/recovery-coach-training-organizations/ for a list of addiction recovery coach training organizations
    2. Verify that you meet the qualifications to apply for the course (e.g. be 18-years-old, have a GED or high school diploma, one year sobriety from any addiction)
    3. Take and pass the course, retain the coaching certificate for future purposes
    4. Research places like Recovery Community Organizations or treatment centers to work or volunteer as a recovery-coach-in-training
    5. Apply to your state certification board for recovery coach certification (a fee may apply)
    6. Complete the recovery-coach-in-training supervised practice hours that are required by the state board
    7. Send in your application with paperwork verifying the completion of practice hours to the state credentialing board with a certification fee (fee varies for every state, from $100-$250)
    8. Receive your recovery coaching or peer-recovery support specialist certificate
    9. In the next 2 – 5 years take the required courses for renewing this certificate. Refer to your state board for more information on courses and renewal time frames. A renewal fee will be required.

    What kind of certification do I need to be a recovery coach?

    For an addiction recovery coach, the certification and training is prefaced with the terms: peer-support specialist, certified peer-recovery practitioner, recovery coach or peer-recovery specialist. Every state is different and every state uses different names for these certifications. Look for courses that offer the training needed for an addictions coach and a peer working with people in mental health recovery certification. It is the exact same training, in the same exact classroom, for two different jobs descriptions! It may be confusing now, and quite possibly the content and descriptions of  these courses may change going forward. But I would have to have a crystal ball to predict that for certain.

    I suggest you first take a certification training course. You can make the decision after the training is completed to apply for state board certification. As a coach if you are interested in being your own business person, certification by a training organization should be adequate. If you want to work in a treatment center, with a recovery community organization, social services agency or hospital, certification issued by the state’s certification board or the International Certification and Reciprocity Consortium (IC&RC) is required by the institution hiring you. If you want to carry professional liability insurance, or be reimbursed by Medicaid for your services, certification by a state certification board is mandatory.

    What is a state certification board?

    The process for receiving a certificate as a recovery coach is overseen by a state’s certification or licensing board. A state certification board tests and renews practitioner’s (coaches, therapists, nurses, etc.) certificates to ensure their knowledge is up to par. Also, that they have the ethical knowledge to practice in their profession. These processes for certification, such as training, educational requirements, exams and renewal guidelines, varies from state to state. These certification standards are recognized by health care companies, insurance companies, Medicaid, Medicare as well as companies that hire these practitioners.

    These state certification boards are the same boards that issue licenses or certifications for drug and alcohol counselors, and therapists. Some states have combined licenses and certifications boards all in one office, so it could be the same office in which nurses or hairdressers receive their licenses. I suggest you search the Internet for drug and alcohol certification for your state. Then search for the state board website for recovery coach or peer-recovery support specialist certification. As of May 2008, thirty state credentialing boards had developed criteria for the training and deployment of recovery coaches and peer-recovery specialists, so you should have no trouble finding these boards on the Internet.

    What is Reciprocity?

    Reciprocity is a term you will see used often on these board sites. When you are certified through your home state’s certification board, you may have the ability to transfer that credential to another state. This is called reciprocity. State certification boards may offer reciprocity to certified coaches in other states. The state boards have the authority to set reciprocity requirements for coaches to practice in their state. Not all certifications are eligible for reciprocity. It is vitally important that you investigate reciprocity guidelines prior to relocating to another state, because it can be a very complicated process.

    There are national and international recovery coach certifications available. In 2013, the International Certification and Reciprocity Consortium (IC&RC) developed a peer recovery credential. The application for the peer-recovery certification appears on the IC & RC web site. An IC & RC credential is accepted by many agencies and treatment centers when they are hiring recovery coaches.

    In next week’s post I will review what kind of training you need to have in order to apply for recovery coach certification.

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  • What is the difference between a recovery coach, a peer recovery support specialist and a professional recovery coach?

     

    melissa-new-post

    I published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013. A recovery coach, a peer recovery support specialist and a professional recovery coach’s job descriptions have expanded significantly since then. The organizations that offer recovery coach training numbered around 50 in 2013. Today, the number has grown to 250. Recovery coach certification training is one of the fastest growing aspects of the coaching field, with many states establishing recovery coaching and peer recovery support-specialist certifications. Yet, for many people who seek to achieve basic recovery coaching information, the process of training, certification, credentialing or licensing are baffling. With all of this growth and change, anyone who is interested in being a recovery coach is very confused about the necessary training, what to call this training and even what to call themselves! I want to make an attempt to clear up this confusion and answer these questions:

    • What is the difference between a recovery coach, a peer recovery support-specialist and a professional recovery coach?
    • On what kind of certification should a future recovery coach focus?
    • What are the guidelines for certification of a recovery coach?

    (Some of the answers to these questions will appear in upcoming posts.)

    What is a Recovery Coach?

    A recovery coach is a person that works with and supports individuals immersed in an addiction(s), and coaches people in recovery from the abuse of alcohol and drugs, gambling, eating disorders or other addictive behaviors. Sometimes recovery coaches who work with people with addictions have been referred to as a peer recovery support specialist, a recovery support specialist, a sober companion, recovery associate or quit coach. In all cases these terminologies describe the same job description; a person who meets with clients in order to aid in their recovery from addiction(s). Even though many certifications for recovery coaches are classified as peer recovery support practitioner certifications. I prefer to use the term recovery coach in describing a person coaching an individual in recovery from addiction, instead of using the term “peer,” mainly because there is no requirement that a recovery coach be a peer (meaning they are an addict in recovery). Although it may be believed having experiential knowledge is a best practice for a recovery coach, it could be a recovery coach has knowledge of addiction and recovery perhaps by knowing an addict, having a family member with an addiction or taking courses in the treatment field.

    I have kept the term “non-clinical” out of this definition of a recovery coach because over the course of several years, I have seen drug and alcohol counselors, family and marriage therapists (MFTs), licensed clinical social workers, interventionists (LCSWs), psychotherapists and psychiatrists, train to be recovery coaches and then add coaching to their resume. I hear from these individuals that they embrace the coaching approach, and merge the knowledge they have as a clinician or interventionist with recovery coaching methods.

    Some individuals seek recovery and sobriety from addictions by frequenting a recovery community organization (RCOs) or recovery support center. An RCO is an independent, non-profit organization led and governed by representatives of local communities of recovery. There are recovery coaches at these recovery community organizations. These coaches have very diverse backgrounds. I have met coaches that were addicts, homeless, offenders, teachers, lawyers and highly educated individuals, who choose to help another person in recovery. I have seen these coaches espouse 12-step ideologies as well as non-12-step recovery models such as Buddhist Recovery, Moderation Management, Kundalini Yoga or Harm Reduction. Sometimes, the recovery coaches at these centers receive a salary from the RCO, however, the client is not charged for the recovery coaching services. RCO recovery coaches can also be volunteers, opting to perform their coaching duties for no reimbursement at all.

    Lastly, recovery coaches can be employed by treatment centers or sober living homes and receive compensation from them. In cases such as this, the client is billed for the coaching services from the centers or homes. I know many a recovery coach who has opened a transitional living home or a supportive sober living environment. They coach the people who reside at these locations and their presence adds to the quality of the recovery experience.

    Is recovery coaching covered by insurance?

    Unfortunately, the answer to that question is no. No independent health insurance company covers the services of a recovery coach working with an individual in recovery from an addiction. There is currently only one state, New York, that has an arrangement with the state’s Medicaid offices to reimburse for recovery coaching for individuals who are diagnosed as dependent on a substance. Other states, Tennessee, Maryland and Massachusetts, are formulating similar Medicaid payment plans, but these reimbursements are not yet in place.

    What is a peer to peer recovery support specialist?

    A nearly universal definition of a peer to peer recovery support specialist is an individual with lived experience who has initiated his/her own recovery journey and assists others who are in earlier stages of the healing process of recovery from psychic, traumatic and/or substance-use challenges and, as a result, can offer assistance and support to promote another peer’s own personal recovery journey. A peer to peer recovery support specialist is also called a peer, peer support-practitioner, peer mentor, or a certified peer. All of these terms basically describe the same job description. More and more, this job description is focused on the peer to peer recovery support specialist working with a person in mental health recovery.

    The certified peer to peer recovery support specialist workforce is relatively new in the behavioral health field, with state-recognized certification programs first emerging in 2001. Within this short time frame, states have recognized the potential of peer specialists to improve consumer outcomes by promoting recovery. Many social service agencies pay the peer’s salary, and the client does not pay for the coaching. In the mental health/behavioral health field, when referred by a social services agency or mental health treatment organization, reimbursement for a peer to peer recovery support specialist is covered by a health plan or Medicaid.

    Peer to peer recovery support specialists can also work independently from an agency and be reimbursed by the client or a family. Peer to peer recovery support specialists can also choose to provide these services as a volunteer and receive no financial reward.

    What is a professional recovery coach?

    A professional recovery coach, is sometimes referred to as a recovery life coach. A professional recovery coach has experience and training in the recovery models, and training as a professional coach. These professional and credentialed coaching programs are sometimes referred to as life coaching training. A professional recovery coach can receive training from any of the 250 organizations that train recovery coaches, and select not to receive the certificate from a state certification board or the IC & RC (see the certification information in next week’s post). A professional coach can receive training from the ICF – International Coach Federation’s accredited coach training programs, and apply for a credential issued by the ICF.

    A professional recovery coach can assist a client with a variety of coaching interventions including, but not limited to recovery from addictions, dealing with mental health diagnoses, divorce, financial downturns, grieving, career change and even family relationship issues. The client is billed for the coaching services from the professional recovery coach. Again, healthcare plans do not reimburse for these coaching services.

    Stay tuned for next week’s post on certification for recovery coaches.

  • The Family Relationship Consultant

    by Ronald B Cohen, MD

    According to Ronald B. Cohen, MD, an experienced Bowen Family Relationship Consultant, and this week’s guest blogger, we all struggle with balancing emotional closeness and distance in our families or origin.

    Learning and Doing

    “How long can we go on being angry?”

    — Elie Wiesel

    Consequently we can all benefit from relationship coaching and consultation. This guest blog, originally published on the FamilyFocusedSolutions.com web site in May 2015, can be found in its entirety along with social media comments and links to related blogs, at http://www.familyfocusedsolutions.com/the-family-relationship-consultant/. You may also share your thoughts and experiences concerning the primacy of relationships in your life in the “Post Comments” box on the original blog.

    Relationships matter. We all belong to families whose emotional connections greatly impact our lives. The behavior of any member of a family affects every other member in some way. We exist in our relationships and our inescapable connection to our family of origin.

    Families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation. The family system resides in the self as much as the self-resides in the family system. Bowen Family Systems Theory (BFST) understands family functioning and behavior as arising from an emotional system that is a universal feature of all living things.

    All families have a set of rules, roles and relationship requirements. None of us can ever completely emotionally leave the family we grew up in, nor do we have a choice as to whether or not we deal with them. Even choosing not to deal with them is a way of choosing to deal with them. It just means we leave an awful lot of what’s going on unspoken and have no control over the outcome.

    The goal is to change your relationships with other members of your family of origin to improve your life and your family’s life regardless of what anybody else does. If you change yourself, you fundamentally change the nature of your relationships. Taking responsibility for what you can take responsibility for and attending to your needs in the context of intimate relationships, opens the door to facilitating healing of the entire family.

    Coaching and Relationship Consulting based on Bowen Family Systems Theory (BFST) involves joint observation, investigation and research about present day and historical family functioning. The process of self-differentiation is built upon ownership of one’s emotional reactivity. A primary prerequisite for engaging in the process is to develop realistic expectations when moving toward changing your part in your family’s dance.

    You are learning how to deal with differences without losing connections.

    Bowen preferred the “Coaching” nomenclature because his theoretical underpinnings, process of interaction, and desired outcomes were so different from conventional psychotherapy that the term therapy did not capture all of its essential aspects. The journey of self-differentiation may be described as “Growing in the ability to be fully responsible for my own life while being committed to growing closer to those I love.”

    Autonomy and emotional connection become congruent and not adversarial.

    The “work” itself is an individual and somewhat solitary undertaking that emphasizes self-directed effort. Learn to observe non-reactively the relationship patterns in your original family and explore your role in these patterns. Strive to bring your behavior more in line with your deepest beliefs, even if this means upsetting family members by disobeying family “rules.”

    You can make change in your family relationships even without the participation of other family members. If you want your life to be better you have to do the work.

    Remember, you are completely in control of your process and end up in a better place whether or not anybody else in the family signs on.

    The lives of our children and our children’s children are deeply affected by how we live our lives. Healing current relationships avoids leaving a damaging legacy for our descendants.

    Consultation with a well-trained Bowen Family Systems Theory “Coach” can help develop a solid self in the wider historical context of our most important relationships.

    Best of luck on your unfolding journey of a lifetime.

    Ron Cohen MDRonald B Cohen, MD is a Board Certified Psychiatrist and Bowen Family Systems Theory Coach and Relationship Consultant in Great Neck, New York. He can help develop a solid image of your ‘self’ in the wider historical context of your most important relationships. To request more information or contact Ron Cohen directly for any reason, please email him at: RBCohenMD@FamilyFocusedSolutions.com or call him at: (516) 466-7530

  • Alcohol Kills One Person Every Ten Seconds

    manhattan_bridge_post_versionThe misuse and abuse of alcohol affect the lives, health and well-being of billions of people. A World Health Organization 2014 report stated the consumption of alcohol led to 3.3 million deaths around the world. In essence, the report says that alcohol kills 1 person every 10 seconds.

    Shekhar Saxena, head of the World Health Organization’s Mental Health and Substance Abuse department, reports that there are roughly 3.25 billion people in the world that drink, and these drinkers consume an average of 4.5 gallons of pure alcohol a year. China is estimated to increase it’s per person, per year alcohol consumption ratio by an additional 1.5 liters of pure alcohol by 2025.

    According to SAMHSA’s National Survey on Drug Use and Health (NSDUH), more than half of all U.S. adult citizens drink alcohol, with 6.6% meeting criteria for an alcohol-use disorder.

    One in 10 deaths among working-age adults aged 20-64 years are due to excessive alcohol use.

    A CDC study, published in June of this year, found that nearly 70% of deaths due to drinking involved working-age adults, and about 70% of those deaths involved males. Nearly 88,000 people die in the U.S. from alcohol-related causes annually, making it the third most preventable cause of death in the United States. In 2013, fatal accidents involving an alcohol-impaired driver accounted for 10,076 deaths or 30.8 % of all driving fatalities.

    Men are more likely than women to experience alcohol-related deaths. Although more women are drinking today as compared to 2012, of the 88,000 alcohol related deaths, approximately 62,000 were men and 26,000 were women. This study proclaims that excessive alcohol use can shortened the lives of working-age adults by about 30 years.

    Alexandra Sifferlin for Time Magazine reported that harmful alcohol use not only leads to addiction, but it can put people at a higher risk of over 200 disorders like liver disease, tuberculosis and pneumonia.

    Binge drinking can damage the frontal cortex and other areas of the brain

    The CDC report shows that 16% of drinkers partake in binge drinking, which is the most dangerous form of alcohol consumption. Some of the risks associated with binge drinking are well known. It increases the risk for sexual assault, violence and self-harm. But the physical effects of such behaviors on the body are often not discussed. According to the National Institutes of Health (NIH), there’s strong evidence to suggest that regular binge drinking impacts executive functioning and decision making by damaging the frontal cortex and other areas of the brain.

    According to the 2013 The National Survey on Drug Use and Health (NSDUH), approximately 5.4 million people (about 14.2%) in the age range of 12-20 years, were binge drinkers (15.8% of males and 12.4% of females).

    One in every four families are impacted by alcoholism

    More than 10% of U.S. children live with a parent with alcohol problems, according to a 2012 study.

    According to Herma Silverstein, author of the book; Alcoholism, one of every four families has problems with alcohol.

    The CDC study also found that about 5% of the alcohol related deaths in the U.S. involved people younger than age 21.

    In 2012, 58.3% of people who tried alcohol for the first time were younger than 18.

    Drinking during pregnancy can cause brain damage to the infant, leading to a range of developmental, cognitive, and behavioral problems, otherwise called Fetal Alcohol Spectrum Disorders (FASD). People/children with difficulties in the following areas may have FASD or alcohol-related birth defects:

    • Coordination
    • Emotional control
    • Learning challenges
    • Socialization skills
    • Focus in class, holding down a job

    These statistics are over powering and most definitely build an excellent argument to stop drinking, especially over this Fourth of July long holiday weekend. Please share these statistics with a friend, post on your social media pages, re-publish in your blog, or newsletter.


    References used in this blog:

    The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is one of the 27 institutes and centers that comprise the National Institutes of Health (NIH). NIAAA supports and conducts research on the impact of alcohol use on human health and well-being. http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

    Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. The mission of PCD is to promote the open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention. http://www.cdc.gov/features/alcohol-deaths/

    The National Survey on Drug Use and Health (NSDUH) provides national and state-level data on the use of tobacco, alcohol, illicit drugs (including non-medical use of prescription drugs) and mental health in the United States https://nsduhweb.rti.org/respweb/homepage.cfm

    Substance Abuse and Mental Health Services Administration (SAMHSA), is an agency of the U.S. Public Health Service in the U.S. Department of Health and Human Services. http://www.samhsa.gov/

    Alexandra Sifferlin, (2015) What Drinking Does to Your Body over Time, Time Magazine, http://time.com/author/alexandra-sifferlin/

    And

    Alexandra Sifferlin, (2014) Alcohol Kills 1 Person Every 10 Seconds, Report Says, Time Magazine, http://time.com/96082/alcohol-consumption-who/

    Silverstein, Herma. (1990), Alcoholism. New York: Franklin Watts http://allpsych.com/journal/alcoholism/#.VZQkhWPH_VI

     

  • How Emotionally Mature Are You in a Heated Conversation?

    manhattan_bridge_post_versionI am working with a client who is struggling in his recovery. He is having trouble being emotionally mature in heated conversations with his live-in girlfriend. I discussed with my client how he acts when he is in an argument.

    My client would like to believe that he is a mature, rational, 40-year-old adult, but if he is honest, if we all are honest with ourselves, we’ve all have some emotional immaturity within us.

    The truth of the matter is that we can act like adults in our relationships or we can act like we’re 6-years-old.

    When one partner shows emotional immaturity, the other one follows suit, often without much hesitation. Then the entire discussion fails. Perhaps we are triggered by a feeling of being less than, or of rejection or abandonment. In a flash we become the 6-year-old that was that was reprimanded by their older sister, the 9-year-old who wasn’t selected for the baseball team, or the 12-year-old seeing their aunts and uncles fight at Thanksgiving dinner.

    As a coach, I like to differentiate between the emotional maturities of the 6-, 9- or the 12-year-old, as compared with the maturity of the forty-year-old. When we begin to mature, our childlike behavior no longer reaps the same reward and we are forced to act more maturely.

    A 6-year-old is very limited in their list of options of how to handle a situation. They were learning as they go, finding out what works and what doesn’t. As adults, we have choices and options that a 6-year-old didn’t. Before you react to something, ask yourself this: Do I want to be 6, 9 or 12 – or do I want to be 40? A true adult gets to choose!

    Let me illustrate the difference. . .

    Immature Mature
    I snap at my partner because I feel irritation. I recognize that I am irritable and why, so I calmly let my partner know how I feel and what I need to help me feel better.
    I hold something that bothers me inside until I blow up at my partner. I hold something in until it comes out sideways. I tell my partner as soon as I am aware that something is bothering me so we can calmly discuss it.
    I call my partner names and belittle them when we are arguing. I point fingers, invade my partner’s space and raise my voice I realize that name-calling and belittling does not help the situation and I can voice what is really bothering me instead. I recognize my body language, keep my hands at my sides, lower my voice and keep my distance.
    I stuff my feelings down or lie to my partner because I am afraid it will start a fight or they will reprimand me I am honest with my partner because I am emotionally prepared for their reaction.
    I act on my sense of urgency to fight with my partner, knowing that I am right, reactive and emotionally activated. I recognize that I am reactive and I force myself to wait until I feel more stable to discuss it with my partner. I never respond immediately to something when I am angry, even if my partner insists.
    I am defensive, hurt and argumentative when my partner complains about something I am doing. I recognize that my I am not perfect; I say I am human, I can make mistakes. I expect that sometimes my partner will have comments about my actions or behavior.
    When my partner complains about me, I remind them that they have done the same thing or they did something that bothered me in the past. (pointing the finger, deflection or cross-complaining) I hear that my partner is bothered by something and I validate their feelings. Any complaints I may have about them can be brought up another time.

    I showed my client this chart and asked how he reacted to the most recent blow-up with his girlfriend. He identified several immature characteristics in these columns that he used in the recent exchange. How many characteristics did he use, did this number of immature responses overwhelm the number of mature responses? Then we talked about what the mature responses would be.

    Immediately, he said this was a good chart and he was going to show her this chart to tell her about how she was also immature in this past discussion. I suggested he not to do this, saying that a mature partner need not shame his partner, even if it is under the guise of using a learning tool. It would be more important for him to practice having mature adult responses to future, potentially explosive situations, so the temperature of the next conversation does not rise. Then his girlfriend will see and emulate his mature behavior in future dialogues.

    Using correct tools of engagement in heated discussions was never taught in our families or at school. We learned how to argue and fight from our parents, family members or friends. At forty, it is time for my client to approach a heated conversation as a forty-year-old and not a 12-year-old.

  • Why I can’t make a good decision when I am fatigued?

    manhattan_bridgeFatigue takes a toll on the brain

    In the August 2004 issue of the journal Sleep, Dr. Timothy Roehrs, the Director of Research at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit, published one of the first studies to measure the effect of fatigue or sleepiness on decision-making and risk-taking. He found that indeed it does take a toll on effective decision-making.

    Cited in the October 12, New York Times Science section, Dr. Roehrs and his colleagues monetarily rewarded sleepy and fully alert subjects who completed a series of decisions and tasks. At random times, the subjects were given a choice to take their money and stop. Or they could forge ahead with the potential of either earning more money or losing it all if their work was not completed within the time remaining. A kind of “Who wants to be a Millionaire” science experiment.

    Dr. Roehrs found that the alert people were very sensitive to the amount of work and time they needed to do in order to finish the tasks and understood the risk of losing their money if they didn’t. But the sleepy subjects chose to quit the tasks prematurely or they risked losing everything by trying to finish the task for more money, even though it was likely that they would not be able to finish.

    According to the National Commission on Sleep Disorders Research (1998) and reports from the National Highway Safety Administration (NHSA, 2002), a high number of accidents can partly be attributed to people suffering from a severe lack of sleep.

    Each year, according to the NCSDR, the cost of sleep disorders, sleep deprivation and sleepiness is estimated to be $15.9 million in direct costs and $50 to $100 billion a year in indirect and related costs. And according to the NHSA, falling asleep while driving is responsible for at least 100,000 crashes, 71,000 injuries and 1,550 deaths each year in the United States. Young people, in their teens and twenties, who are particularly susceptible to the effects of chronic sleep loss, are involved in more than half of the fall-asleep crashes on the nation’s highways each year. Sleep loss also interferes with the learning of young people in our nation’s schools, with 60 percent of grade school and high school children reporting that they are tired during the daytime and 15 percent of them admitting to falling asleep in class.

    We’ve always known that sleep is good for your brain, but new research from the University of Rochester provides the first direct evidence for why your brain cells need you to sleep, and sleep the right way. The study found that when you sleep your brain removes toxic proteins from its neurons that are by-products of neural activity when you’re awake. Unfortunately, your brain can remove them only while you’re asleep. So when you don’t get enough sleep, the toxic proteins remain in your brain cells, wreaking havoc by impairing your ability to think — something no amount of caffeine can fix.

    Skipping sleep impairs your brain function across the board. It slows your ability to process information and problem-solve, kills your creativity, and raises your stress levels and emotional reactivity. Basically, it affects your decision-making ability.

    Decision Fatigue

    The mental work of making decisions time after time can wear you down. Decision fatigue is the newest discovery involving a phenomenon called ego depletion, a term coined by the social psychologist Roy F. Baumeister. This sort of fatigue can make quarterbacks prone to dubious choices late in the game, a CEO leans toward disastrous dalliances late in the evening or a recovering addict deciding to use after a long day at work. It routinely warps the judgment of everyone, executive, delivery driver, rich or poor — in fact, it can take a special toll on the poor. Yet few people are even aware of it, and researchers are only beginning to understand why it happens and how to counteract it.

    Decision fatigue helps explain why ordinarily sensible people get angry at colleagues, splurge on clothes, pick up candy at the market’s check out lane and can’t resist the dealer’s offer to rustproof their new car. No matter how rational and high-minded you try to be, you can’t make decision after decision without paying a price. It’s different from ordinary physical fatigue — you’re not consciously aware of being tired — but you’re low on mental energy. The more choices you make throughout the day, the harder each one becomes for your brain, and eventually it looks for shortcuts, usually in either of two very different ways.

    One shortcut is to become reckless: to act impulsively instead of expending the energy to first think through the consequences. (Sure, tweet that photo! What could go wrong?) The other shortcut is the ultimate energy saver: do nothing. Instead of agonizing over decisions, avoid any choice. Ducking a decision often creates bigger problems in the long run, but for the moment, it eases the mental strain. You start to resist any change, any potentially risky move — like releasing a prisoner who might commit a crime. So a fatigued judge on a parole board takes the easy way out, and the prisoner stays in prison.

    These experiments on Decision Fatigue demonstrated that there is a finite store of mental energy for exerting self-control. When people fended off the temptation to scarf down M&Ms or freshly baked chocolate-chip cookies all day at the office, they were then less able to resist other temptations, like stopping for a bottle of brandy on the drive home. When they forced themselves to remain stoic during a tearjerker movie, afterward, they gave up more quickly on tasks requiring self-discipline such as brushing their teeth, taking off their make-up or sleeping with the guy that paid for the movie. Willpower turned out to be more than a folk concept or a metaphor. It really was a form of mental energy that could be exhausted.

    In the rest of the animal kingdom, there aren’t a lot of protracted negotiations between predators and prey. A lioness doesn’t arbitrate with an antelope. To compromise is a complex human ability and therefore, it is one of the first abilities to decline when Decision Fatigue sets in. If you’re shopping, you’re liable to look at only one dimension, like price: just give me the cheapest. Or purchase only the products you have coupons for. Or purchase only the items which are covered by food stamps. Or limit yourself to only the $100. you have in your budget for groceries. And now, you have to put away the barrettes you got for your daughter, and the athletic socks for your son. Shopping can be especially tiring for the poor, who have to struggle continually with trade-offs.

    Researchers argue that this sort of Decision Fatigue is a major, and a largely ignored factor in trapping people in poverty. Because their financial situation forces them to make so many trade-offs, they have less willpower to devote to school, work and other activities that might move them up into the middle class. It’s hard to know exactly how important this factor is, but there’s no doubt that willpower is a special problem for poor people.

    Decision Fatigue is a reason that the liquor, candy and soda is displayed in the front of the store, featured prominently near the cash register, just when shoppers have depleted all their decisions in the aisles. With their willpower reduced, they’re more likely to yield to any kind of temptation, but they’re especially vulnerable to booze, candy and soda. While supermarkets figured this out a long time ago, only recently did researchers discover why.

    Despite this series of findings, brain researchers did find that glucose is a vital part of willpower. They helped solve the puzzle of how it increases the brain’s energy. Your brain does not stop working when glucose is low. It stops doing some things and starts doing others. It responds more strongly to immediate rewards and pays less attention to long-term prospects. A perfect environment for alcohol abuse.

    The discoveries about glucose help explain why dieting is a uniquely difficult test of self-control and why even those people with phenomenally strong willpower in the rest of their lives can have such a hard time losing weight. They start their day with virtuous intentions, resisting croissants at breakfast and dessert at lunch, but each act of resistance further lowers their willpower. As their willpower weakens late in the day, they need to replenish it. But to resupply that energy, they need to give the body glucose. They’re trapped in a nutritional catch-22:

    1. In order not to eat, a dieter needs willpower.
    2. In order to have willpower, a dieter needs to eat.

    Fatigue at work

    At work when we are fatigued, we are pretty good at avoiding the urge to spend money, but not so good at resisting the lure of relaxation, such as scrolling through Facebook, online shopping or viewing pornography on the web.  Today there are so many choices to make. Your body may have dutifully reported to work on time, but your mind can escape at any instant. A typical computer user looks at more than three dozen Web sites a day and gets fatigued by the continual decision-making — whether to keep working on a project, or check out YouTube, or follow a link to another interesting research topic or buy something on Amazon. Ever wonder why Cyber Monday is one of the biggest shopping days of the year?

    The cumulative effect of these temptations and decisions isn’t intuitively obvious. Virtually no one has a gut-level sense of just how tiring it is to decide. Big decisions, small decisions, they all add up. Choosing what to have for breakfast, where to go on vacation, what to do next, how much to spend from this paycheck— these all deplete willpower, and there’s no blinking indicator light on your dashboard to warn you that your willpower is low.

    When the brain’s regulatory powers weaken, frustrations seem more irritating than usual. Impulses to eat, drink, spend and say stupid things have no filter and alcohol causes self-control to decline further. The Decision Fatigue effect was even demonstrated with dogs in two studies by Holly Miller and Nathan DeWall at the University of Kentucky. After obeying sit and stay commands for 10 minutes, the dogs performed worse on self-control tests and were also more likely to challenge another dog’s turf. Fatigued humans are also more likely to get into needless fights over turf. In making decisions, they take illogical shortcuts and tend to favor short-term gains (like ending the meeting and going home) and delay reviewing costs (yes even adding numbers up on a calculator is a decision).

    “Good decision making is not a trait of the person, in the sense that it’s always there,” Baumeister says. “It’s a state that fluctuates.” His studies show that people with the best self-control are the ones who don’t schedule endless back-to-back meetings, they avoid temptations like all-you-can-eat buffets, and they establish good sleeping habits. Instead of deciding every morning whether or not to exercise, they work out with a friend. Instead of counting on willpower to remain robust all day, they conserve it so that it’s available for important decisions.

    “Even the wisest people won’t make good choices when they’re not rested and their glucose is low,” Baumeister points out. That’s why the truly wise choose not to restructure the company at 4 p.m. Board meetings are not held at night. Major commitments are not made over cocktails. And if a decision must be made late in the day, they make sure they have eaten something like an apple or an orange to recharge their glucose levels. “The best decision makers,” Baumeister says, “are the ones who know when not to trust themselves.” 

    Next week’s post will feature tips and tools on how to achieve a good night’s sleep.


    Resources for this article came from:

    Baumeister, R.F., & Heatherton, T.F. (1996). Self-regulation failure: An overview. Psychological Inquiry, 7, 1-15.

    Kathleen D. Vohs and Roy F. Baumeister, Running Head: Self-Regulation and Choice-Decision Fatigue Exhausts Self-Regulatory Resources-But So Does Accommodating to Unchosen Alternatives http://www.chicagobooth.edu/research/workshops/marketing/archive/ WorkshopPapers/vohs.pdf

    Baumeister, R. F.; Sparks, E. A.; Stillman, T. F.; Vohs, K. D. (2008). “Free will in consumer behavior: Self-control, ego depletion, and choice”. Journal of Consumer Psychology 18: 4–13. doi:10.1016/j.jcps.2007.10.002.

    Baumeister, R. F.; Vohs, K. D. (2007). “Self-regulation, ego depletion, and motivation”. Social and Personality Psychology Compass 1: 115–128. doi:10.1111/j.1751-9004.2007.00001.x.

    Dr. Timothy Roehrs, (August 2004), The Journal Sleep, http://www.journalsleep.org/PDF/AbstractBook2004.pdf

    Drowsy Driving and Automobile Crashes, NCSDR/NHTSA expert panel on driver fatigue and sleepiness,
    http://www.nhtsa.gov/people/injury/drowsy_driving1/drowsy.html

    Dr. Travis Bradberry (December, 2014), Sleep Deprivation Is Killing You and Your Career , Forbes Magazine,
    http://www.forbes.com/sites/travisbradberry/2014/12/01/skipping-sleep-is-career-suicide/

    John Tierney, (2011) Do you suffer from Decision Fatigue? New York Times Magazine,
    http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?_r=0&pagewanted=print

    Holly Miller (2014) Self-control without a “self?”: common self-control processes in humans and dogs Department of Psychology, University of Kentucky, Lexington, KY 40506-0044, USA.

    Psychological Science (Impact Factor: 4.43). 04/2010; 21(4):534-8. DOI: 10.1177/0956797610364968, Source: PubMed

     

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    Thank you for your response. ✨

  • Thinking about my mistakes from the past

    manhattan_bridge_post_versionOne of my clients, Caroline, is a brilliant woman who has hit bottom, very, very hard. She is an Ivy League-educated woman, mother of three, and the wife of a wealthy professional in the suburbs of Chicago. But unfortunately, she drinks. After two years in and out of five rehabs, of countless detox stays, restraining orders and divorce proceedings, she is now 8-weeks sober and living in a homeless shelter in the city center of Chicago. She is working with a family reunification therapist to slowly piece together the relationship she lost with her teen-aged children. Caroline expressed to me that she is afraid her past actions have permanently affected her children, so much so that they will reject her and hate her, forever:

    “I am having an especially hard time with my “past mistakes.” The Daily Reflections yesterday spoke to me about leaving the past baggage behind, which of course I would love to do, but it’s hard. I feel terrible and ashamed of the things I did. I try to stay in the present but right now, in the family therapy sessions, my past mistakes are coming up in such big ways and will continue to do so when I see my children in supervised therapy. I can’t imagine what they think of me, a homeless drunk. I don’t know how to help them put the past behind, but I guess that’s what the therapist is for.”

    I shared with Caroline some thoughts about having an especially hard time with mistakes from the past. Sometimes, I told her, how we deal with our personal mistakes is by beating  ourselves up, by not letting go of a mistake we have made and/or worrying about what other people think about that mistake. Yet, in our recovery, we have an opportunity to let go of those old tapes. However, the tapes that are playing, over and over, in our heads, are actually old tapes from our childhood, remembering how our parents treated us when we made a mistake. Perhaps they “beat us up” either emotionally or physically, or both. Well, it is time to let those old tapes go, because they were never about you and the mistake you made. They were really about your parents who were triggered by your actions into reliving the mistakes they made, and then reacting to them.

    Not letting go is part of our addiction. Let’s say this: we are hardwired for compulsive thought. It is part of us, and in our sobriety our compulsive thought is switched from one focusing on drugs and alcohol (or work, sex, gambling or purchasing things) to something more productive and positive. Just as you are successfully turning off the compulsive thought about using or acting out, it’s time to switch off the compulsive thought about not being good enough and beating up yourself over your past mistakes. You can use these slogans: “Let go, let God,” “lesson learned,” “what is in the past is in the past.” They should be the new words, the new mantra you use to combat these destructive and negative tapes.

    What do other people think about your mistakes? Research proves they think very little about your mistakes. Yes, I know it is your kids, your husband and/or your parents and you worry about what they think of you or how they judge you. But honestly, that same research shows people really don’t spend that much time thinking about you. As much as you think they do, they don’t. Your kids are thinking about what to wear to school, what the new girl in history class thought about what them, or your husband is concerned about the bills or the next Harvard Alumni meeting. The fact is your neighbors don’t think about you at all! Yes, maybe a little gossip in the parking lot of the school, but truly, that two-minute exchange is dwarfed by them worrying about what people think of them. So let that go. People care about themselves. They think about themselves. (Just like you are thinking about yourself, right now?)

    Now here is the most important part of my conversation with Caroline. “I don’t know how to help them put the past behind them.” Caroline is a co-dependent. She is always doing, doing for others. She has placed herself behind her husband, his business, and her children for more than twenty years. It got her a little angry sometimes, and so she drank. Well, things got a little out of hand when she began drinking alcoholically. Caroline thinks she can help her kids put the past behind them. But, she can’t. That is her kids’ job. Yes, she recognizes that a therapist can help her children. But still she wants to do their job for them. No she can’t rob her children of this opportunity. The life lesson her kids will learn about putting things in the past and forgiving, will be one of the biggest “Ah-ha” moments they will have.

    I explained to Caroline the only way that she will be in her kids lives going forward is if she is sober. She said she knew that. The only way she can help her children put the past behind them, is by emulating that for them, by doing a 9th step, by making her amends. She seemed to digest that comment. Today, she had a lengthy session with the reunification therapist, so I am hoping Caroline will call me tonight.

  • I am angry — How do I fight fair?

    The following post, I am angry — How do I fight fair?, is the fourth post in my HALT (Hungry, Angry, Lonely, Tired) series of blog posts. This post is about anger and a particular client, and how he might have better conversations with his girlfriend, even when they start out with hot-headed disagreements and potentially explosive discussions.

    First, I asked my client to describe what kind of person he is. Does he like a good debate? How does he conduct himself in an adversarial discussion? Does he avoid conflict at all costs? What about criticism? Does he interpret it, or disagreement, as an attack on him? Will he use a verbal dagger to stab his opponent, only to regret it later? Does he lose his head when an argument ratchets up a notch? Or does he back away, withdraw and become silent when he is angry? Is it his style to dredge up everything a person has done in the past to use as a weapon? Will he cry to get sympathy, or storm out of the room to end a discussion, all together?

    In response, he laughs, and says, “at one time or another, all of the above have been characteristic of my ‘discussion’ style.” He asks, “How do I fight fair?”

    Regardless of the nature of most relationships, conflict happens. For many of us, conflict creates significant discomfort, and we revert to “fall back” modes of handling it. As I mentioned in a blog post last month, it’s typical to retreat to what we learned as children, that being in a conflict situation with someone means you are going to get out of control, start acting like a child, and/or become aggressive. The truth is, conflict is a normal human component, just as normal as joy, happiness, and sadness. If handled appropriately, conflict can actually strengthen relationships, improve intimacy and our understanding of each other.

    Conflict happens when two people disagree about their perceptions, desires, ideas, or values. It is not about the other person being a bad person. It is a disagreement about viewpoints. If you focus solely on the disagreement, dealing with conflict becomes easier. Fair fighting is a way to manage conflict effectively and the feelings that come with it. To fight fairly, you can follow several basic guidelines to help keep your disagreements from becoming entrenched or destructive. You may find this difficult when you think another’s point of view is irrational or just plain unfair. But remember, he or she may think the same thing about your ideas.

    1. Take your conversations into a private room or office. Consider the damage that fighting in front of your children can inflict. It can scar them emotionally, especially if you don’t have the self-control to contain the conversation. An argument conducted in front of your peers will likely be destructive to your career. Moving to another location will give you the opportunity to gather your wits, and can help you remain calm. By remaining calm it is more likely that others will consider your viewpoint.
    1. Keep what is in the past, in the past. Don’t bring up previous fights or heated discussions that don’t pertain to a current discussion. I have a household rule: You get one chance to criticize a behavior or action, and discuss it. Then it is gone, off limits for any discussion going forward. Throwing every complaint from the past into today’s argument resolves nothing. It is often a behavior of someone that knows they are losing credibility and uses this deflection tactic as a last defense. Storing up lots of grievances and hurt feelings over time is counterproductive. It’s almost impossible to deal with numerous old problems for which recollections may differ.
    1. Talk about what is really bothering you. Vague complaints are hard to process. Stay on topic, and deal with only one issue at a time. If you don’t focus on what really bothers you, you will come away from this exchange frustrated at not having your needs met, or being heard. Avoid back-stabbing or hitting below the belt. As your blood pressure rises, you get into fight mode rather than resolution mode. Simply avoid attacking your partner personally. Saying things like “Your father always did that” or “You can’t keep it in your pants,” guarantees the conversation will deteriorate beyond the point of resolution. Attacking areas of personal sensitivity creates an atmosphere of distrust, anger, and vulnerability. Accusations will lead others to focus on defending themselves rather than on understanding you. Instead, talk about how someone’s actions made you feel.
    1. Give your partner a face-saving way out of the disagreement. Avoid following them through the house, yelling at their back or screaming and kicking at a closed door (yes, that’s a form of violence!). How an argument ends is crucial. Recognize when an olive branch is being extended— perhaps in the form of an apology or a suggestion to discuss it at a later time. That’s a signal that it is time to end the discussion even if the matter is not resolved to your satisfaction. Recognizing this opens the door to resolution at another time and gives your partner that all too critical face-saving way out of the disagreement.
    1. Set a time limit. Arguments should be temporary, so don’t let them get out of hand. Don’t allow the ugliness of an argument to stretch on indefinitely. Having the last word, never automatically makes you the winner. Let the last word go, walk away, and have that last word with yourself, outside or in the basement, alone.

    In my next post, I’ll focus on step-by-step guidelines for fighting fair.