Episode 22

all right i think we are starting here another great episode of finding peaks recovery center as your host nailed that introduction that’s a soft launch right here it was great it was powerful really yeah just playing with a few different intros like that oh we’ve we’ve we’ve just started yeah oh oh you just came into our lives that’s surprised look yeah yeah so anyways let us know finding funny peeks at peaksrecovery.com if that works for you the viewers right likely not jason told me to do it sitting here today with the friend colleague chief operating officer clint nicholson everybody pleasure and chief clinical officer jason friesma everybody welcome back to the show we were intending to do a show today with the doctors about medication assisted treatment but that’s coming to you now in the future because they got a little bit busy today so here we are so we’re going to talk about treatment modalities today cognitive behavioral therapy motivational interviewing when to insert it when not to do it um kind of as an introduction to this you know because i like to build on a little story every time i approach absolutely stay awake this time going back uh we did a podcast long long time ago with a special friend of ours uh dr steven alardy who’s a professor at university in kansas i believe is the university that he’s working at and he does a lot of research on depressive uh disorders major depressive episodes and so forth um check him out online he’s got a lot of great videos but he did a little podcast session with us and i think he was talking about how to resolve a major depressive or disorder as a single diagnosis code said in that regard using strictly cognitive behavioral therapy it takes up to 90 days to resolve the issue in individual therapy sessions as an intervention okay so taking a step back from that data sounds powerful but in a 45-day stabilization model such as peaks recovery centers or a 90-day recovery program over time we are dealing with very complex individuals substance use disorder major depressive major depressive episodes psychosis mania a lot of varying diagnosis for the individuals that we treat at any given time so it doesn’t feel reasonable just to launch into a cognitive behavioral therapy and that’s all we’re going to do you know at a center like ours or within any early short-term recovery episode in that regard so just curious about mainly where to start with this but also yeah but also too how do we because families are you know all of the addiction treatment centers websites are saying evidence of evidence-based practices well if it takes 90 days just to do nine you know a major depressive clean that up a little bit then what are we doing with all the other diagnosis doesn’t seem to really fit into what we’re trying to do in stabilization phases so maybe just as a broad approach to this why why don’t we just use a single approach to therapy through the first 45 days at peaks like cognitive behavioral therapy yeah i think that’s fair and i and i refer back to some of our other podcasts that we’ve done where people come into peaks and probably enter any residential program at a different place everybody um has varying degrees of motivation and a wider range of symptoms that they’re dealing with and so if somebody comes into our program and really they aren’t even sure if they would like to be sober or if they’d like to make changes to their life at all jumping straight into cbt cbt does require a little bit of buy-in from somebody they need to kind of be interested and motivated to change and so if somebody isn’t quite yet motivated to make some changes other approaches like motivational interviewing as you might suspect um would be a better approach in those instances and and those modality that modality particularly is designed to help um clients move from that starting line of like maybe i want to change maybe i don’t or i don’t want to change and get them to okay i’m ready to change does that make sense yeah okay yeah i think um people are complex you know like even a single diagnosis like um like major depressive disorder like that has many so many factors to it that i even think that cbt in a 90-day model would be really difficult to completely um resolve like a major depressive episode i think the idea of being eclectic in your approach is probably i mean if you think about complexity and then being eclectic is going to allow you to be able to meet all of the different needs at different times because like jason said like in one moment you may have somebody who’s highly motivated to to move forward and make these changes and a more um sort of i don’t know confrontational approach like cbt might be really effective but if you have somebody who’s still on the fence to go in there and say hey well you know actually your thought patterns are not are this but they need to be or should be or could perhaps look like this they’re going to be like what the hell are you talking about you know they’re not even going to be able to hear you so being able to i mean my personal approach i like to go in with a little bit of mi and then slide in with the cbt and then you do a little bit of solution focused on top of that you get a nice little sandwich there as far as treatment modalities go but you have to first and foremost meet the client where they are and if you’re not paying attention to that then no matter what treatment approach you have no matter what intervention strategies you’re using you’re going to miss the mark so well i think what’s interesting i don’t know about your program um but the program that we both work in no no the master’s program the master’s program sorry i’m aware of that the program we both work but i do think you know we were trained to pick one modality absolutely as clinicians and to stick with it and the word you know to take an amalgamation of these different tools and combine them having an eclectic approach um was pretty heretical actually to a master’s program right and then you enter the real world with real people and you can if you only have a hammer the world looks like a nail isn’t that the same and like you have to have a lot of other tools on the tool belt i think um in order to approach clients in a sophisticated way yeah absolutely i remember being in grad school thinking that oh i’m never going to use cbt i’m an existential therapist that lasted about three days so i’m pulling the gestalt yeah


so cognitive behavioral therapy to me is you’re sitting in a room as a therapeutic intervention individual has one reality seemingly not a true reality in this moment the practitioner has an alternative reality and that’s more aligned with the world for the way that it is and the goal then is through that rapport building mechanism to help them see the better framework of reality and to move and lean into that um is that accurate yeah i mean i think i think that’s a good representation of it for the most part like basically people have cognitive distortions they aren’t thinking as clearly as maybe they could and um and there are a variety of techniques in cbt to begin to uh challenge and or reframe thinking yeah that’s pretty much it yeah it’s a it’s a lens it’s just somewhat distorted right like there’s just a i don’t know a smudge on the lens and you’re there to sort of say well what if you wipe this much away then what then what does the world look like so and you’re so you’re not only are you highlighting that hey you might have a smudge on your lens you’re also presenting them with alternatives to what the world may look like without that much yeah and and i know one of your big um beliefs and i believe rightfully so is that to do good clinical work is to engage with your own clinical work in that regard because when i think about a practitioner who’s not well themselves their alternative reality could be in a sense a liability um in that regard if they’re not working on themselves inaccurate seen in that way too does is that um or what i’m stating about that seemingly true within cognitive behavioral therapy oh yeah absolutely i think it’s true right if you’re kind of carrying your own cognitive distortions into a therapy session it can be hard to help other people out with that clinton mentioned solution focused which really entails helping uh clients come up with solutions that they can come upon themselves and i i find that clinicians that haven’t done their own work just get use that as an opportunity to say solution focus is focusing on my solutions for you right absolutely feels a lot more like parenting or telling right yeah just telling people and like the bob newhart video just like stop it like it it requires more nuance than that quite frequently to help people change behavior yeah i mean sometimes yeah sometimes occasionally the bob new heart approach works which is just well you feel sad you should stop that i do think too that cbt in the in the a big reason you know that dr elardi uses it and that it is an evidence-based model because it is a pretty um regimented and structured model and so when we’re using eclectic approaches like that’s hard to do a clinical study on and so when people are doing clinical studies you have to kind of get into that lane and stick to the parameters of that lane and so that is why that appears a lot i think in in studies and so in practice like that is definitely a tool that is important to pull out from the toolbox but we have the ability to to get out of that just that modality too and be able to use other tools um clinically as needed that makes sense to like yeah yeah i mean it’s um i don’t know the more options you have then the more opportunity you have to address what’s actually happening in the moment you know i think that if you’re too focused on trying to i don’t know like force a modality into the moment you you miss things like you um i’ve seen that a lot with especially like newer clinicians who are focused on who use a lot of worksheets and handouts and stuff i think that they you kind of come in with an agenda of like oh my goal is to get through this worksheet and so as you’re going through that worksheet somebody may make a comment that you’re going to miss because your whole focus is just like i just need to get back to this worksheet so and i think that that can happen if you’re too focused on one specific clinical modality i think the ability to um to know when it’s appropriate to pull which evidence-based practice is actually the sort of art of being a therapist like that’s the art of being a good counselor is knowing when to pull what tool out and um and then being able to use it really effectively so because there’s so many good i mean there’s a there’s a time and a place for everything you know cbt is an amazing modality when it’s time to use cbt right solution focus like jason said like it’s not really solution focused if you’re just giving people answers or if you’re telling them what to do like that’s not a solution that’s a tell yeah so i think that there are um it really comes down to sort of the skill of the clinician and really being able to pay attention to the moment and really hear and recognize what the needs of the client are in that moment in order um i think that that is really actually what the whole i don’t know that like i said that’s the art of being a therapist that’s where it really comes into play yeah so and then so taking one step back to ping that mi language that motivational interviewing um as a therapeutic intervention modality however we seek to to put it in this framework um is that the most tactful sort of maybe first time approach that is often taken or um or is there something a little bit more preliminary to motivate motivational interviewing that’s what motivational interviewing in and of itself is actually a person-centered it’s an offshoot of person-centered therapy yeah and so all that means all person-centered means too is that like you hold the person in unconditional positive regard and you build a rapport with them and and then um and then the therapeutic journey goes from there so like it’s kind of implied within am i med i think motivational interviewing is where you meet people where they are um and so to me that is the first tool i usually pull out of the toolbox unless they’re well down the path of like taking action and and doing a lot more introspection and other things and are available for that but you know helping somebody walk through the ambivalence of like do i want to change or do i not want to change that’s just where motivational interviewing is a really natural tool to pull out in my opinion yeah yeah i mean i think it’s a good place to start it’s some people sit in it a little bit longer than others it’s i don’t tend to stay in that space for very long um because i i mean i believe that counseling is about change right like that’s the goal is to change and so to sit in space and um but you have to get that buy-in first like jason said you have to wreck it you have to be able to recognize and understand well what is the person’s actual willingness to make this change and so from that point once you’ve identified that then you can start moving on into these other different modalities you know you have cbt you have trauma informed care which is again another sort of person-centered approach that really focuses on building safety and rapport and relationships i mean you have uh you know even relapse prevention strategies uh dbt um act i mean they’re all of these different you know modalities that you can start to pull from once you know where that person is and at that point that’s when you start to to pull pull out of your toolbox and start implementing these different strategies based on where that individual is in the moment and then but and certainly like when i’m working with our clinical team at the core of all of this honestly is our relationship with our client yeah right like i can have the best tools and know cbt in and out and dbt and all that but if i don’t have the relationship if i don’t have that connection with a client none of that matters to be honest with you like um if i don’t have that buy-in right and and that is the part i think um that’s hard to measure and you can’t really see it um it it is felt which i know you guys love like it’s a it’s a feeling it’s a feeling it’s a explain that yeah i know i know it’s confusing that’ll be a different episode i’ll be in that seat but like i do think uh but i think that’s the magic sauce that connects all of us absolutely and allows uh you know and i i was thinking too back to the cbt thing like i find cbt to kind of be a front door approach with clients like you it’s it’s has a high face value like you it’s clear what you’re doing it’s clear what you’re asking a client to do and it’s clear where you’re trying to take the session and some clients love that and it’s really great others put walls right there and you have to find another tool and i know we joked about gestalt but pull your addiction out of your body put it on this chair let’s talk to it and see what it’s saying to you it sounds it can sound ridiculous to people who don’t like that but like to other people it’s this freedom of to have a conversation over here with my addiction and that is an entire dif entirely different modality absolutely yeah no but i i mean yeah to jason’s point i mean a lot of i like to tell a lot of new counselors that you know about 95 of being a good counselor is actually just being like a decent human being you know being a good listener being emotionally present not judging them and that really like takes the win out of their sales because they just spent 50 grand on a master’s degree so but really it is like it’s about being a decent person because that relationship that initial connection that trust is the foundation of everything and if you don’t have that if you can’t make that connection if you can’t show up genuinely and authentically as a human being in those moments like jason said you can have all the shiny new tools in the world but i mean if you don’t have a house to work on then what’s the point right yeah right when you said a really important word which was authentically because when i talk to new counselors i say that as well but i also say and it’s so important that you be yourself yeah right that authenticity like you can’t fake rapport clients no smell it a mile away right the younger the the keener the sense of smell


exactly yeah absolutely so as a and and of course there’s dbt dialectical behavioral therapy so there’s a variety of acronyms there’s a variety of different ways that we can go about this um but as an as an early sort of stabilization therapeutic intervention what are like the top three that are used most often i think we’ve discussed two of them i mean i actually think it’s mi cbt and dbt okay i think those are the three yeah truthfully okay then what is dialectical behavioral therapy so that is really about um helping people get out of the extremes of emotions and and finding um uh and not being driven by emotion dbt is super helpful um when people well it’s almost a training for helping people manage and regulate their emotions because obviously in the case of substance use and even in the case of mental health issues the emotions are regulated by other things and so when people begin to get healthy emotions can can be overwhelming or some a lot of times people just walk in with overwhelmed emotions and being taught um distress tolerance and emotional regulation um and and kind of how to access the wise mind if you will the part of the brain where i can just kind of observe what’s happening and not be so reactive to it um i think that’s a really fundamental part of a stabilization process yeah i mean my three are a little i i like to focus i guess i consider dvt a form of mindfulness so um so i i would think that mindfulness would actually be a primary uh i do think that cbt is a primary mi is the primary but i would also say that solution focused at least for me personally is i’m pretty solution focused guy because in the end we’re looking for solutions so it’s a matter of being able to get to that place of safety where you can start to explore those and actually make some headway but you do have to have buy-in and as part of the foundational process of it so um but yeah those would be my go-to’s for and i think it’s going to be different for every counselor to be quite honest you know but mi is almost always going to be a part of it because again if you don’t know where the person is in their journey then how in the heck are you going to meet him there so now i’m thinking of this clinical sort of ninja right slicing somebody with a little mi and then when it gets you know a little bit outside of where mi needs to is taking it then you know maybe hit it with the cbt or uh the dbt in that regard and just you know kind of as you go you’re offering the therapeutic intervention these modalities um in real time and the practitioner success is their ability to know when to pull those out within the tool right right absolutely yeah uh in this regard so uh as we kind of come to a conclusion here because what’s happening with these evidence-based practices is they set up you know the group setting and they put the practitioner in the middle of it and then they get all of these people to show up to it and then they just drive through it it sounds like though there’s an outcome and an opportunity to say these are evidence-based practices i don’t think those evidence-based trials are intending to say now just go out and do cbt for the next 90 days i think all they’re trying to point at in a real strict sense of things is that when you use it it does work and but the trials are just going to strictly focus on the cbt is that and accurate i think that’s exactly yeah what we’re trying to say yeah cool cool yeah because on the admissions line you know at peaks and working and people can’t say well what evidence-based modalities do you and i think they’re thinking about it in this strict tone of like johnny’s got major depressive disorders so i better hear you guys hitting him with the cbt but if we can’t engage with rapport and if we can’t move past ambivalence you know through mi then cbt dbt these therapies seem right way out in the distance absolutely if somebody comes in they say i’m depressed and you say no you’re not then that’s i mean you can try that but it’s probably not going to work that’s yeah yeah you’re looking through the wrong lens yeah you’re perfectly happy so no that’s that’s bad cbt yeah yeah absolutely good you can do that you can say that over and over again for 90 days and it wouldn’t work so awesome well i honestly when we started this didn’t think talking about these modalities would be so much fun but i had a great time and um really appreciate you guys investment and getting everybody access to this information with a little bit greater understanding hopefully about how these work how it’s happening in real time and that when we think about trials and studies and those sorts of things they’re just pointing at its efficacy not that it needs to be delivered in that time constrained setting as well too there’s a lot of other complexities that we could talk about with trials and for how we’ve arrived at these evidence-based practices but for a future episode in that regard so uh love you guys love you too good question i think we motivationally interviewed you like you shifted a little bit yeah he just said he came in expecting it to be a little dull and boring and we tipped the scales to being an engaging that’s that clinical magic that’s what that master’s degree is about you don’t you don’t know what’s happening to you you just walk away a little bit better each and every quinn and i are really hosting this but yeah right we just let you think


all right thanks again for joining us here on another finding peaks episode it’s great as always to be in the social share it’s great to be joined by two wonderful great uh professionals in this industry great friends of mine as well too uh until next time check us out on the instagram the facebooks the podcasts the twitters i don’t know if we do twitter i don’t even know if anything


findingpeakspeaksrecovery.com please give us your ideas your thoughts instagram things you would love to hear us talk about in the future and uh until next time thanks for joining us