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Transcript for November 2012 Brown Bag

>> Through multiple sources I was able to extract what I think is a pretty good description of classical intervention and the way they work and what they do, what they don't do. And so I want to focus on that with you today. And that will be the first half of the presentation, about 20 minutes. And then at the end of that I do a brutal critique of classical intervention models, which then sets up the second part of the presentation, a reaction to my own model called -- it has to do with a focus on the adult lifespan. And you'll see that the assumptions are different. The respect and treatment of the client is different. And the outcomes I think are much, much better. And so I want to share both of those with you today. Before we start, let me ask, some of you are rehab, right? Any rehab people in here, all of you? Okay, so I know some various people. That's disappointing, because I was hoping to hear some things from them. But that's all right. So what I will say is your training clearly is to put you in a position so you can do your appropriate professional intervention as necessary after you do a client assessment. Let's talk about all that and see how that works. Does that have to be there, Chet? All that stuff?

>> Oh, I don't need that.

[ Inaudible ]

 

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>> For professors, 15 minutes. Associate is 10, assistant is 5. For an adjunct, you wait till I get here. That's just how that works. I've been part of our work since 2000 -- no, 1996, late '96. And over the course of time I've taught all the courses. And kind of developed in my own specialty, which is adult learning and I'm the professor that teaches the adult learning courses in spring and I'm still doing some work out in the Pacific. So you have one assignment to earn your one unit of continued education credit. I want you to write down this URL and access it. It's my own blog website. Check it out, read an article. You've got to read one article. And then your assignment is to send this link to three other adults that you know that could benefit from the content of my site. And that would be your parents, a rich uncle who lives in Las Vegas, you know, you get to pick. But probably somebody that's mid-life or beyond who will find this really helpful and really interesting.

 

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Okay, so I'm going to begin by talking about definitions. Justifications for interventions. We'll talk a little about standards and goals. And then I'm going to introduce about six different classical intervention models so you can see how they actually work. I don't have one specifically for rehab, but I've got a lot of crisis intervention stuff and substance abuse kinds of interventions and you'll see how that all plays out. All right, so what is an intervention? I'm using this term as if I know. And I'm using it as if you know. And it turns out that we all kind of know what they are, but do we really know what an intervention is? So typically the definition that I find most commonly in use is that it's an attempt to get people the necessary professional help that they need in response to something, a problem in their life. And there are lots of different attempts to do that. Most of them are systematic. You know, they're thought out, they're codified. There's steps and so on. And so we typically see interventions in response to a whole range of things. And as I did my review, almost every professional group engages in interventions. Everything from accountants to stock brokers to obviously to rehab specialists, educators. We all engage in interventions.

 

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So here's some of the topic areas for which interventions are typically applied. Health issues. Stress management. Injury recovery. Substance abuse of course. Disabilities, whether it's temporary or permanent. Antisocial behavior, like an arrest. Relationship ruptures. I love that word: relationship ruptures. Family problems. Divorce. Spousal abuse. The anticipated intervention after assessment and the intervention is done to try to remedy the situation. Child loss, another. In this economy a frequent form of rehab intervention, financial problems. We don't always think about that as a possible intervention area, but if you're underwater in your mortgage and you crank up your credit card debt, you need an intervention. Cognitive distortions, of course things like post-traumatic stress syndrome and a whole range of self-regulation problems, and I'll say more about those in a little bit, later in the program. I think the one that really gets most of us in this room, human performance deficiency. So a failure, underachievement, motivational issues. And an example I get from K12 would be this: in the public school system in California, because we have a standardized curriculum, that's where we do the intervention. And it's done by grade level with approximation to age level and maturity level.

 

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Those are pre-planned interventions for students to get them up to a grade level of academic and intellectual functioning. At the college level we see many interventions, particularly after an assessment. Somebody goes into the health center to do an assessment and realizes that they have XY and the doctor does an intervention. If you are a little weak in some of your academic skills, they do remediation. Relationship development. Classic intervention. Make you a leader so you can function more adequately in the social settings. And other than that, another one would of course would be cultural diversity training. I see that quite a bit. So interventions are everywhere. I think I probably convinced you on that part of it. So typically interventions fall into two camps. One is in response to unplanned events. So a disease, a traffic accident, chemical dependency, low self-esteem, reporting their problems, okay? The other category is where we actually do interventions in advance to prevent something from happening or at least to minimize the likelihood that it would occur. So health education, classic intervention before there's a problem. Training, preventative training. Personal family counselling, coaching, mentoring, all those would be examples. Oh, the big one for us: formal education. Formal education is a preventative intervention.

 

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And the idea for those of you in rehab is that you're going to come here, you're going to get training, we're going to mentor you. We're going to get your skill level up so that when you actually go out into the world of work you'll know what to do. We won't have to come and do an intervention. You'll know what to do. So those are the two categories that we see them falling into typically. All right, why do we do these things called interventions? Well, the simplest explanation I can give is to either maintain somebody's current level of functioning or to return them to where they were before, before they had a problem requiring intervention. And it's often believed by most professionals that you want to do interventions timely. You want to them quickly and appropriately and at the right time. Because if you don't, it could allow the situation to worsen. And if the situation worsens, it makes recovery less likely. And of course the longer you wait, the greater the costs, psychological costs, emotional costs, relationship costs. If you're a substance abuser and you're not getting treatment, you're probably destroying your most important relationships in life.

 

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And of course there are always financial ones too. The longer you wait, the more it's going to cost, because the longer you're making it. So what about goals? Typically there are six goals that we hear mentioned with regard to most interventions. First let me say something about purpose. Like I said, it's to either maintain current behaviors and functioning or to return somebody to a pre-crisis state. Now, something magical happens once you accept that as the purpose. Number one, it assumes a deficiency or a pathology on the part of your client. That's why you do an intervention. All right, that's the first thing. That's pretty heavy duty. It makes that assumption. But it also assumes that you can agree on what the outcome should be. What's the purpose of the intervention? What's the target behavior? Okay, that assumes that we all have some shared understanding and agreement on what normative behavior looks like. And of course we don't. Of course we don't. So right off the bat there's some things going on behind the curtain we may not have thought about that are real interesting, real serious and actually impact your clients in lots of ways. Here are six goals that are typically mentioned with regards to interventions. The first is to relieve stress, reduce and relieve stress.

 

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Second, restore the individual to optimal level of functioning. Next, to understand what precipitated the crisis. To identify remedial measures and resources that would be probably likely to remedy the situation. Next goal, to establish some connection between the current situation your client's in and where they were before. So bridge, I like this. A conceptual bridge that they can walk over to return to where they were before. And the last is you want to assist your client in initiating new ways of perceiving, thinking, feeling, right? And hopefully leave them with some adaptive coping skills that they can use in future events, future crises. So those are goals. Those are legit. They certainly make sense to most of us who work in this field. So let me share with you some models, classical models and you'll see how this stacks up. I'm going to go pretty quickly on this, but I'm not going to teach them here. I'm just going to show you the way they operate and how all those assumptions are inherent in the model per se. So we're going to be first looking at the Johnson model and this systemic intervention model, or SIM.

 

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And these deal classically with substance abuse issues, alcohol, drugs and so on. All right, so in the 1950's a guy by the name of Robert Vernon Johnson, the father of clinical interventions, came up with this way to deal with substance abuse issues. And what he came up with was what we call a compassionate confrontational technique. And the idea is that you take a substance abuser and you put them in a situation and you stress them out and you push them. You confront them about how damaging and destructive they are and their behavior and they're ruining their relationships and nobody likes them. You push them. You push them. And you want to precipitate a crisis so that the only way out is treatment, the intervention. Now Johnson's model was this incredible breakthrough because up to that time we wouldn't have real consistent success with substance abuse cases. By the way, his treatment entry rate was about 50 percent. So about half decided, "Yeah, I'm ready to go. I'm ready for treatment." People thought that was pretty great. Now let me show you the alternative. The systemic family intervention model was proposed as an alternative to Johnson's approach. The idea is that instead of just focusing in on the clients you work with the client's support network. Family, friends, colleagues. We pull them all together. We create a team. And it coordinates with the client as a working team. And it's pulled off in a loving and respectful manner.

 

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The client isn't pressed into a breaking point, isn't accused of maladaptive behavior. In fact, it starts out with an invitational workshop. Everybody comes and spends a couple days with them. They talk about what's going on, life treatment, substance abuse issues, how they started out early. Everybody talks about that. It uses coping rather than confrontation. And the result, about 90 percent treatment entry rate compared to what we saw with Johnson's approach. Big breakthrough. But, ladies and gentlemen, the assumptions behind this model are exactly the same ones behind Johnson's model. They haven't changed. Just the way the procedure is done is different. Here's the two compared. So, Johnson focuses on the patient. SFI focuses on the family support system. Johnson focuses on the individual. SFI focuses on the group. Johnson is potentially disrespectful, SFI respectful. We get the idea. So I wanted to show you two different competing models used with substance abusers, but again the assumptions behind them and the goals are the same. It's just a different way of putting them together. Crisis intervention. Anybody ever do any crisis intervention here? Anybody work in a crisis intervention center? Anybody? I'm the only one? This was in the 60's in San Diego.

 

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Primarily my clients -- the occasional suicide -- but primarily they were middle class substance abusers who overdosed and they were scared and that kind of thing. So I'm not talking about those days. Anyway, Robertson in the late 60's -- I met him a couple times -- came up with this seven-stage model. And this is the model that's typically used in crisis centers all across the country. They all use this, they're all trained in this. And they treat gang rapes, school violence, substance abuse, suicide, marital abuse, that kind of stuff. Let me show you what it looks like. It looks like this. And so with all good interventions, it begins with an assessment. And you have to do that so you know where you're going and how quickly. And then clues [inaudible]. So one of the first things I would do if I got a suicide is I would ask, "If you're going to kill yourself, how would you do it? Do you have a gun here? Is it loaded? Do you know how to use a firearm?" You have to assess how serious the situation is before you do anything. So that's the first step. Then you establish rapport with the client. And if it's over the telephone, you've got to be pretty slick, pretty gentle. Identify the major problems, including what's the last straw? What would it take for you to actually kill yourself or take more drugs? What is it? So you identify that.

 

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Then you move up to dealing with feelings and emotions. Then you start generating some alternatives. "Well, have you thought of some exploration stuff?" Then you come up with an action plan you can formulate that the person on the phone agrees with. Now you're starting to resolve the crisis. Then you do a follow-up plan and get agreement and so on. So that's the classic crisis intervention model that's used today and all over the United States. I was actually trained in that as a clinician. Another one, help release model. This is the idea that health related behaviors are determined by these people engaging in healthy behaviors when they perceive themselves to be susceptible to a serious health problem. So they've got to agree that it's coming if they don't change their ways. When they think the problem is serious. When they are convinced that treatment and prevention would save their bacon, you know prevent them from the discomfort or pain of a medical condition. And of course they need to be exposed to how to take healthy action in their life. So something has to trigger this. So that's an interesting model. But the assumptions are just like Johnson's model, crisis intervention model. They haven't changed. Here's another one, various degrees of behavior. And this one focuses on the behavioral intent more than anything else of the client. The idea is that they haven't had any predisposition towards good outcomes.

 

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They have to have bad dudes that will support the behavior that you targeted. They have to believe that others, family, friends, spouses, will agree that their new behavior is better, is an improvement. And they have to again be exposed to those actions to take the actions and pull that off. Same assumptions, different approach. Another special cognitive learning theory. And this was the idea that people can actually think their way through a crisis and get to a better level of functioning. And part of it is you have to increase the patient's belief that they have the skills to master and implement the behavior. They've got the skills. You teach them that. They practice. You have to, the person in intervention, has to teach or model the target, where it is you're heading. The direction in which you're going. So you either model it or teach it. Then there are other things that we can address, failed attempts. And then you explore successes, behavior change and techniques. So you give a range of options to the client and give information to the client on the effectiveness of what's going to happen with the adoptive behavior. And lastly, if possible, you hook them up with people who had the same problem who engaged in the behavior in a much better outcome. So they get testimonial evidence. So a little different approach, same assumptions. Same client requirements.

 

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They came up with this in 1991. This one here is stages of change model. It has these steps, precontemplation, contemplation, action and then maintenance. So I won't really overwhelm you with that. But again it's a rational approach to implementing an intervention in someone's life. Okay, now I want to critique these a little bit. Let me identify what all these models have in common. And in contrast, when you see mine you'll notice right away that it's quite different from the classic approach to adult interventions. First of all, the emphasis in all those I shared with you, if you scratch them and look deeply, is on behavioral and cognitive change in your client. Behavioral and cognitive change resulting in what? Symptom reduction or symptom elimination. That's what you're targeting. That's where you're headed. All of those models are saying something is wrong with the client. Pathology. Disease. A deficit of some type. A learning deficit. Learning disability. Something is wrong. And all of them assume that we can identify a behavior. And I suggest to you that that's a real problem for us in society, given how diverse we are, how stratified we are. And it's just real tough to come up with something that works for all of us. Another, this is critical, all of those models assign blame. It's the client with the deficit. It's the client with the pathology. It's the client with a substance abuse problem. It's the client in the abusive marital relationship.

 

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They assign blame and require that the client assume the responsibility for what's gone wrong in their life. "It's my fault. I did it. Yep." Finally, each of those models require resignation and therapeutic compliance. Meaning first what they've got to do, you tell them. You have to know what to do. You prescribe the behavior and the treatment outcome. They have to do what you say or it's not going to work. So again, this is all behind the curtain. You don't see it in terms of classical interventions. But those are all the components that make it work. Take one away, not going to work. Also, all those models require to function patient readiness. If there's barriers you've got to minimize it so they can get over those barriers, whether they're emotional or psychological or logistical. You've got to minimize barriers. They have to have the skills to be able to you know comply with the intervention. They have to do something. They have to participate. They have to have a skill. And believe that when they change their behavior it will be reinforce. Something good is going to happen. Their reputation is going to improve. Their spouse is going to come back to them. They're not going to be dependent on drugs. They'll be able to hold down a job. You know, their children will love them.

 

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So there's some reward. It has to be inherent in each of those models or people are not motivated to do it. There has to be normative pressure. Most types of these treatments fail because there's no normative pressure. You have to have a group of people pushing you to get better to eliminate the maladaptive behavior. The have to believe. There has to be a belief that change will compliment your self-image so you look better, you feel better, people will receive you more positively. And you have to have a positive assessment. You learn about direction. Finally it has to be the right cues and time and place of change. So all of that is also inherent in those classical models from the standpoint of client change, client improvement. Okay, let's just chat for a moment. Any part of it that's unclear or that you don't understand or want to take issue with? Because I would welcome and interesting discussion on that. So here's one. Yes, miss?

 

>> I don't know if motivational, the last one, really has all the same assumptions. I mean, the client is directing what they want to change.

 

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>> Okay.

>> And so it's like it's not specifically completely following those other assumptions, in that they have the responsibility, not necessarily to dish out the blame, but they are the people who have the power to change things. So it's more rooted in the side of blame and empowerment.

>> Or responsibility. That component is in it. Are you responsible for what's going on in your life? Which is a little different than blame. But it might be closer than you think. [Inaudible]. There are intervention models other than the classical ones I showed you guys that are much improved over these. But most of them still do not clients fully with the respect and dignity that I think we should do. I know there's a lot of stuff going on in the rehab field. And in education we treat students with respect and dignity. We don't make them do anything. But if they do it, they get a grade.

 

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If they don't do it, bingo, they get [inaudible]. But I was thinking about the classical intervention models in my critique. There are some variations in use today that are much improved. They still have some of those same components. Still some of it is there. The main one is we begin to think about what to do with our clients and the fact that there's something wrong, dysfunctional element, okay? All of them, even education assumes that students come because their vessel is empty and we're going to fill it up. It's kind of the little banking system of education [inaudible]. So those are there. You just have to be able to articulate it effectively the way we should so we can really think about what we're doing. But there are some [inaudible]. So this is the classical stuff that I wanted to show you. This is intervention at its worst. It makes my model look much better.

 

>> As question come in, if you could repeat them, because the people online can't hear the audio.

 

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>> Okay. Just anyone?

>> Yeah, when you talk.

>> Should I be standing here not moving?

>> I think they can hear you.

>> Is that better. Hi out there.

>> And then if you have questions from me I'm going outraise my hand.

>> Okay. Did you have any?

>> I personally don't.

>> I mean --

>> No, no. Nothing yet.

 

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>> Okay, so nothing on that? Okay, we're ready to switch to the second part of the presentation. Let me present my model. And let me just say this: the first four steps will be very familiar to you. It's stuff that you already do, that we do. What's interesting about my model is I actually chain together as an intervention chain. So I actually put in a structure and a context where you say, "Oh, I see that fits with that. That fits with that. That fits with that." It's the last one, the focus on my own research, my life restructuring part of the intervention model that you haven't seen before. So we'll spend a little bit of time on that and I'll show you how it works. I don't have time to train you, but I'll show you how it works and you'll get a sense of that. And the new can critique my model and see what you think about it. Okay, setting up the second PowerPoint. How many people are up there?

>> Let's see, we've got one, two, three, four. And I know three of the four at least I know are rehab. Grace, I'm not sure what your background is, but maybe rehab also.

>> Okay. Are they here in San Diego?

 

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>> No. Dylan's in Illinois. Vanessa Smith is in North Carolina. Sarah Gardner is actually a current student here at San Diego. And again Grace, I'm not sure where you are.

>> Well for those of us who are out of state, we're having a terrible day today. Couple of clouds and it's only about 72. So we're very unhappy. This is not what we expect this time of year. Right. Okay, let's talk about life coarse interventions, my model. And obviously it's a work in progress and there may be things that don't make sense [inaudible], but let me share it with you. And again, I want to contrast this with classical interventions. So here's what I want to talk about. In my new model I'll share with you my definition of assumptions for client change. I'll explain and demonstrate the model and the six steps of intervention. Again, lastly we'll kind of sum up and talk about implementation. Okay, why a new model? Why course interventions? Why in the world did I come up with this? Well, for the reasons I just said a moment ago, traditional intervention focuses more on behavioral and cognitive change and symptom reduction. And the focus is wrong. It's not transformational and it doesn't focus on better understanding for your client. That's what this model does. That's what I am trained to do as an educator. That's what I do in my professional practice as a teacher and a researcher.

 

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I focus on learning and understanding, and if possible, learning that transforms the student to a new level of reality and higher level of functioning. The new model, the Barnes model, does not assume any dysfunctionality. There's no deficits that we're responding to. That's not even relevant. This model does not have any blame. And it doesn't require resignation and therapeutic compliance with some external standard. So just in terms of those important points it's different. Let me tell you what it does do. Life course interventions, this is kind of a big word, but they are simply adaptations and adjustments to what happens in your life. And so this is what the model is all about: assisting your clients in developing requisite skills, the confidence and the competencies to be able to do that, to make these life adjustments. If you stood back for a minute and you think about all the issues you deal with, this is really what you're doing. Unless you're in a profession where you're dealing with treating emotional disorders for which the only option would be drugs, but we're not talking about that. But we're talking about people who have experienced challenges in their life that require a response. So the purpose of this model is to connect people with who they are. And I use the phrase connecting people in the past, present and future. One of the things I've noticed in working with adult learners is that many of them don't have a coherent life narrative.

 

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They do not have a coherent life narrative. Which means they don't really know who they are. I mean, they know who they are in the present, and yesterday, maybe last week, okay? But they don't really know who they are if they're not connected that way. And if you're not connected that way, then it's kind of difficult to project that to the future where you want to be in 10 years. Real tough. So this model focuses on that. It focuses on clarifying and updating people's mental models of the world. What do I mean by that phrase? We all have a perception of how the world operates and our place in it. Unfortunately, most of our mental models are not very accurate. I've got graduate students today that still don't believe that the United States is largely a socially constructed experience. Okay, and that there are multiple realities in the world, not just the ones that you embrace. There are people who think entirely different than you do, and they act different. So part of this model is to get people to update their worldview, okay? Their mental model of the world. Another one is they have personal and interpersonal effectiveness, to advance that. Everybody isn't good with that. To assist your clients in distinguishing important from unimportant and irrelevant things. And lastly, a lot of people want to find something. They want to find happiness or clarity or inner peace. That's going to be individual, on a side note. But usually people are motivated because they want to find something. They want an answer to a question or they want to figure out what life's all about. So that's a part of this model as well, to move people in that direction. But it's something they do themselves. They have to. Life course interventions can be self-initiated. They are often collaborative and they are best when they are collaborative.

 

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They're guiltless. No guilt going on here. "You were bad, son. You were bad." No guilt. They're self-managed and monitored. And they're evaluated against a dynamic evolving standard, because that's what's really going on in the world. It's not static. It changes, evolves, gets more sophisticated. Hence, the assessment and the evaluation you do as well. Finally, life course interventions are transformational. They are platforms from which people can remake themselves and move forward. There again they can update their model of the world and so on. So that's the core. This is the heart of my life course interventions model. This is the heart. But I want to explain the steps just generically so you can see it. Then I'll go through them step by step and give you a little more detail so you get some sense of what I'm talking about. Again, the first four will be very, very familiar to you. You've done them, you've experienced them. They're going on in your life right now probably. Okay, you'll see this. And again, what I think is useful about my approach is I connected all those. And you can see how they are connected and successfully more complicated and challenging. The last two, but particularly the last one, life restructure, is the one I'll spend more time on to explain.

 

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Okay, here they are. Six steps. Accessing information and resources. Showing the way, which is a fancy phrase for modelling. Connecting the dots, fancy phrase for teaching skills. Mentoring, everybody knows that one. Collusion, working with others to see how that plays out. And then the one that's new is this life restructure. Let's do that. Okay, the go from less complex to more complex. The earlier intervention strategies don't require as much commitment as five and six. [Inaudible]. Six requires much more self-regulation than one. And the autonomy increases as you go through the intervention steps. Finally, they all require a little reframing. Five and six require a huge reality reframe. And by that, again I mean adjusting your mental model so that it's accurate and expansive and includes all the things that you want to include. So with that, let me show you quickly the steps. So the first one, access the information resources, again you know this, you do this. The goal is to connect people with accurate and timely information and appropriate resources. Everybody in this room does that. Hey, Frank, this is one spot I want you to take a look at. I think you'll find it helpful given your research interest. We do that kind of stuff all the time. So process. Explaining, demonstrating, making a referral. The outcome is you want the client to have an expanded database and a capacity, an improved capacity for doing things like solving problems and making decisions. Pretty straightforward.

 

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Intervention level two, showing the way. The goal here is to teach a certain modelling. You do that in your work with clients. I do it in my work with students and it's not always explicit, but it's certainly influencing. The way you handle yourself, the values you exhibit. The lifestyle you live are all of importance to people that you're working with. They pay attention to them. And they learn from it if it's done right, done well. So what we're talking about here are values and belief systems. So you do it with the client because the values and belief systems may not be functioning well for them. Not working well. Creating problems. You show them some options of living in harmony in the environment they're in, and you try to encourage constructive behaviors, again by modelling. You're showing them. Parent's do this with their children. This is how you raise your kids. Although I'm going to get lectured on that, but they also see how you behave and what you do, what you don't do. Of course the outcome would be being able to behave appropriately in the right context and develop a greater level of emotional intelligence. So again the process is a modelling process. Everybody does this when it's modelled. The next one, oops. The outcome -- oh sorry, living with greater harmony, clarity, consistency, okay.

 

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Connecting the dots. Intervention level number three. What do I mean by that, connecting the dots? This is teaching them how to things in life. Things that we know are effective, are more effective than maybe the set of skills and competencies that they currently have. So reviewing what their critical thinking is and helping them to apply it to their daily life so they live more rationally. Helping them create a Swiss army knife. What do I mean by that? I used the narrative in my research of a Swiss army knife to demonstrate that you need to have the skills that work for you in life to be effective, to be successful, to be content. And everybody's Swiss army knife is a little bit different. You pick the blades and the tools that are on your knife, which you've got to. You've got to do the work. You've got to develop the skills which are your blades and your tools. You have to do that. And you carry it in your pocket. It's portable. Once you have them, you have them. Your portability is important here. So when connecting the dots, it's helping them understand they need to create their own Swiss army knife. What are the potential skills they need for living? And the last one is developing more competency through self-regulation, multiple learning and [inaudible]. Let me just define these two approaches. Self-regulation is a set of conflict skills that allow us to manage ourselves, to monitor where we're going, to make adjustments, to speed up or slow down our thinking, to multitask.

 

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Multiple literacies refers to the fact that in the old days when our parents were in school, they mastered the three R's: reading, writing and arithmetic. That's no longer adequate in the 21st century. We need a whole set of competencies and literacies. So everything from environmental literacy to health literacy, managing your healthcare, your family's health. Citizenship literacy. How do I participate in a democratic republic life in the United States where I'm one of 218 million people? How do I do that? You know, how does that happen? So multiple literacies. And I'll say more about that in a minute, but it's how we make sense of the world and explain things. So what's the process on this? Well, it's just instruction. What we do is train and encourage and create meaningful opportunities for practice. So again, this one should be familiar to you as well. But these are more sophisticated than [inaudible] which is more sophisticated than access to resources and information. The outcome ideally, greater operational knowledge, better self-regulation and competence in navigating one's life course. Number four, mentoring.

 

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This will be familiar to everybody. Fourth step of intervention in my model. The purpose of mentoring is to develop understanding, judgment and personal empowerment through a relationship with another person, usually someone who's more advanced and knowledgeable or [inaudible]. The relationship builds trust and intimate sharing. Mentoring is a process. We're engaging other human beings through monitoring, guiding and corrective feedback. So that's basically the concept that's going on here. A little more challenging and difficult than simply being a student sitting in a classroom or attending a workshop to learn skills. A little more challenging, a little more sophisticated and more demanding of the client I'll just say. By the way, each of these steps can be included in previous steps. And they don't necessarily have to be in order. I just put them that way because they become successfully more complex as we sequence up to number six. What's the outcome of mentoring relationships? Well, at best greater understanding of the life roles you're in. And it helps you acquire specialized skills and I'll show you those in a second.

 

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By the way, mentoring is not constrained by age, gender, culture or perspective. Everybody can have a mentor. Everybody can engage in mentoring. It's universal. All right, collusion. Intervention level five. There's only six. We have one more to go. What do I mean by this one? I had to come up with something a little bit different than just social interaction, so I came up with this. And the idea is that when you collude with someone it's intentional. You know, colluding is an intentional relationship. And I didn't want this to be limited to multicultural collusion, which is significant obviously. But it can also be intergenerational at its best. So that's why you have all those wacky pictures. This was Mark before he got his doctorate. So what's the process of collusion? Well, we have to work more collaboratively with other people, but particularly those who differ from you in lots of ways. Socioeconomically, culturally, generationally and so on. The process involves commitment. You can't just stand there and [inaudible]. Again, we teach these things. And this model we would actually teach the client or assist the client in developing these skills through practice and discussion. Maybe through a relationship, we talked about it. But anyway, embracing multiple realities, inspiring assured vision.

 

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We see some of this in the leadership literature. Inspiring through things we call personal inquiry, challenging the process and enabling other people to add. What's going on here is working with others. This is not done independently. Working with others has its own set of requirements and challenges. It's hard. But there are more and more people different from you. What's the outcome? Well, the outcome should be more [inaudible] because it's expanded. And advancing your attentiveness with and through others. So that's significant. So to expand your attentiveness with and through other people. And it should open a lot of doors. Okay, here is the last one. This is the one I've been saving because it's kind of cool. This is what I call life restructuring. This is the most difficult and challenging of these interventions. I suppose it could be done independently but I've never, never seen it happen that way. And I actually taught a course on this life restructuring here. And had like [inaudible]. And we went through the whole process and a lot of exercises. And the evaluations were outstanding. And not everybody was going to do everything, certainly not at the same time, not in the same fashion, but again they saw the targets. They saw where they wanted to go.

 

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They picked those, picked their pace and then began working on their skills. Let me show you how this plays out. So the purpose of intervention level six is to assist somebody in transforming their life course, their life. That's the purpose. And how do we do that? Well lots of things. And they're all important. You remake yourself by [inaudible]. It looks like reframing your reality, your mental model of the world. You remake yourself by redefining yourself and your perspective, by connecting your past, present and future like that personal narrative I talked about. And by integrating knowledge and systems. One of the biggest challenges of the 21st century is that information is becoming increasingly atomized. Hard to keep up with. There's so much reading. So this is about putting things together systemically so you can actually use what you know, okay? And again it's a process that can be taught and you can support your client in that regard. Now, intervention level six requires some things that none of the previous ones did. Allow me to share what they are. It requires what I call level five commitment. Meaning that if you're going to restructure your life, you've got to do whatever it takes, whatever it takes, to make that happen. It's not something you can do on the weekends or occasionally or [inaudible].

 

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It takes more than that. It requires pretty good critical thinking skills. I'm not going into a lot of detail, but it takes a lot of decision making and all of that, managing your own thought process. It requires these life tools that I've been referring to for the last 15 minutes and I identify what I call the [inaudible]. These are hopefully remembered as a Swiss army knife. You've got these now. But things like inspecting and adapting to change, anticipating and planning. Managing your [inaudible]. Relationships, resources and personal risk exposure. Collaborating with others, so collusion. And the ability to resolve conflict in your life. So when I identified these I said, "You know, if it was me I'd make sure I have those things on my Swiss army knife." There's other stuff you can put on there too, but you've got to have those. We talked about that in exercises. We demonstrated them. People told stories how these blades on their Swiss army knife helped them. That's part of it. It also requires competency in self-regulation. I keep using this one. This is a big one here.

 

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The ability to self-regulate. This is of course to live the way you want with intention and purpose. But it involves very basic thinking management. It involves self-monitoring and goal setting. Goal activation and something called goal discrepancy detection. If your goals and behaviors are different, can you detect that difference? Do you see gap? Can you close that gap? And it involves self-evaluation and behavior modification. So that's what I mean by self-regulation. That's a competency. [Inaudible]. Environments, citizenship, cultural, there's a bunch. [Inaudible]. Critical to transformation experiences. And it has to do with the ability of the client to critically reflect on what they're experiencing and what they're learning, to make sense of that. And to look at it and challenge their assumptions and values. To actually think that through. One of the things that I have the students do in this course I taught on life restructuring was write in a journal things that they were learning. Now what does this mean? You know, [inaudible]. I just had them do that. [Inaudible] continuing learning. It never stops. It involves construction of our academic model of the world and that's that reality reframing I'm talking about. So all of us are [inaudible]. We don't just start using it. You practice. You work at this. You get better at it. Use techniques that are useful for it. So the life restructuring intervention differs from the others because it has all of these pieces. Pretty sophisticated. We've actually had something in between collusion and this one so it's not quite a big jump. It is a pretty big jump. It takes effort and dedication to do this. But interesting things can happen.

 

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Let me show you. The outcome would be the creation of a different adulthood. I use the phrases second and third adulthood and I'll show you a little graphic in a minute. But you can recreate your life, your adulthood and who you are, through planning, courage and collaboration. You can do that. People do that, not as much as I'd like, but people do that. We can assist our clients, our adult clients, in doing that. I explain this to them, showing them some pathways, helping them develop the skills and then letting them do it. Honoring the client, by the way. Here's my graphic. All right, everybody in this room is in their first adulthood. I've got one foot in there and I'm trying to pull my foot out of there, but it's what you do in your professional life. Get married, raise a family, advance in your career. Put funds in your 401k, or in our case [inaudible]. But what happens when that ends? When you get to the retirement age? Some people keep working of course. They just reduce the amount of time. I'm an example of that. I retired two years ago. I still teach part-time. But other things are going on too in my life and in most people's lives. And if you're a baby boomer you've got maybe three more decades, another 30 years, and for some of us it's maybe longer than that. So what do you do for the rest of your life? And so this life restructuring because a really relevant alternative to consider, okay? So [inaudible] I also call that the growing on line. If you're [inaudible], if you're transforming, there's a possibility of creating a second adulthood and maybe even something that lives your call elsewhere, where you pretty much got it together.

 

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You're centered. You're spiritually at ease and you're positioned to help others through lots of different ways by showing the way and teaching, mentoring. You're able to do that. So this is all the outcome of life restructuring. It's a different life, way of living. We're more mediated purpose. But this is from our first adulthood, because that one will come to an end for most of us. And so you can use this interventional approach and the six steps and all the other stuff that happens after that and ways to grow up as you move forward. Okay, a couple of comments about implementation and then we'll have some questions and throw some snowballs if you want. But you know, be nice, be nice. All right, why, when and for whom? Now who should take care of this life course intervention thing I'm talking about? Well, we believe that life course interventions should always be collaborative and they should make adults more self-aware and critical of their own life. More in control and understanding their emotions and reactions to life transitions and challenges and events. And more empowered to make appropriate personal and situational change. So it's really an empowerment model, like you were talking about earlier. But hugely empowering, hugely. And the way you do this, you've got to have the right thinking skills and the right adult competencies. Which we have six intervention steps. So when? When would you do this? Well, like most change models, you should know with the client when they are ready to do it, they're able to make a commitment. Now remember, I said intervention level six requires a level five commitment no matter what. Accessing information, much less so, much less so.

 

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Much less so [inaudible]. These are often triggered by defining life events. A birth, a death, completion of a degree program, a new job, you know triggered by that. Loss of a parent. It could be self-initiated. They're best when they're collaborative, more powerful. Who will benefit from these? Well, I like to say interventions, life course interventions, can benefit any adult at any level in society, any age level, okay, whether it's young adult, middle adult or old adult. I think it can benefit everybody. Like most adult learning models, these things, because they involve thinking and planning and some resource allocation, favor people who are more educated and economically advanced, comfortable. Our education does that, favors people like us. Not everybody can do this. Not everybody wants to do this. Not everybody has the ability to do this. But ultimately they have to be self-monitoring and managing for this to make any sense and work. So let's just start by taking that. That's the presentation. Let me see if you have any questions you want to ask or say. Any thoughts? Little different. You can see the treatment is completely different than the classical models. There's no blaming. There's no focus on deficits or on dysfunctionality. We're not trying to reduce symptoms. That's not part of it. It should be in response to a crisis, or it could be preventative. The students I had in my class, the life course instruction, it was all preventative on their part. Nobody had to do it. But it was something they wanted to think about, especially where they're going in the next 30 years.

 

[ Inaudible ]

 

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Well let me just say here that the farthest I've taken this is looking it out conceptually, evaluating it and then teaching a course on it. And there was a weekly seminar that actually met in this room. We went through the various competencies, skills and all of that. And I talked about multiple realities, what it's like. I talked about the angst that many adults experience, and young adults, particularly in college who are changing rapidly. Their values are shifting. And you know, you only notice that when you go home at Thanksgiving and interact with your parents and they go, "Oh my gosh, what happened to you? Are you a liberal?" So you know what I mean, it's change, particularly change rapidly. So we talked about some of those things and we talked about you know the issue for adults with families. So you're changing and you're creating a second or third adulthood. What's the rest of the family doing? Where do they fit in? How does it impact them? So we talked about all those interesting aspects of it. Yes, question?

>> All right, it says it seems much in this model is too abstract or requires too high-level processing for those with cognitive impairment. Can it be adapted for this population? If so, how? If not, is there a model you recommend for them?

 

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>> That's a great question. Yeah, guilty as charged. Everything you said is true. It is conceptual. And it's what I do. And it is challenging. And no, this one I don't think is going to -- I didn't think about that clientele when I created it. And maybe I should have, but I didn't. It was meant more towards people, clients that we work with that have been functioning a little more adequately, have some skills. But great question. I want to think about that. How could we adapt it to the disability community in ways that would make sense? And I don't know the answer, but I will think about that.

 

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[ Inaudible ]

Yeah, so I think because you know you work independently, you're autonomous. I think that's going to be an issue. You know, if you get somebody who doesn't have the ability to utilize the internet, a URL, they're not going to do it because they can't do it. So that's a great question. And so my initial response would be it's not going to work with that clientele. Could I maybe make it work? I don't know. I need to think about that and I have not.

>> One of the questions I had about your model, when you started [inaudible]. You talked about different models for treating different kinds of issues, such as substance abuse treatment.

>> Right.

>> Would you see this approach as something that could really replace the existing approaches to treating substance abuse? You talked about in your model there's no guilt, there's no pathology and so, like these labelling models and treatment models. Do you think you could use this to treat substance abuse?

>> Yes I do. Have I tried it? No. Yes, I do. And again I think if you think about what works best, like the 12 steps where they have a guy, a friend, a guy, figure out what works best. And you're really talking about those education components. The first three steps. And then the fourth step in the intervention, which is mentoring. So you're really talking about that. And I think yes, it could. I have no data to back that up. I don't see why not. You're just eliminating some of the guilt and so on. And remember when I said it's best when it's collaborative? Well it would make sense to pull in family members and significant others if you're working with somebody with that kind of issue.

>> There's a lot of elements of this that I find intriguing for that. Because you talked about -- I think especially the last part of the model when you talked about the second adulthood. And it's kind of this really transforming your entire life course, which I think sometimes might be a treatment that just deals with the symptomology and maybe not the just the overall way the person sees their life.

 

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>> Right.

>> And so I think this model could be effective for that.

>> I think it could be too. Again, I haven't tried it. I need to test that. But getting back on the 12 steps, one of the classic examples of these models. You know, one of the things you're required to do is accept God. It's a religious-based model. And you accept Jesus as your savior and that's part of what's going on there, okay? My model doesn't require you to do that kind of stuff, okay? You know, nor should it I don't think. People can make their own minds up about those kinds of issues independent of maybe some of their life challenges. So I just toss that in the mix as well. That's a good question. Thank you, great question. What else?

>> In the initial models you were saying that it's making the assumption that there's a deficit or something lacking.

 

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>> Yes.

>> And I get that you were saying this isn't really helpful. How is this not assuming that there's a deficit in understanding or a deficit in skills?

>> Well, because we don't focus on it and it's not part of the actual intervention itself. So we're not focusing on that. So that would be an important way that it differs from classical intervention that in fact focuses on the disease you know focuses on that part of the problem, the crisis. We just don't focus on it. So I mean, I said if you know you're in a mentoring relationship and your colleague is a marijuana smoker, I don't know that I even care, unless it gets in your way of you being employed or carrying out your responsibilities to others, right? I wouldn't care. It wouldn't come up, wouldn't be a part of the intervention itself. It could be, but now again initially it's not. So a difference in that way. So I don't want to say that if someone has a personal crisis or a behavioral problem that it wouldn't come into play. But it initially isn't the focus. So if somebody came to me and they said, "You know, I'm interested in various treatments for heroine addiction." And I say to you something about that. I say, "Okay, well let me give you some resources to look at." And I give you a couple people you can talk to, including a great person from the University of California. [Inaudible]. And there's my intervention. I don't need any more data than that. I don't need to assign guilt. I don't need to be worried about why are you scratching all the time? I'm not. I'm interested in making that referral and helping that person, assisting that person in essence to get the right information or the right resources. Does that help? What else? So does anybody want to try this? Want to restructure your life yet? Or are you excited to [inaudible]. Yes?

 

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[ Inaudible ]

Yeah. Well some of this will be in there. And I'll say a lot more about critical thinking and that and about meaning making. I'll do a whole lecture on meaning making, the process, show how it's done. Yes? You'll be taking my course it sounds like. Excellent.

>> This seems to be very much in line with motivational interviewing.

>> I don't know what that is, so tell me what that is.

[ Inaudible ]

>> The basic assumption of motivational interviewing, they say everything is done with a person's permission.

>> Okay. That makes sense to me. Again, I would be encouraged to say I know there are some good techniques that are being used today that don't always follow this classical path in terms of all the things to which a client must submit, right? But I'm sure there are, because they're better. You know, what I love about the rehabilitation profession is that this valuing of your clients is so paramount. And working with John and Fred and Karen and all the others, it's really affected my work as teacher/professor on the other side. It really has influenced me to think in those terms. Valuing the clients, supporting, empowering the client, you know, teaching, treating people with dignity and respect and acknowledging their autonomy. And so really I think that's a great emphasis. Yes?

 

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>> I have one.

[ Inaudible ]

>> And resources.

>> Resources.

>> Let me say a little more about that. I came up with this three R's thing because it's kind of catchy, the three R's. Relationships are one of the most important things we do in life, is manage those well. Or maybe not so well, but that's one of the skillsets. So intimate relationships, more distant ones, family relationships. Our family is dealing with a 92-year-old mother who just fell last week and broke three ribs. I can tell you the tension in our family has gone very, very high. And we sort of battle each other in a way to a solution to that. And so relationships are huge and need to be managed. And different types of relationships require different skills. Resources, financial resources. Maybe some of your talents. Maybe you're a musician. Resources need to be managed, obviously. And then the last one, the personal risk one, is a little more subtle. One of the things I did in this restructuring course was that we looked at all the kinds of risks to which we are exposed that we don't think about.

 

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[ Inaudible ]

So I was feeling more than I should have. I was thinking about, "I hope they're doing their brown bags. I hope they're doing something." Thinking about that.

[ Inaudible ]

But my point about risk is that you need to know what your risk is and how much are you willing to expose yourself to? And so one of the things we did in the course is we talked about different levels of risk exposure and solutions. Yes?

>> All right, I would assume that this model might lead to less burnout or frustration in service providers, correct?

[ Inaudible ]

Once you provide the resource to the client, the ball is in the client's court. Thoughts?

>> Yes to just about everything you just said. Indeed, one of the things that I like about this model that's so rewarding for the rehab practitioner, particularly from my perspective as a professor at [inaudible]. When I see students grow from the beginning of the class to the end in one semester, I mean it's an amazing reward. It is incredible. So yeah, there is a lot of reward inherent to the practitioner in this. In the end you understand that you do an assessment so you know on what level people need the intervention. And of course they should tell you that themselves as well. So I think you're absolutely right about that. And the other part of the question had to do with the --

 

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>> Let's see here. It says, I would assume that this model would lead to less burnout or frustration for the service provider.

>> Got that.

>> And the second one, to use Dr. Barnes' example of opiate addiction, once you provide the resources to the client, the ball is in the client's court. Thoughts?

>> Yes, that's definitely true. This is an empowerment model. And ultimately if you've ever worked with substance abusers, you know that the only way they ever improve is if they make the personal commitment to do the work. That's the only way. Nobody can do that for them. And so taking that concept and building it into this, the idea is that you really have to manage these interventions. Although you're the recipient and you're getting some assistance from the practitioner, information, maybe management help, feedback, corrective feedback. You're getting all that, and the client does the work. And I don't know if that's a fundamental assumption in the rehab field, but it certainly is as a teacher, as an educator.

>> It implies they have to be motivated to make their own changes.

>> Yeah. Or does it stick? It just won't stick. So you're absolutely right about that. And again I see that as positive, uplifting, respectful. We're not talking about just functionality deficits. Doesn't come into the conversation. Anything else from the students in foreign lands?

>> This person says, "Great explanation, thanks."

 

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>> Cool. Get your continuing education. You got it. Thank you. This has been fun for me to share this. I don't get to do it as much as I'd like. I hope it was useful. I think they're going to put this on the website so you can go back and access it. And is it narrated? Is it?

>> No, but your audio will be there with the same as you presented.

>> Oh, so they can hear that? Okay. Email me if you have any questions or anything you want to follow up on. My email address sbarnes@mail.sdsu.edu. And don't forget to go to my boomer website, please. I want you to check that out. Thank you very much.