Speaker 1: Hi, everybody, it's Jinny. You've probably heard me with Eric
Speaker 1: on some episodes of The One You Feed. I have
Speaker 1: a question for you. Are you your own worst critic?
Speaker 1: I mean, when you pay attention to how you talk
Speaker 1: to yourself, is it just kind of mean? And do
Speaker 1: you often feel beat down and just heavy inside? If so,
Speaker 1: I truly understand the struggle. I used to believe that
Speaker 1: relating to myself this way was what kept me performing
Speaker 1: at any acceptable level, and without it, I thought I'd
Speaker 1: drift off into the deep end and become a failure
Speaker 1: in pretty much every aspect.
Speaker 2: Of my life.
Speaker 1: But it turns out that's actually one of the inner
Speaker 1: critics worst lies that it helps you. I mean maybe
Speaker 1: short term you get a push and do well, but
Speaker 1: long term it's corrosive and it actually keeps you from
Speaker 1: living to your potential. I've created a free three part
Speaker 1: video series that teaches you how to get to the
Speaker 1: other side of the inner critic like I have, and
Speaker 1: you can grab it today. Just head to oneyufeed dot
Speaker 1: net slash Inner Critic. I'm sharing this with you as
Speaker 1: not only an inner critic survivor, but also a certified
Speaker 1: mindfulness teacher, and you can learn to relate to yourself differently,
Speaker 1: living with an inner lightness and not a sense of
Speaker 1: being at battle with yourself, and life is so much
Speaker 1: better when you're a friend to yourself. I promise, So
Speaker 1: go to one youfeed dot net slash inner Critic for
Speaker 1: my free mini course see you in the videos.
Speaker 2: We can call it all kinds of things. We can
Speaker 2: call it a disease, and that's a whole nother discussion
Speaker 2: to have. But it's really really different for different people.
Speaker 2: How people get into this struggle, how they experience it,
Speaker 2: and how they ultimately can get out of it.
Speaker 3: Welcome to the one you feed. Throughout time, great thinkers
Speaker 3: have recognized the importance of the thoughts we have, quotes
Speaker 3: like garbage in, garbage out, or you are what you think,
Speaker 3: ring true. And yet for many of us, our thoughts
Speaker 3: don't strengthen or empower us. We tend toward negativity, self pity, jealousy,
Speaker 3: or fear. We see what we don't have instead of
Speaker 3: what we do. We think things that hold us back
Speaker 3: and damp and our spirit. But it's not just about thinking.
Speaker 3: Our actions matter. It takes conscious, consistent and creative effort
Speaker 3: to make a life worth living. This podcast is about
Speaker 3: how other people keep themselves moving in the right direction,
Speaker 3: how they feed their good wolf. Thanks for joining us.
Speaker 3: Our guest on this episode is doctor Jeff Foot, a
Speaker 3: psychologist and nationally recognized clinical research scientist with over thirty
Speaker 3: years of experience utilizing evidence based treatment approaches for the
Speaker 3: treatment of substance use issues and post traumatic stress. He's
Speaker 3: the co founder of the Center for Motivation and Change
Speaker 3: outpatient programs in New York City, Long Island, Washington, d C.
Speaker 3: And San Diego, as well as the residential program CMC
Speaker 3: Berkshire in Western Massachusetts. Jeff is a member of the
Speaker 3: Association for Behavioral and Cognitive Therapies and the American Association
Speaker 3: of Addiction Psychiatrists. Today, Eric, Jenny, and Jeff discuss his
Speaker 3: books Beyond Addiction and his Beyond Addiction workbook.
Speaker 4: Hi Jeff, Welcome to the show.
Speaker 2: Hi. Nice to see you guys.
Speaker 4: Hi Jenny, Welcome to the show.
Speaker 1: Thank you. Hey, guys, it's so good to be here
Speaker 1: with you.
Speaker 4: I'm really excited to talk with you, Jeff. I think
Speaker 4: we both are. You've done some really interesting work in
Speaker 4: a couple of books now. One is called Beyond Addiction
Speaker 4: and The newest one is called Beyond Addiction Workbook for
Speaker 4: Family and Friends, Evidence based skills to help a loved
Speaker 4: one make positive change. And I have to say, as
Speaker 4: somebody who has been in recovery for the vast majority
Speaker 4: of my adult life, I get asked so many times
Speaker 4: by family members and friends and partners of addicts, what
Speaker 4: do I do? What do I do? And there's been
Speaker 4: a response for a long time which was, well, try
Speaker 4: going to alan On right like, it's free, it's there,
Speaker 4: it's something. But your book was one of the first
Speaker 4: things I'd seen that really went into depth about ways
Speaker 4: that you can have a positive impact on the person
Speaker 4: and ways that go beyond simply detaching with love but
Speaker 4: actually not having to completely detach and being loving and
Speaker 4: be motivational and help lead them perhaps to change. And
Speaker 4: so that's why I'm so excited that we're going to
Speaker 4: get to talk about this.
Speaker 2: Yeah. Great, Yeah, I think that's a good read. There's been,
Speaker 2: you know, as you said, the traditional pathways that people
Speaker 2: are recommended to, and when families run into these issues,
Speaker 2: it's heartbreaking, heartrending, terrifying, and when you're in the role
Speaker 2: of family member trying to help or frankly, any role
Speaker 2: of trying to help, whether it's a friend, it's a therapist,
Speaker 2: there's a lot going on there that's difficult, and there
Speaker 2: are a lot of tools that we now know are
Speaker 2: really useful, that are not just setting limits and detaching,
Speaker 2: And again, those can be the thing to do at
Speaker 2: any given moment. We're not. So just to be able
Speaker 2: to have a larger toolkit and a greater understanding and
Speaker 2: a greater sense of compassion in this whole arena, I
Speaker 2: think is a pretty powerful thing. So that's what we've
Speaker 2: been trying to work at.
Speaker 4: Indeed, well, why don't we start like we always do
Speaker 4: with the parable giny. I'll let you take it if
Speaker 4: you like, I like.
Speaker 1: I would like to, all right, So it goes like this.
Speaker 1: A grandparent was talking with their grandchild and they said,
Speaker 1: in life, there are two wolves inside of us who
Speaker 1: are always a battle. One is a good wolf, which
Speaker 1: represents things like kindness and bravery and love, and one
Speaker 1: is a bad wolf, which represents things like greed and
Speaker 1: hatred and fear. And the grandchild stops and thinks about
Speaker 1: it for a second, looks up at their grandparent and says, well,
Speaker 1: which one wins? And the grandparents said the one you feed.
Speaker 1: So I'd love to know how that parable applies to
Speaker 1: you in your life and also in the work that
Speaker 1: you do.
Speaker 2: I've used that parable before myself. I think it's a
Speaker 2: lovely narrative to walk through with folks, especially because that
Speaker 2: internal battle is really intense for people. I think I've
Speaker 2: used it more in the context of I'm a clinical psychologist,
Speaker 2: so I do a lot of direct work with people
Speaker 2: struggling with substances and lots of other stuff. And there
Speaker 2: you are, there's the battle right in front of you
Speaker 2: internally with somebody. You know, I'm trying to take one
Speaker 2: path and keep getting pulled back to the other path
Speaker 2: and feeling really bad about that and beating themselves up
Speaker 2: and so forth. It's a pretty extreme struggle, and it's funny.
Speaker 2: I have. My favorite painting of all time is by
Speaker 2: this guy, Frank Frizetta, who used to like illustrate dime
Speaker 2: magazines back in the thirties and forties, of Conan the Barbarian,
Speaker 2: and they're the most stunningly beautiful oil paintings you've ever seen,
Speaker 2: and they're usually around monstrous battles, and one of them
Speaker 2: is this horrendous looking monster on top of this other
Speaker 2: horrendous looking warrior. And what I've always taken from that
Speaker 2: I show it to clients actually fairly often, and as
Speaker 2: an illustration of this is one, don't underestimate the battle
Speaker 2: because it's ferocious. And two it's a little ambiguous as
Speaker 2: to who you want to win here, because both of
Speaker 2: these guys are pretty horrendously struggling and terrifying. Reminds me
Speaker 2: of the parable a little bit. It's like, it's not
Speaker 2: necessarily clear always which path I'm going to take, and
Speaker 2: there are difficulties on both paths. Actually, I've always appreciated
Speaker 2: the idea of, like, how do we learn to have
Speaker 2: an awareness of the path that we want more and
Speaker 2: to be more intentional about that path. And I think
Speaker 2: that's one way we've talked about it with people in
Speaker 2: this kind of a struggle. I will say that over
Speaker 2: the last number of years, and this is related to
Speaker 2: the work that we're doing now with families and helpers
Speaker 2: in this approach that we've called the Invitation to Change,
Speaker 2: that there are some really important elements around this whole
Speaker 2: idea of good and bad that are really powerful to
Speaker 2: sort of take account of and if I had to
Speaker 2: try to put it succinctly as related to that parable,
Speaker 2: the idea of like there's a good side and a
Speaker 2: bad side, and we've got to stay with a good
Speaker 2: side can also be just a terrible setup for people,
Speaker 2: sort of like can I hit the ejector seat and
Speaker 2: make all the bad stuff go away? And the answer
Speaker 2: is no, you can't. You can't eject the difficult parts
Speaker 2: of yourself. You can't eject the difficult parts of life
Speaker 2: that are going to come around the corner tomorrow. And
Speaker 2: can we learn to think about those two sides differently
Speaker 2: and relate to them differently. And in the invitation to change,
Speaker 2: there's one of the concepts we talk about is willingness,
Speaker 2: So as it applies to a helper. I'm trying to
Speaker 2: help my son, you know, I'm so terrified, and I'm
Speaker 2: trying to get him to do the right thing, and I'm,
Speaker 2: you know, the impulse to control that situation, the impulse
Speaker 2: to make the bad stuff go away. I'm going to
Speaker 2: send them to rehab and then they'll fix him and
Speaker 2: then it'll be good. You know, I'll send in the
Speaker 2: wilderness camp and that'll get rid of this problem. Is
Speaker 2: that pull to temporarily make bad stuff, so to speak,
Speaker 2: go away, as opposed to inviting it in and going
Speaker 2: there's really hard stuff here, there's really good stuff. Can
Speaker 2: we live with both? You know, the terrible chatter in
Speaker 2: your head that tells you what a horrible human being
Speaker 2: you are all the time? Like, we can't eradicate that?
Speaker 2: Can we put it in the passenger seat and just
Speaker 2: welcome it in the car And to go into another parable,
Speaker 2: another metaphor, and say, we're not going to kick you
Speaker 2: out of the car. We know you want to chat
Speaker 2: a lot. We just don't really want you grabbing the
Speaker 2: steering wheel all the time anymore. But you're part of us,
Speaker 2: you know. And the quote unquote bad stuff, it's like,
Speaker 2: it's not so bad, and it's part of who I am,
Speaker 2: and it's part of who I've become in my life
Speaker 2: and all the difficult, painful things I've struggled with, And
Speaker 2: can we accept those parts as opposed to being a
Speaker 2: choice between one or the other. So I hope that
Speaker 2: makes sense in terms of that response to the parable.
Speaker 2: But I've started to think about it that way more
Speaker 2: over the last bunch of years, because again, that pull
Speaker 2: to go for the good and put away the bad
Speaker 2: is not so helpful, I think for folks, you know. Anyway,
Speaker 2: that's my long winded response to the parable.
Speaker 1: It's a wonderful response. You're not alone. I mean, we
Speaker 1: have grown to think of our inner world that way too,
Speaker 1: in that it's not vanished the bad and only focus
Speaker 1: on the quote unquote good. That it's about integration, it's
Speaker 1: about holding it all, it's about relating to it wisely
Speaker 1: and skillfully and doing healing work. And so I'm really
Speaker 1: glad that that's your response because it brings us to
Speaker 1: a point where we can sort of have a more
Speaker 1: integrated interpretation of things. But I agree with you that
Speaker 1: parable does tend to point us towards being maybe intentional
Speaker 1: with the choices we make so that we're headed down
Speaker 1: a path. And I just think about the role of
Speaker 1: community when, as you mentioned, sort of discerning what path
Speaker 1: we want to go down, and that the role of
Speaker 1: community can be supportive in us when we're trying to
Speaker 1: discern that, and that family and friends can be so
Speaker 1: when it's the closest community that people have. And it's
Speaker 1: wonderful that you start your the actual book that you
Speaker 1: wrote around understanding that people don't use substances in a vacuum, right,
Speaker 1: Family and friends often make the critical difference in someone's recovery,
Speaker 1: and I'd love to know. I mean, it's a wonderful
Speaker 1: thing to hear, because so often it's a powerless feeling
Speaker 1: to be a loved one of a person with abuse
Speaker 1: and feel like you can't fix them. So could you
Speaker 1: sort of take us into the role that family and
Speaker 1: friends can make in a skillful way?
Speaker 2: Sure? Yeah, And I think you guys mentioned that sort
Speaker 2: of that sense of there can be a more traditional
Speaker 2: set of ideas about this that have words like detach
Speaker 2: associated with it, even if we tag on detached with love,
Speaker 2: which kind of softens it up a little bit. Still,
Speaker 2: this idea that to be helpful you need to step back,
Speaker 2: and again, there are important things in there that not
Speaker 2: to be ignored, like I may need to step back
Speaker 2: because my limits have been breached and I'm burned out
Speaker 2: and I can't do it, and so forth. That's all
Speaker 2: true for certain people certain times. But to the point
Speaker 2: you just made about making sense of the behavior one
Speaker 2: of the foundational things we do with helpers. And again
Speaker 2: I'll broaden that from family to lots of people, including
Speaker 2: therapists and mental health professionals and so forth, who struggle
Speaker 2: with this idea also, but especially within a family, the
Speaker 2: idea that this is now entered into our world, this
Speaker 2: meaning Wow, I just realized my fifteen year old is
Speaker 2: smoke in a bunch of pot and he got kicked
Speaker 2: out of school. Or I just realized my husband has
Speaker 2: been drinking a ton and he's hiding and I didn't
Speaker 2: realize that's why he goes to sleep early every night.
Speaker 2: And I just realized whoever is using quote unquote hard drugs?
Speaker 2: And I'm horrified. I've never heard of such a thing,
Speaker 2: And what's wrong with them? You know, nobody's trained in this.
Speaker 2: You know, they don't send families to school to learn
Speaker 2: how to deal with substitute issues or compulsive behaviors. And
Speaker 2: it just occupies this place in our culture that's really
Speaker 2: stigmatized and really looked down upon. And really, what's the
Speaker 2: other word othered? You know that people use that like
Speaker 2: you're outside of the norm, you're outside of the good circle.
Speaker 2: You're representing something scary, something we don't understand. You're doing
Speaker 2: irrational things, you're sort of breaching the social contract here
Speaker 2: where we're supposed to be, you know, together and honest
Speaker 2: and open with each other, and now you're doing a
Speaker 2: bunch of weird stuff that's not that, and some of
Speaker 2: it's just weird, and some of it's really harmful, and
Speaker 2: some of it's really scary. So the natural response to
Speaker 2: that is to be scared or nervous or anxious or
Speaker 2: mad or want to make it stop. And one of
Speaker 2: the things we start with with people is to try
Speaker 2: to help them put it in a different context and
Speaker 2: spend a lot of time with this first idea in
Speaker 2: the Invitation to change that we describe as behaviors make sense,
Speaker 2: which is walking through a bunch of common desires for
Speaker 2: us human beings. I'd like to sleep better, and I'd
Speaker 2: like to feel part of and I'd like to want
Speaker 2: to get out of bed in the morning. And i'd
Speaker 2: like to be able to focus better, and I'd like
Speaker 2: to lose weight, and I'd like to be funny, and
Speaker 2: i'd like you know, there's a long list of things
Speaker 2: that we go through, and we say, you know, is
Speaker 2: anybody here not want some of these things, or anybody
Speaker 2: think these things are weird or scared or you know,
Speaker 2: immoral it's like, of course not, you know, and then
Speaker 2: we say, well, so, we actually have the magic formula
Speaker 2: for many of these things. And it's called alcohol, or
Speaker 2: it's called heroin, or it's called crack or and you
Speaker 2: know what, it really works and it works incredibly quickly,
Speaker 2: and it's really reliable, and I can just get it
Speaker 2: on my own and I don't have to worry about
Speaker 2: other people. And it's just a way to start to
Speaker 2: help people understand that the desire to use substances, we
Speaker 2: can call it all kinds of things. We can call
Speaker 2: it a disease, and that's a whole nother discussion to have.
Speaker 2: But it's really really different for different people, how people
Speaker 2: get into this struggle, how they experience it, and how
Speaker 2: they ultimately can get out of it. I can look
Speaker 2: around a room of ten people and clients in a
Speaker 2: group here in our rehab and there are ten very
Speaker 2: very different stories of when this started, why it started,
Speaker 2: what it means, what will be helpful to unlock that
Speaker 2: person and help them move forward in a more positive
Speaker 2: way for themselves. Really literally ten different stories. You know.
Speaker 2: I have TSD from being in combat, and I lost
Speaker 2: my wife last year and I'm mourning, and I haven't
Speaker 2: gotten over it. I don't know what to do. I
Speaker 2: am a sixteen year old and I'm just a knucklehead
Speaker 2: and I'm just hanging out with my friends and got
Speaker 2: out of control. And you know, like those are all
Speaker 2: really different things, and one definition doesn't help when we
Speaker 2: apply it. So if I, as a helper, can go, okay,
Speaker 2: what makes sense about this from the perspective of this
Speaker 2: person I'm trying to help? Why is my kid using
Speaker 2: Why is my husband drinking too much? Why does my
Speaker 2: dad abusing pain pills? And let me really sort of
Speaker 2: understand that and step into their shoes. It just changes
Speaker 2: the whole equation. It makes it a compassionate discussion. It
Speaker 2: makes it a compassionate feeling I want to help them,
Speaker 2: as opposed to feeling like why are you doing this
Speaker 2: to me? So it's just a starting sort of foundational
Speaker 2: point of this is human behavior. This is not a
Speaker 2: demon that's come into your loved one. Sometimes it looks
Speaker 2: demonic when it gets to be a really bad place,
Speaker 2: it's still not a demon. It's just a human being
Speaker 2: struggling in a more or less severe way, in more
Speaker 2: or less behaviorally disrupted ways, and you can understand it. Actually,
Speaker 2: it doesn't mean you like it, doesn't mean you accept it,
Speaker 2: doesn't mean it's cool with you, just means you can
Speaker 2: understand it, which really is such a shift for most
Speaker 2: people and just profoundly affects their ability to actually engage
Speaker 2: in a different way. And engaging in a different way
Speaker 2: is the beginning of a whole different trajectory forward in
Speaker 2: terms of helping and in terms of being helped.
Speaker 4: That all makes a lot of sense to me. I mean,
Speaker 4: I bet sober in twelve step programs and they saved
Speaker 4: my life twice, so I have great things to say
Speaker 4: about them. And one of the things that eventually caused
Speaker 4: me to sort of withdraw from that to a certain
Speaker 4: degree was this idea that is, alcoholics and addicts we
Speaker 4: were fundamentally different than other people who quote unquote, weren't
Speaker 4: you know? They were the ormies, We were the sick ones, right,
Speaker 4: And I just ceased at a certain point to believe
Speaker 4: that because to your point, there may be something different
Speaker 4: in my ability to use alcohol from your ability to
Speaker 4: use alcohol, right, And there may be something different in
Speaker 4: my level of coping skills versus your coping skills or
Speaker 4: his level of trauma versus my level of trauma, right,
Speaker 4: But the core human experience is, Okay, I'm trying to
Speaker 4: make the best out of my life the best way
Speaker 4: I can figure out with the tools and the skills
Speaker 4: that I have, and for some of us, me my
Speaker 4: way of doing that turned out to ultimately be very
Speaker 4: destructive for me. But the underlying situation, which was I
Speaker 4: don't want to hurt so bad, right, is a noble question?
Speaker 4: Is not that different than say, the parent who doesn't
Speaker 4: want to hurt so bad because their child is using right.
Speaker 4: And so to me that commonality seeing like, okay, this
Speaker 4: is just the human response to a difficult situation, not,
Speaker 4: as you said, a moral failing, not a thing that
Speaker 4: fundamentally cuts me off from the rest of.
Speaker 2: The human race. Yes, yes, well said yeah, And that
Speaker 2: cutting off from the human race, or that I'm different
Speaker 2: or we're different or us addicts kind of language to
Speaker 2: describe stuff. Again, it can be a very powerful tool,
Speaker 2: and as you said, it may have been a very
Speaker 2: powerful tool for some period of time to kind of
Speaker 2: extend a hand and lift you out of a really
Speaker 2: bad place. And I think that sense of community and
Speaker 2: commonality is incredibly powerful. You know of just I have
Speaker 2: kept myself sequestered away because I'm uniquely bad. But now
Speaker 2: maybe there's a community people who I can talk with
Speaker 2: and not feel shame every second. Yes, okay, so that's
Speaker 2: incredibly powerful. Yes, and can we have more? Can we
Speaker 2: expand to the common humanity of all of this, which
Speaker 2: is whether I'm using heroin or not, we're all humans,
Speaker 2: you know.
Speaker 4: Yeah, that mutual understanding between alcoholics and addicts is the
Speaker 4: hugely healing thing.
Speaker 2: Yeah, you know.
Speaker 4: I mean I remember my first A meeting and I
Speaker 4: took the book home and just sobbed as I read
Speaker 4: it because it was the first time I'd ever heard
Speaker 4: anybody put words to what was happening in me. Yeah,
Speaker 4: you know, so I agree with you, Like, there's that
Speaker 4: initial piece that is really beneficial, and I think it
Speaker 4: gets to the idea of labels, right. There are situations
Speaker 4: in which labels and diagnoses are useful and there are
Speaker 4: situations where they're not. And knowing when and how hard
Speaker 4: to hold a label or an identity is really kind
Speaker 4: of an ongoing dance.
Speaker 2: Yeah. We hired a pretty young person here recently just
Speaker 2: for a summer thing in our clinical setting, just as
Speaker 2: a support person and really nice, really smart person. And
Speaker 2: they came to me after about a month here. I said,
Speaker 2: how's it going, and they were like, it's really intense,
Speaker 2: and really I'm really liking it. It's really great. He's like,
Speaker 2: I have to be honest, when I when I first
Speaker 2: started working here, I just sort of had this expectation
Speaker 2: that the clients were going to be like really hard
Speaker 2: to deal with and kind of a little bit like
Speaker 2: crazy and a little bit like my stress. First of all,
Speaker 2: I was like, holy crap, really.
Speaker 4: God, we're hiring process.
Speaker 2: How did you slip through the grags? But secondly, I
Speaker 2: was like, wow, right there it is stated out loud,
Speaker 2: you know, the cultural norm, the cultural understanding, Like it's
Speaker 2: those people, they are different somehow. It's insane, and it's
Speaker 2: such a barrier to help, to helping and to being helped.
Speaker 2: And you know, it's not like somebody who's struggling in
Speaker 2: this way is not acutely aware of what role they
Speaker 2: now occupy in society. You know, people struggling in this
Speaker 2: way are very deeply understanding of the fact that I
Speaker 2: don't talk about this stuff with anybody because I'm one
Speaker 2: of the bad ones. Now, you know, it couldn't be
Speaker 2: a worse setup for trying to get help. I mean,
Speaker 2: mental health in general, as you guys are well aware,
Speaker 2: is stigmatized, so there's sort of all kinds of difficulties
Speaker 2: with that. But I'll illustrate the whole stigma thing in
Speaker 2: another realm, which is we're doing increasingly through this vent
Speaker 2: and epidemic, we're doing more grief work with families. So
Speaker 2: we have a foundation that does training for families around
Speaker 2: the country and it's free and it's a great thing,
Speaker 2: and we use this invitation to change model to train
Speaker 2: family members and also now to train professionals. But increasingly
Speaker 2: we're having to deal with death and what they would
Speaker 2: call in the scientific literature drug related deaths DRDs. And
Speaker 2: as I started to read that literature over the last
Speaker 2: year because we don't want to reinvent the wheel here,
Speaker 2: and there's been a lot of really really good work
Speaker 2: in this arena of beread meant, but more recently just
Speaker 2: started to do some work in drug related deaths. And
Speaker 2: there's a whole literature on status of death, high status deaths,
Speaker 2: low status deaths. You know, high status death is my
Speaker 2: wife fought to the bitter end with cancer, and she
Speaker 2: always put on a brave face and we did fundraisers
Speaker 2: and you know, she's the face of the campaign now
Speaker 2: and all that stuff that people go true in that
Speaker 2: kind of an illness, for instance, which is viewed heroically
Speaker 2: in our society. You know, she never gave up her spirit,
Speaker 2: never flagged those kind of things, which is fine, except
Speaker 2: for it's in contrast to then, Oh, you died from
Speaker 2: a heroin overdose. Okay, so one, we don't really want
Speaker 2: to talk about that. Two isn't that kind of your fault?
Speaker 2: Three isn't that kind of because you're a bad person
Speaker 2: and you kind of got what you deserved. I mean,
Speaker 2: it's all these horrific things tied to it. And you
Speaker 2: can imagine as a family member, first, you've been through
Speaker 2: this life now with this person where you felt like
Speaker 2: you couldn't talk about this with your family or your
Speaker 2: friends or anybody because this is a stigmatized struggle. And
Speaker 2: now you've lost this dear person in your life and
Speaker 2: you can't talk about it either. And they say, oh
Speaker 2: my god, I'm so sorry your son die. What happened?
Speaker 2: And you're like, what am I going to say? So
Speaker 2: if I say he died of a fentyl overdose. What
Speaker 2: do I get back? I get judgment? You know. So,
Speaker 2: even in that realm of loss, the stigma stuff is
Speaker 2: so pernicious and so destructive to getting help.
Speaker 1: It really is their barriers, and they are inaccuracy. I mean,
Speaker 1: it's not correct that this is a moral feeling. It
Speaker 1: keeps people stuck and suffering, and it's not helpful. We
Speaker 1: probably have listeners here with family members who are struggling
Speaker 1: with addiction. You say, the first place to start is,
Speaker 1: you know, understanding and that behaviors make sense. So if
Speaker 1: I'm a friend of our family or a helper with
Speaker 1: a loved one who's got addiction, you know, how do
Speaker 1: I begin to understand the behaviors that my loved one
Speaker 1: is exhibiting? Like, for example, can I really help them
Speaker 1: if they seem like they don't want to change? Like,
Speaker 1: how do I even start to gain an understanding? Like
Speaker 1: what's a practical step here?
Speaker 2: Right? Well, it's funny, that's such a great way to
Speaker 2: pair it. How do I help them if they don't
Speaker 2: want to change? So one of the things we know
Speaker 2: now is that one of the most powerful ways I
Speaker 2: can help them if they don't want to change is
Speaker 2: by understanding them as opposed to trying to get them
Speaker 2: to do something. If I can just start with understanding,
Speaker 2: So just to zoom out for a second, the invitation
Speaker 2: to change approach that I've been told talking about is
Speaker 2: this model that we've developed over the last five sixty
Speaker 2: seven years that comes from a variety of other evidence
Speaker 2: based approaches. And so we didn't like make it up
Speaker 2: and think, oh this is cool. We got a bunch
Speaker 2: of smart ideas. This is from several three, in fact,
Speaker 2: major evidence based ways of helping. One is called community
Speaker 2: reinforcement and family training. That's craft and that's a very
Speaker 2: powerful intervention that family members can use. Another is motivational interviewing,
Speaker 2: which is just learning a new way of communicating that
Speaker 2: is not confrontational, that is more helpful in terms of
Speaker 2: eliciting change and inviting change than it is demanding change.
Speaker 2: And then something called acceptance and commitment therapy, which focuses
Speaker 2: a lot on changing our relationship to our beliefs, to
Speaker 2: our own pain. As we say in acceptance and commitment
Speaker 2: therapy is called act. There's this idea of holding it lightly.
Speaker 2: So these concepts I have about myself or about other people,
Speaker 2: or how much pain I can tolerate. Are these kind
Speaker 2: of things. I can be a little bit more gentle
Speaker 2: with those ideas and be a little more flexible with
Speaker 2: those kind of ideas. So anyway, those are the elements
Speaker 2: that are going into this invitation to change or the
Speaker 2: ITC and we arrange them in a circle around a wheel.
Speaker 2: And then there's spokes that are parts of these different sections.
Speaker 2: There's three main parts. There's helping with understanding, so I'll
Speaker 2: talk about what those are, but there's elements of how
Speaker 2: do I understand this in a new way. There's helping
Speaker 2: with awareness, which is really about can I be more
Speaker 2: aware of myself in this process of helping, which is
Speaker 2: a crucial aspect of effectively helping. And then the third
Speaker 2: part of this is helping with action. What can I
Speaker 2: literally do? What are my tools, which are mostly in
Speaker 2: the zone of communication tools, What ways can I engage
Speaker 2: in communication that are less likely to get in the way,
Speaker 2: more likely to help illicit change? And what behaviors can
Speaker 2: I change? What can I reinforce differently, what limits can
Speaker 2: I set that kind of thing? So those are the
Speaker 2: three main parts, and then we always preaching practice like
Speaker 2: no one's good at any of the stuff, You're really
Speaker 2: gonna have to take some time to learn it. You're expecting, asking,
Speaker 2: wanting them to change. So if you think about that,
Speaker 2: you're asking them to try new behaviors. They're going to
Speaker 2: have to take time to do that, and they need
Speaker 2: time to practice new things. Being abstinate from a substance
Speaker 2: or changing my relationship to a substance takes time and
Speaker 2: takes practice. So practice is an important part for everybody.
Speaker 2: Then back to what you were asking about, how do
Speaker 2: I help them understand on a practical level. One of
Speaker 2: the things that I have just encountered so many times.
Speaker 2: And I don't know if this will resonate with you guys,
Speaker 2: but just working with hundreds of families over the last
Speaker 2: bunch of years, when you ask a father, a wife,
Speaker 2: a whoever, let's just hold on for a second, what
Speaker 2: do you think is going on? Why do you think
Speaker 2: they like drinking? They know the answer. It's not a mystery.
Speaker 2: Sometimes people will say, I don't know, it's crazy. You
Speaker 2: know that doesn't make any sense. But if you then
Speaker 2: slow it down a little bit more, and not that
Speaker 2: they always do and not that they know all the
Speaker 2: nuances of it. But people really will be like, yeah,
Speaker 2: my kid is really anxious. I knew the first time
Speaker 2: they spoke pot that they had changed their whole relationship
Speaker 2: to their own anxiety, and it actually allowed them to
Speaker 2: hang out with their friends. And I was really terrified
Speaker 2: because I thought, oh, no, this is going to go badly.
Speaker 2: But they understood the reasons. They understood what was going
Speaker 2: on in there. And why does your husband drink so much? Well,
Speaker 2: he hates his job. We have a new baby, and
Speaker 2: we have a three year old, and he's not that
Speaker 2: good with kids and he wishes he could be, but
Speaker 2: he feels bad about himself as a dad and blah blah.
Speaker 2: So I think he drinks to go to sleep and
Speaker 2: just turn it off. Okay, not that complicated and incredibly important.
Speaker 2: And you are actually an expert here, mister and missus
Speaker 2: family member, which is a really helpful way to start
Speaker 2: with people, which is not to assign them responsibility then
Speaker 2: for the change, but it is to say you're the
Speaker 2: expert here. You actually know much more than I do
Speaker 2: about your loved one, and let's start with what you
Speaker 2: understand about this, which again kind of normalized is it
Speaker 2: and puts it back into the It's not a foreur
Speaker 2: line fire kind of discussion. It's just like you get it,
Speaker 2: you understand their behavior. That again, is one of these
Speaker 2: things that sort of helps change the equation as a
Speaker 2: starting point for most helpers.
Speaker 4: Let's move on to a couple other aspects. You know,
Speaker 4: understanding being really important. Another thing I think is for
Speaker 4: a family member to take a loving, supportive role, they
Speaker 4: have to be able to manage their own emotions and
Speaker 4: what's going on inside them, and that can be really,
Speaker 4: really difficult. Can we just talk a little bit about
Speaker 4: that process. I don't think there's an easy answer for it.
Speaker 4: I don't think you're going to in two sentences say
Speaker 4: well just do A and B which is what we want?
Speaker 4: Or you want an easy answer, do this and you'll
Speaker 4: no longer be terrified. What are some things that FLY
Speaker 4: members can think about as ways of being able to
Speaker 4: cope and live in the uncertainty and the fear and
Speaker 4: the hurt.
Speaker 2: Yep, So the way you just put that would be
Speaker 2: an important place to start, which is, can we invite
Speaker 2: you to live in the fear and the uncertainty. So
Speaker 2: the second major section of this approach is self awareness,
Speaker 2: and we start with very basic tools like can you
Speaker 2: check in with yourself in terms of your emotions? Can
Speaker 2: you check in in terms of your physical body and
Speaker 2: how you're experiencing things? And you're always have a tight
Speaker 2: feeling in your chest and your stomach is in knots,
Speaker 2: and your shoulders are up to your ears, and you
Speaker 2: have headaches and you're constantly tired, And can we check
Speaker 2: in about your thought processes, like I'm always having panicky
Speaker 2: thoughts about like we forgot we didn't do enough, or
Speaker 2: we got to call that other person, or we got
Speaker 2: to you know. So just starting with basic self awareness,
Speaker 2: which is something that usually flies out the window, and
Speaker 2: flies out of the window reasonably as a human animal
Speaker 2: in the face of emergency. You don't usually stop to
Speaker 2: check in with yourself when you're standing there and there's
Speaker 2: a bear across the road. You just do whatever you
Speaker 2: think you should do, and not even what you think
Speaker 2: you should do. You just do something which is usually run,
Speaker 2: which is not necessarily the best thing to do. But
Speaker 2: that awareness is the anchor to then becoming more effective helper.
Speaker 2: We often talk about that in terms of this invitation
Speaker 2: to the helper. It's not just an invitation to the
Speaker 2: person we're trying to help change. It's an invitation to
Speaker 2: the helper to be part of the change process and
Speaker 2: to really make that clear, like you are part of this.
Speaker 2: It's not just can we get this person to do
Speaker 2: this and change that. You're part of the change process
Speaker 2: with them, which includes very foundationally you being aware of yourself,
Speaker 2: and you being aware of yourself has to do with
Speaker 2: how do I react, how do I intentionally choose how
Speaker 2: I'm going to act as part of being a more
Speaker 2: effective helper, But it also includes checking in with myself,
Speaker 2: being aware of myself with compassion so that I can
Speaker 2: take in the fact that this is so freak and stressful.
Speaker 2: I can't believe it. This has been going on for
Speaker 2: a year or a month or ten years and it's
Speaker 2: still happening, and I'm embarrassed and I'm stressed out and
Speaker 2: I'm terrified, and like, Okay, that's important to acknowledge. To
Speaker 2: be a sustainable process as a helper, you actually have
Speaker 2: to look at the gas gage on the car just
Speaker 2: driving down the road and going I'm not looking at
Speaker 2: the gas caage. I just have to get to Nevada tonight.
Speaker 2: I'm just going to keep driving Okay, don't look at
Speaker 2: the gas gage, but you will run out of gas.
Speaker 2: So ignoring the internal process, ultimately we'll catch up with you.
Speaker 2: And it's not a compassionate way to approach yourself, and
Speaker 2: it's not sustainable. So those are sort of basic tools,
Speaker 2: and there's all kinds of ways to start to help
Speaker 2: people notice themselves and check in with themselves and just
Speaker 2: the behaviors they start to notice about themselves. Can you
Speaker 2: check in at the end of the day and do
Speaker 2: a little journaling about you know, how anxious were your
Speaker 2: thoughts today? Or how many negative types of thoughts do
Speaker 2: you have about yourself? Or check in every hour for
Speaker 2: one minute and see what has been the nature of
Speaker 2: my thinking over this last hour. You know, am I
Speaker 2: in panic mode? Am I in self hatred mode because
Speaker 2: I haven't done this right? And you know, am I
Speaker 2: just numb? And I'm ignoring everything? So those are basic
Speaker 2: self awareness ideas. But something else you said also makes
Speaker 2: me want to talk about another part of self awareness,
Speaker 2: which is the thing I was referencing earlier, that idea
Speaker 2: of willingness, which is also a pretty crucial part of
Speaker 2: being a helper, which is the idea of changing our
Speaker 2: relationship to how difficult this is the pain of this,
Speaker 2: and again totally normal. I put a hot knife on
Speaker 2: your skin, You're going to pull your arm away or
Speaker 2: push my arm away. We want to get away from pain.
Speaker 2: The impulse to control the pain, to make it stop,
Speaker 2: to push you away, to go away myself is really
Speaker 2: strong and is ultimately not going to be such an
Speaker 2: effective way to help. So the issue is not how
Speaker 2: do I tolerate more and more pain? The issue is
Speaker 2: can I change the way I understand this? Because ultimately,
Speaker 2: the idea of willingness is you are living with your values.
Speaker 2: You want to be helpful to this person you love.
Speaker 2: You want to stay connected, you want to be reliable
Speaker 2: for them, and you want to help make things go
Speaker 2: in a new direction that is by definition going to
Speaker 2: be painful. That's the other side of that coin. So
Speaker 2: my value is what I care about as a person,
Speaker 2: and the way I want to show up is one
Speaker 2: side of the coin. The other side is always going
Speaker 2: to be this is difficult, this is uncomfortable, this is scary,
Speaker 2: this is heartbreaking, And can I start to understand that
Speaker 2: that's okay? I don't have to make that go away.
Speaker 2: As part of this equation, and in fact, it is
Speaker 2: part and parcel of this of this process that we're
Speaker 2: engaged in. You know, let's put it in a positive realm.
Speaker 2: If we think about being in love, that's a coin also,
Speaker 2: so not many people who've actually been in love think
Speaker 2: that's the best thing ever and nothing bad ever happens.
Speaker 2: It's awesome. Once you get in love, you're good for
Speaker 2: the rest of your life. Most people experience love as
Speaker 2: and then I got my heart broken, and then they
Speaker 2: did this and that and I couldn't believe it, or
Speaker 2: I got scared and the like. It's a mixed bag.
Speaker 2: And the more intense the positive feeling in that case love,
Speaker 2: the more risks involved, the more really painful difficult things
Speaker 2: are going to come along with it. So sort of
Speaker 2: asking the question, would you rather not have love as
Speaker 2: a way to take away the pain? So you can
Speaker 2: do that, you can stay away from relationships and keep
Speaker 2: the chances of that kind of terrible, heartbreaking pain, keep
Speaker 2: them low, get them to go away, and you lose
Speaker 2: the other side of the coin, which is I have
Speaker 2: an experience of feeling in love, so I'm going to
Speaker 2: be a helper. Great, that's awesome, That feels important to
Speaker 2: you to do that with your loved one. Can you
Speaker 2: get your head around the fact that it's scary, it's vulnerable,
Speaker 2: Bad things happen, You'll feel bad, you'll feel disappointed, it's okay.
Speaker 2: Can we include both of those as part of this process.
Speaker 1: You know a lot of the things you're describing there,
Speaker 1: for me fall under the umbrella of mindfulness. I'm a
Speaker 1: mindfulness teacher and I have a mindfulness practice, and I
Speaker 1: mean learning about mindfulness and practicing mindfulness, I think is
Speaker 1: something that can help you gain self awareness. It can
Speaker 1: help you gain emotional regulation and increase your distress tolerance.
Speaker 1: It can help you, you know, learn how to be
Speaker 1: with this pain and the discomfort without feeling like you
Speaker 1: need to banish it or run away from it. I mean,
Speaker 1: there's so much that can be gained there, so I
Speaker 1: just mention it as listeners are hearing all of this.
Speaker 1: That's also another avenue to pursue, and that would do
Speaker 1: a lot of the things you're talking about.
Speaker 2: Yeah, as a self compassion and mindfulness person, you're probably
Speaker 2: familiar with Kristin Neff or yes, yep, So you know
Speaker 2: she's done a lot of research on self compassion, and
Speaker 2: one of the elements of self compassion is present, moment
Speaker 2: focus or mindfulness. So if we apply it directly to
Speaker 2: I am a family member, I'm trying to help and
Speaker 2: my kid is not home yet. Just to make it
Speaker 2: incredibly concrete, what is a self compassionate, self aware, mindful tool?
Speaker 2: Why is it important in that moment? Because I can
Speaker 2: then anticipate them coming home for the next two hours,
Speaker 2: which is not being present, it's living in the future.
Speaker 2: I can keep reciting all the nasty things I'm going
Speaker 2: to say to them for making me feel so scared.
Speaker 2: I can be remembering when this happened a year ago
Speaker 2: and they had been in a car accident and it
Speaker 2: was horrible, and I'm just imagining that's what's going to
Speaker 2: happen now. None of that's about being present or mindful,
Speaker 2: you know. So you're right, it's a very powerful tool,
Speaker 2: and it's a part of this idea of the self
Speaker 2: compassion part of this. You know, how do I not
Speaker 2: go to those places and stay here with what's actually real?
Speaker 4: Yes, So then do you recommend that and as part
Speaker 4: of what you do, give people training in that, because
Speaker 4: it's one thing to recognize, to check in and go, Okay,
Speaker 4: I'm upset inside. Yeah, I'm living in the future. Yeah,
Speaker 4: telling myself stories that may not be real. It's a
Speaker 4: whole nother thing to actually then be able to somehow
Speaker 4: work with that in a skillful way. Yeah, right, you know,
Speaker 4: because the emotions around this stuff can run so hi.
Speaker 4: I mean, if you know, the thought of your child dying,
Speaker 4: there's not a much more primal thing to wrestle with,
Speaker 4: Like I just want to be compassionate to listeners and
Speaker 4: people listening to say like, these are all the right actions,
Speaker 4: but the emotion around it doesn't just change easily. Yeah,
Speaker 4: how do you encourage people to be on a learning
Speaker 4: journey with that and to be able to manage those
Speaker 4: really primal sort of emotions.
Speaker 2: So I think of this model as one that allows
Speaker 2: for tons of room for skill building and learning from
Speaker 2: lots of different buckets. I'll go back to kind of
Speaker 2: the center of the circle, the invitation of the chain
Speaker 2: circle being practice, practice, practice. It's an ongoing mantra, and
Speaker 2: it's a mantra of self compassion to your point, which is, yeah,
Speaker 2: these are good ideas, and now what right, like the hell? Like,
Speaker 2: what am I supposed to do? With that. Yeah, you
Speaker 2: try sitting there at ten o'clock at night not losing
Speaker 2: your crap, you know about my kids not home yet.
Speaker 2: So we do encourage people, and part of that is
Speaker 2: is normalizing it in a community. I'm looking around the
Speaker 2: room at a bunch of other parents who are also like,
Speaker 2: oh my god, you know, how can I possibly stay
Speaker 2: calm in those moments. I'm getting feedback from people who
Speaker 2: have stepped down that road a little bit further and
Speaker 2: have actually had some experiences of being more mindful and
Speaker 2: what it gave them. So I can draw on the
Speaker 2: community support and learning for that. And then there's formal practices.
Speaker 2: You know, what does it mean to be more mindful?
Speaker 2: You know? Can I start doing a meditation practice? Can
Speaker 2: I start doing square breathing? Can I, you know, do
Speaker 2: any number of very basic beginning ideas of how do
Speaker 2: I stay present a little bit more? I think in
Speaker 2: the context of early work with people, it's also about
Speaker 2: kind of talk about this with other people, you know,
Speaker 2: kind of get feedback, kind of get support. Can I
Speaker 2: normalize this, get encouragement. We get it, you know, we
Speaker 2: get how hard that is. And let's start with that.
Speaker 2: Let's affirm the fact that this is really hard and
Speaker 2: there's a really big lift, you know, and you're not
Speaker 2: going to know how to do it very well.
Speaker 1: Yeah, we've talked a bit about understanding your loved one
Speaker 1: and why they do what they do. We've talked about
Speaker 1: how important it is to care for yourself and gain
Speaker 1: some of these self awareness and self regulation tools. So
Speaker 1: let's move on to actually how to help. You talk
Speaker 1: a lot about starting where your loved one is, and
Speaker 1: you also introduce this idea of positive communication as a
Speaker 1: critical skill for making change. You say, positive communication skills
Speaker 1: will improve your odds of being heard and your loved
Speaker 1: one feeling understood. But for any given conversation, the outcome
Speaker 1: is not guaranteed, right. You talk about not attaching to
Speaker 1: the outcome. So I'm wondering if you can just explain
Speaker 1: a little bit about what are positive communication skills and
Speaker 1: what does that look like in practice.
Speaker 2: Sure, and a lot of that work. As I said before,
Speaker 2: there's sort of the different elements that go into the
Speaker 2: invitation to change. A lot of the positive communication skills
Speaker 2: come from motivational interviewing. That's an approach developed by Bill
Speaker 2: Miller and Steven Rolnick probably thirty five years ago, now
Speaker 2: much more widespread in the culture. Lots of people get
Speaker 2: training in that. You know, who doesn't get training in
Speaker 2: it is family members, But who does get training in
Speaker 2: it is professionals, which is unfortunate that that's a split.
Speaker 2: But I sort of think of them as a wolf
Speaker 2: in sheep's clothing. Those kind of skills. People think of
Speaker 2: them as, oh, yeah, those are just simple management skills.
Speaker 2: And I learned that in management training. And you know
Speaker 2: the difference between how simple they might seem and applying
Speaker 2: them is that when it comes to your own family,
Speaker 2: everything goes out the window. So the same executive sitting
Speaker 2: in my communication skills group in our treatment program, who's like,
Speaker 2: this is a little basic, isn't it, And then I say, yeah, great,
Speaker 2: why don't you try the seven steps of positive communication
Speaker 2: in requesting that your wife address you more respectfully? Go ahead,
Speaker 2: let's put that communication together. And it's just excuse my language,
Speaker 2: but a shit show. It's like, yeah, that doesn't work
Speaker 2: so well when you're talking to your wife who you're
Speaker 2: really mad at and frustrated with, and you know their
Speaker 2: first response is like, just take the freaking garbage, will you?
Speaker 2: Or just talk more respectfully for me, or you know, okay, great,
Speaker 2: you missed only seven out of the seven elements there,
Speaker 2: Let's let's try it again. So that's where those skills
Speaker 2: really matter is when the temperature is higher, and the
Speaker 2: temperature is higher when it's our family or someone we
Speaker 2: care deeply about and who's making us upset or scared
Speaker 2: or whatever. So motivational interviewing has some very basic communication skills.
Speaker 2: The thing that we start with, however, again most foundationally
Speaker 2: in communication, is can we figure out ways to listen?
Speaker 2: Because again, if I'm distressed you're doing stuff that I
Speaker 2: don't like, I wish you'd stop. Please, If you stopped,
Speaker 2: I'd feel better. That's our basic starting point, right, So
Speaker 2: wouldn't yelling at you be good? Wouldn't that be effective?
Speaker 2: Or wouldn't just telling you to knock it off be
Speaker 2: a good thing to do? Or let me just be
Speaker 2: real with you and tell you what a jerk you're being.
Speaker 2: All those kind of ideas, which again are normal reactions
Speaker 2: to difficult situations and wildly ineffective. So if you sort
Speaker 2: of put yourself back in your own shoes and go, well,
Speaker 2: what's helpful to me? If someone's suggesting something new or
Speaker 2: suggesting I change something or giving me some feedback. What's helpful?
Speaker 2: What if I noticed in my life that's helpful. From
Speaker 2: a good manager versus a bad manager, a good teacher
Speaker 2: versus a bad teacher, or parents where the interaction went
Speaker 2: well versus a parent when the interactions didn't go well.
Speaker 2: Someone demanding stuff, mandating stuff, dictating things to me using
Speaker 2: a crappy tone, insulting me, taking away my autonomy. Those
Speaker 2: aren't usually on top of the list for people about
Speaker 2: what helped me, and would certainly not what helped me
Speaker 2: sustain that change. Maybe you can get me to do
Speaker 2: something this moment by raising your voice enough, but we're
Speaker 2: not going to go down a good path probably if
Speaker 2: that's the way you got me to do this. So
Speaker 2: what are the things that help people? And just starting
Speaker 2: with can I just understand what's going on with you
Speaker 2: a little bit? So it connects to the understanding section
Speaker 2: of this whole thing, But it's just as a human interaction.
Speaker 2: Can I legitimately sit with you and try to listen
Speaker 2: to you? You know, it's an entire form of couples therapy.
Speaker 2: Amago therapy is based on can you just freaking listen?
Speaker 2: And nothing else. Can you just listen and reflect accurately
Speaker 2: reflect back what I just said instead of inflecting it
Speaker 2: with everything that you wished I said or wished I
Speaker 2: would do. So that's a profound place to start, and
Speaker 2: we do just very basic exercises of just listening to
Speaker 2: in diads, in trainings with parents, with each other. Can
Speaker 2: you just listen and then say nothing? And then what's
Speaker 2: it like to listen? I just wanted to say something,
Speaker 2: I wanted to interject, I wanted to offer an idea,
Speaker 2: I wanted to give a suggestion. Great, we get that.
Speaker 2: What was it like for the speaker to not have
Speaker 2: you do that? It was like a blessed relief that
Speaker 2: someone wasn't jumping in. I'd never have anybody listening without
Speaker 2: cutting me off and telling me their story. You know.
Speaker 2: All that kind of stuff is what you usually get
Speaker 2: when you help people try to learn basic ideas about listening.
Speaker 2: So that's one place that we start with positive communication.
Speaker 2: Might not think of it as communication, but that's communication.
Speaker 2: How do we increase communication between two people? Listen?
Speaker 1: I'll interject there and just give a little testimonial. My
Speaker 1: mom and I went to therapy together at one point
Speaker 1: in time and engaged in that exact thing where I
Speaker 1: would say a few sentences or a couple of sentences,
Speaker 1: because you'd get more than two or three and it's
Speaker 1: too much, So you say a couple of sentences, and
Speaker 1: then my mom would have to use my words and
Speaker 1: say the exact same thing back. And it is shocking
Speaker 1: how hard that was for both of us because what
Speaker 1: inevitably happens the first time is you're listening through your
Speaker 1: own filter, so what you say back is actually sometimes
Speaker 1: grossly different, but often subtly enough different that the meaning
Speaker 1: isn't the same. So really getting the words right and
Speaker 1: saying it back to one another, like you said, just
Speaker 1: doing that and then when I would say something to
Speaker 1: my mom and then she would say it back to
Speaker 1: me exactly, I felt so heard often for the first time,
Speaker 1: and that alone, so that she heard me really was powerful,
Speaker 1: Like it got us from being opposing people in a
Speaker 1: situation to like sitting side by side. I just wanted
Speaker 1: to underscore, like, having been through that too, you're right,
Speaker 1: it's so powerful just to hear one another really and listen.
Speaker 2: Yeah, yeah right, so continue, sorry, no, and if you
Speaker 2: put it in the context, just that simple process as
Speaker 2: a beginning step to put it in the context of
Speaker 2: could you talk to your husband and just say that
Speaker 2: this is really scary for you. You don't understand exactly
Speaker 2: what happens in terms of his drinking, but you'd like
Speaker 2: to understand, and you'd like to listen. Yeah, okay, so
Speaker 2: you invited that discussion. Then he takes a chance and
Speaker 2: he says, well, I get really stressed out and I
Speaker 2: don't know what else to do, and I know it's
Speaker 2: a bad thing to do, but I just that's what happens.
Speaker 2: If your response to that is yeah, but can't you
Speaker 2: just do yoga more? And don't you realize how bad
Speaker 2: that is for the rest of us. I'm not in
Speaker 2: listening mode anymore. I'm really sort of requesting you to
Speaker 2: talk so I can jump all over it and get
Speaker 2: my point in and litigate my case as suppose to you.
Speaker 2: Can I actually just hear what you're saying. Yeah, nothing
Speaker 2: else happens. We've made a huge step if I just
Speaker 2: stop and listen. There are lots of other communication strategies
Speaker 2: that are also pretty straightforward and again equally hard to
Speaker 2: do so, like, for instance, simply listening not so simple,
Speaker 2: but directly out of motivational interviewing. There's this idea of
Speaker 2: asking open ended questions instead of closed ended questions. So
Speaker 2: closed ended questions are ones you can answer yes or no.
Speaker 2: Are you feeling better? Yeah? No? Like that's my only choices?
Speaker 2: Right you been doing? That's an open ended question? Or
Speaker 2: using affirmations in response to what someone is saying. I
Speaker 2: really appreciated how open you were with me about that.
Speaker 2: Thinks it's simple. I really appreciated you speaking at all
Speaker 2: and taking a chance. Okay, these are not big things.
Speaker 2: They're not like rolling out a bunch of skills I
Speaker 2: got to learn and practice over and over again. They're
Speaker 2: just like, just try it. And these are things that
Speaker 2: are hard in the context of stressors and fears and
Speaker 2: anger and upset. So learning how to ask an open
Speaker 2: endit question, learning how to affirm something that someone is
Speaker 2: saying as supposed to just looking for the thing that's
Speaker 2: irritating that they're lying about again really starts to shift.
Speaker 2: Are you going to even take a chance and talk
Speaker 2: to me anymore? Like I desperately want to communicate more.
Speaker 2: Why can't you be more open with me? Well, because
Speaker 2: every time I'm open with you, you tell me what
Speaker 2: to do differently, or you're telling me what a schmunk
Speaker 2: I am, you know whatever, but you're not actually paying
Speaker 2: attention to me. So when can you listen to Can
Speaker 2: we learn some pretty straightforward tools that encourage more openness,
Speaker 2: and can I reflect back? That's another one. What in
Speaker 2: motivational interviewing, it's called the ore's skills. So that's oars,
Speaker 2: open ended questions, affirmation, appreciate you being open with me, reflection.
Speaker 2: Let me just make sure I understood what you said.
Speaker 2: You said that often you feel really stressed out, and
Speaker 2: so Friday nights is a great time for you to
Speaker 2: meet your friends and drink. Did I get that right?
Speaker 4: No?
Speaker 2: I didn't say that. Okay, So at least we're trying
Speaker 2: to get on the same page. That's what a reflection
Speaker 2: helps us do, as opposed to me assuming I understood
Speaker 2: it and going off into some other realm that's not
Speaker 2: actually what you meant. So again, they can seem pretty straightforward,
Speaker 2: but especially in the context of stressors and family difficulties,
Speaker 2: they're really not basic. They're really like, Okay, we can
Speaker 2: start to repair this system here just with the way
Speaker 2: we're talking to each other, you know, yep.
Speaker 4: In one of the books, you say our mandate has
Speaker 4: become how do we help you shift your motivation? And
Speaker 4: you also say that one thing we know is that
Speaker 4: confrontation is the arch enemy of motivation.
Speaker 2: So talk to.
Speaker 4: Me about the role of a family member potentially wanting
Speaker 4: someone to shift their motivation into wanting to get sober
Speaker 4: or is that even the right way to think about it?
Speaker 4: You know, walk me through that.
Speaker 2: Yeah, sure, Well. There's just been a number of studies
Speaker 2: also about the use of confrontation confrontational strategies or approaches
Speaker 2: to other people, both within substance use, but within other areas,
Speaker 2: but just sticking with substance use. Pretty much all of
Speaker 2: that research, and a lot of that was done by
Speaker 2: Bill Miller and the Motivational interviewing folks and summarizing lots
Speaker 2: of different research studies. Confrontation with other people is a
Speaker 2: really strong indicator of not changing. You can produce non
Speaker 2: change with confrontation. It is a very natural poll again,
Speaker 2: because someone who you care about is doing stuff that
Speaker 2: seems to not make any sense, and I just need
Speaker 2: to let you know that you're doing stuff that doesn't
Speaker 2: make sense and tell you to stop doing it. And
Speaker 2: that should clear it up. And again that's not a
Speaker 2: crazy thought, and it's a natural pull, but it's not
Speaker 2: how most people change by being told knock it off,
Speaker 2: that's bad, you're bad. Do something different, because one of
Speaker 2: the problems with that, and that's the basic issue of
Speaker 2: motivation is that's coming from you, not from me. So
Speaker 2: we don't even have to put confronation in some big
Speaker 2: black light. It's just what it does, is it just
Speaker 2: keeps the locus of change over in your lap as
Speaker 2: the person who's confronting me, not in my lap. And
Speaker 2: if we can come up with ways to help me
Speaker 2: internalize why would I want to change, then we're talking
Speaker 2: about real change, and we're talking about sustainable change, which
Speaker 2: again is in especially with substances. You know, people struggle
Speaker 2: with subs and stuff for years and years and years.
Speaker 2: So we're talking about sometimes a really long term path,
Speaker 2: not like a quick fix getting you to go do
Speaker 2: a thing, go to detox. The relapse rate after detox
Speaker 2: is like one of the highest recidivism rates of any
Speaker 2: sort of struggle that people have in the world. The
Speaker 2: number of people who relapse after strictly just a detox
Speaker 2: physical detox episode is like ninety percent, because there's nothing
Speaker 2: else happening other than we got you to do this
Speaker 2: thing and got you to physically stop taking the subtance
Speaker 2: for five days or ten days or whatever it is.
Speaker 2: Nothing else has shifted. So it really brings back the
Speaker 2: question of how do I help you think about what
Speaker 2: matters to you about this and not have you be
Speaker 2: back on your heels defending against my onslaught my confrontation.
Speaker 2: So that's the problem with confrontation. It makes me defend
Speaker 2: as opposed to be open, and that's not what we
Speaker 2: want to have happen if we're trying to help someone change.
Speaker 2: If I'm getting you to be more defensive, I'm losing you.
Speaker 2: And again it feels natural. And it's not that I
Speaker 2: can't break through in some way in this particular moment,
Speaker 2: but it's me breaking through you. It's not you breaking
Speaker 2: through your own difficulties. I'm the one who smashed the vase,
Speaker 2: you know, not you, and then you're just left with
Speaker 2: the broken pieces. But you have no path forward. Really,
Speaker 2: you just got smashed into And I want you to
Speaker 2: start to have power in this situation and ownership of this.
Speaker 2: A very common exercise we do with people struggling with substances.
Speaker 2: And this is then related to some of these helping ideas.
Speaker 2: But is let's do a cost benefit of your substance use,
Speaker 2: and let's do a cost benefit of Let's say your
Speaker 2: goal was abstinence, which it doesn't have to be abstinence either,
Speaker 2: but let's say it was. Let's look at the cost
Speaker 2: of your use. And that's the thing that most people
Speaker 2: are expecting you to want to ask them about, Like,
Speaker 2: let's look at how bad this is for you and
Speaker 2: all the bad things that's happening in your life because
Speaker 2: of this. I don't know if you're aware of this, Like,
Speaker 2: are you kidding me? Of course I'm aware of it.
Speaker 2: But okay, we'll go through that list. But let's also
Speaker 2: talk about the benefits you get, right, that's part of
Speaker 2: the behaviors makes sense part I actually want to hear
Speaker 2: what's good about this for you. I'm not trying to
Speaker 2: deny that entire half of you as a human being,
Speaker 2: you're doing these things because they help you in certain ways.
Speaker 2: And there's this destructive part for sure, but it's helping
Speaker 2: you still. Both of those are true. We don't need
Speaker 2: to have it be one or the other. And then
Speaker 2: let's look at the costs and benefits of if you
Speaker 2: don't use this substance anymore, what's the benefit. We can
Speaker 2: all cheer that on and say, I'm going to have
Speaker 2: a good life and I'm going to be a virtuous person. Okay, right,
Speaker 2: And what's going to be hard about that? Let's look
Speaker 2: at that also, I won't come out of my house
Speaker 2: because I'm so freaking anxious when I don't smoke pot
Speaker 2: I don't know what to do with myself. All right,
Speaker 2: that's going to be really hard. Can we look at
Speaker 2: all of that? Why would we look at all of that?
Speaker 2: That's the opposite of confrontation. It's the opposite of me
Speaker 2: selling you a bill of goods, saying, look, this is
Speaker 2: a really terrible substance that's happening, and what's doing to
Speaker 2: your life, and you're going to have a great life
Speaker 2: if you stop. Okay, that's me selling you an external
Speaker 2: bill of goods. It's ignoring all the other realities like
Speaker 2: I really like smoking, though, and I'm really anxious when
Speaker 2: I don't smoke. And if I can have that discussion
Speaker 2: where we include all of that stuff, all of the
Speaker 2: parts of the reality here, then I'm actually talking to
Speaker 2: you as a whole person. Then I'm actually asking you
Speaker 2: to assess it for yourself and whether this change is
Speaker 2: worth it, because you know what might not be that
Speaker 2: might be the answer at this moment in my life,
Speaker 2: it's not worth it to me to change my substance
Speaker 2: use pattern like that would be really helpful information to
Speaker 2: have open between the two of us, as opposed to
Speaker 2: you pretending that you're all revved up about this new
Speaker 2: abstinence thing and you're gonna do it, and gosh darn it,
Speaker 2: you're gonna commit to this. You know, like, no, you're not.
Speaker 2: That's not actually what's going on with you. And it
Speaker 2: would be much better for us to be able to
Speaker 2: be open about that, not by me smashing through you
Speaker 2: and going you need to be honest, but me asking
Speaker 2: you what's true, what's real, what can we actually work with?
Speaker 2: I'm going to get much more buy in and much
Speaker 2: more sustained change than if it's really coming from you.
Speaker 4: We talked once before, and we didn't actually get the
Speaker 4: audio right. So, and I think I asked this before
Speaker 4: because as I hear you say that, it sounds like
Speaker 4: all the responsibility ends up on the family member, to
Speaker 4: be patient, to be kind, to be accommodating when that's
Speaker 4: not necessarily what they're getting back. Do you encourage people
Speaker 4: to work with that and to share what's going on
Speaker 4: with them in a way that's non confrontational, right, in
Speaker 4: a way that's not coercing, because there is a bi
Speaker 4: directional relationship there.
Speaker 2: Yeah, for sure. Yeah, well I think that would go
Speaker 2: back to the awareness part. So part of what we're
Speaker 2: helping people build as a helper in the awareness piece
Speaker 2: of this is as I said before, it's sort of
Speaker 2: like the literal awareness of my body and my thoughts
Speaker 2: and my emotions. It's also awareness of my values. That's
Speaker 2: a chunk of it. Who do I want to be?
Speaker 2: How do I want to show up? And those things
Speaker 2: can include things like I want to feel safe. I
Speaker 2: don't want to be yelled at. It's important to me
Speaker 2: to be in a respectful relationship, which may lead me
Speaker 2: to say, look, Tom, I really want to help, and
Speaker 2: here's the things I'm able to do. When you get
Speaker 2: really upset and yell at me, I can't really be
Speaker 2: around for that kind of stuff. So these are my limits.
Speaker 2: So I'm learning how to take care of myself by
Speaker 2: understanding my values, understanding myself, and understanding my truth to
Speaker 2: your question like who am I? Because I am part
Speaker 2: of this change and I am part of this equation
Speaker 2: and I'm not somebody who really can tolerate having you
Speaker 2: yell at me all right. Someone else might be able
Speaker 2: to rolls off and they don't care, not me. So
Speaker 2: I need to learn how to bring my voice into
Speaker 2: this discussion and be able to say those things. That's
Speaker 2: not confrontation, that's revelation. That's you know, me being real
Speaker 2: about who I am and what my limits are and
Speaker 2: my need to take care of myself and have compassion
Speaker 2: towards myself. It's not going to be by hanging out
Speaker 2: with you when you're intoxicated and being a jackass. You
Speaker 2: know I'm not going to do that.
Speaker 1: So another helpful aspect to maybe explore here is the
Speaker 1: difference between enabling and reinforcing. You say, enabling refers to
Speaker 1: anything you do that reinforces or increases the likelihood of
Speaker 1: your loved one's substance using behavior, or any other behavior
Speaker 1: you don't want to support. A positive reinforcement strategy works
Speaker 1: to reinforce your loved one's positive behaviors. So there's a
Speaker 1: distinction there. You explore things like withdrawing wards not natural consequences,
Speaker 1: and ignoring but negative behaviors, you know, the art of
Speaker 1: doing nothing. And finally, you also say that you know
Speaker 1: punishment just doesn't in the long term work, that you
Speaker 1: don't recommend punishment, that punishing something only suppresses a behavior,
Speaker 1: and even in the short term it's suppresed the behavior,
Speaker 1: but it doesn't teach a new behavior, right, which I
Speaker 1: think is a key distinction. Would you unpack the pieces
Speaker 1: of that that you think could be particularly helpful here?
Speaker 2: Sure, the word enabling become a somewhat unfortunate one. There
Speaker 2: are a number of things in just hearing this from
Speaker 2: literally hundreds of families over the years, there are words
Speaker 2: that had meaning at some point and now have become
Speaker 2: condemnations and curse words. You're an enabler, you're codependent, they're
Speaker 2: in denial. I mean, these are words that have sort
Speaker 2: of lost their meaning, which is part of why we
Speaker 2: try to define it a little bit. So that enabling
Speaker 2: has now become a catchphrase for if you are hanging
Speaker 2: in there and staying connected and trying to be helpful,
Speaker 2: you're enabling as opposed to your only path really going
Speaker 2: to be helpful is to step away, and that's just
Speaker 2: flagrantly untrue. And it doesn't mean I'm a doormat. It
Speaker 2: doesn't mean I don't show up with what my values
Speaker 2: are as we just talked about, but it does mean
Speaker 2: that I can stay connected to you in my helping efforts,
Speaker 2: and the ways we're talking about staying connected, as you
Speaker 2: just pointed out, are the literal meaning of enabling would
Speaker 2: be I'm doing stuff that I know is actually going
Speaker 2: to promote your substance use or other destructive behavior, and
Speaker 2: I'm just sort of like pretending it's not or wishing
Speaker 2: that that weren't true. I'm giving you twenty bucks in
Speaker 2: the morning because I want you to be able to
Speaker 2: buy lunch, but I know you always buy drugs. Okay,
Speaker 2: So I know that, So why am I doing that?
Speaker 2: Because it pains me to think that you're not going
Speaker 2: to have lunch? Okay? So can I step back and
Speaker 2: think that actually would be enabling? And it's not a
Speaker 2: dirty word. It's just a behavioral strategy that's not working
Speaker 2: the way I want it to work, and it's probably
Speaker 2: more about my discomfort than what's actually going to be
Speaker 2: helpful versus things like positive reinforcement, where I can say
Speaker 2: these are actions that are going to be I'm going
Speaker 2: to support these actions. I'm going to reward them in
Speaker 2: some way. Rewarding can be just be I'm going to
Speaker 2: be nice to you. I'm gonna give you a kiss
Speaker 2: on the chek, I'm going to cook you some dinner.
Speaker 2: I'm going to sit and watch TV with you if
Speaker 2: you're sober. Those are positively reinforcing positive behaviors, and that's
Speaker 2: what we would be encouraging. When we see those behaviors,
Speaker 2: Can we reinforce them, Can we underline them in a
Speaker 2: way that's going to grow them, which is what happens?
Speaker 2: And can we step away from those behaviors that are negative,
Speaker 2: not by punishing them, but by just withdrawing away from them.
Speaker 2: So if you're drinking, I'm not going to watch TV
Speaker 2: with you. I'm just going to go read in my room.
Speaker 2: So we're not going to have that nice time where
Speaker 2: we like to watch The Last of Us and watch
Speaker 2: weird bizarre fung guy come out of people's mouths. You're
Speaker 2: going to have to do that on your own, and
Speaker 2: you'll be really scared. So what do we notice about
Speaker 2: our loved one that they would appreciate being reinforced by
Speaker 2: That is positive behavior, and how do we start to
Speaker 2: incorporate that into our repertoire. The larger part of it
Speaker 2: is really how do we help families stay connected and
Speaker 2: feel like it's a positive thing, because it is. It's
Speaker 2: just the loveliest thing on earth, and it's the most
Speaker 2: powerful force we have in change is a family member's
Speaker 2: love for their loved one. You know, they're hugely powerful force,
Speaker 2: which we're trying to with this model and with the
Speaker 2: trainings and stuff what we do and with this book
Speaker 2: say you can do this, you can be you can
Speaker 2: be a huge force in this change process. Most people,
Speaker 2: you know, the ninety percent of people who are having
Speaker 2: serious substance problems never get any treatment, literally ninety percent.
Speaker 2: So can we do anything to impact that. It's not
Speaker 2: going to be by training another one hundred and fifty
Speaker 2: thousand therapists. That's not going to happen. I think it's
Speaker 2: going to be by saying to family members, you don't
Speaker 2: need to be ashamed. You didn't do anything wrong, you're
Speaker 2: not a bad person, you didn't cause this, and you
Speaker 2: can be a huge force for something positive happening here.
Speaker 2: And here's some tools for this, you know. And you're
Speaker 2: the best force for this because you love them. You're
Speaker 2: never giving up. You're awesome, you know. And can we
Speaker 2: help you with some tools that are going to help
Speaker 2: you do this in a more effect way.
Speaker 4: Well, I think that is a beautiful place to wrap up, Jeff,
Speaker 4: Thank you so much. We both loved your work so much.
Speaker 4: Love this conversation.
Speaker 1: Yeah, thank you so much.
Speaker 2: Sure, and it's.
Speaker 4: A pleasure to have you on.
Speaker 5: Yeah.
Speaker 2: Well, really nice to meet you guys again. And stop
Speaker 2: avoiding us at Kapala man.
Speaker 5: You gotta come down next time, all right, deal, all right,
Speaker 5: great to see you.
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