Peer Recovery Presentation

Peer Recovery & The Wellness & Advocacy Center

Presented by,

Laura, Chelsea, & Erika

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Focus of our Group

Further exploring "Peer Recovery" and the Wellness & Advocacy Center

What is Peer Recovery?

"Having another person around you who can help you understand through their life that other people have been through it and you're not alone plays a huge role in shifting misperception (Interview, Fisher)."

Me "Are you in counseling/therapy?"

Student: "No, no, no.  I tried that, no way.  The run around and then they call the police because my language is harsh when I'm triggered"  "No way, tell me you how you feel, fuck you!"  I have a family, where I am not judged, I can go anywhere in the state and join a group and feel ok.  They're my relatives but not my family..."  

Who is served?

Drop-in open-door policy, casual, self-sign in.  

Front desk monitor.

18+ identifying themselves as having mental health issue/diagnoses

What services are offered?

Socializing (recovery through connection/conversation)

"It just looks like they're all standing around smoking cigarettes!"

Open Art Studio/Program (recovery through connection and art process)

"Our approach for the Art Program is to focus on process not on final product. Art is enjoyed by a vast number of people, but many people seem to have the idea that good art displays high technical skills. Art is not about the displaying of one's skills.

Our art room is an open-style studio, we do not do directed art projects unless someone really needs to have one because we respect that everyone´s creative moment is very personal. People have many different levels of exposure and understanding of art. We treat everyone on an individual basis. Our concept of fine art is very broad".

-naomi murakami / Art Director 

• Process not content, some instruction
• Art walls
• Art Shows
• Art Selling

http://wellnessandadvocacy.org/art.php

Career Center/Computer Lab (recovery through life skills, accessibility)

http://wellnessandadvocacy.org/computerlab.php

The wellness center has a computer lab that doubles as a career center:

• Staff assistance for looking up job applications, housing options or help them work on their resumes.  
• 8 computers  
• Spanish offered & Rosetta stone for Spanish/English
• Job postings board 
• Resource table  
• Another addition to the career center is a Resource Group, which covers housing, food, clothing and benefits!

Garden (connection, nature, garden process)

The garden is open to any members who want to use it.  They can have their own section of the garden if they want and they can plant whatever they like whether it be vegetables, plants, flowers or fruit.  

The garden can be something personal or communal and the members can take home whatever they grow for themselves.

Groups (peer therapeutic process, specific topics)

Advocacy & Peer Support

"Having walked in one's shoes"
Meetings, Public voice, and teaching self-advocacy through peer support groups.
Giving back, volunteering.

The issues?  

"Part of the recovery is society's recovery from placing so much discrimination and stigma on the person who's been labeled with mental illness.  It's hard to recruit peers as long as the stigma s so great; people don't want to step back in the system (Fisher, Interview).

• Policy, Is there a competency to working with people versus any person assigning themselves the task?

• Public/Political Voice

• Funding

• Where do we fit in this model, how can we be integrated into such services, and is there a blend of licensed therapy services and peer recovery models?  

• How can we use the empowerment of this model in our own practice?
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  FAQ’s for the Wellness and Advocacy Center
  
  
  What are the hours?
  10am-2pm Mon, Tues, Thurs, Fri
  11am-3pm Wed
  
  Who can go?
  The Wellness center offers services to people in Sonoma County suffering with mental health challenges.  It operates as a self-help, drop in style center!  
  
  
  What is the cost?
  It does not cost anything to become a member; you simply do a 45-minute interview.
  http://wellnessandadvocacy.org/membership.php
  
  What services are provided?
  Counseling, art, career services, gardening/free time, music, group support
  
  
  Can I volunteer?
  Yes! We have a multitude of volunteer positions available; you can find them listed here:
  http://wellnessandadvocacy.org/volunteer.php
  
  Is there food? Yes, there is food available.
  
  Can I sign up for housing from the Center?
  Not directly, however there is Internet access and we can help you access applications via the Internet and find out who to contact.  We also have a resource group this October that can help facilitate you in finding information about housing!
  
  Can I sleep there? No, unfortunately we are not a residential facility.
  
  Is there exercise available?
  We offer a walk/stretch group everyday for 30 minutes.  We do not have any official facility for exercise, but walking and stretching are a great way to get in exercise and get your body moving!
  
  Do you do support groups? Yes we offer a variety of support groups! New in October we have a Benefits of Working Group, a Resource Group and a Health Education group!  We are adding new groups all the time.  Visit our Group Website for more information: http://wellnessandadvocacy.org/files/Groups.pdf
  
  
  Do you have other resources available? Yes! We have a lot of resources for other facilities and access to health information
  
  
  Why are your hours so short? 
  Mainly funding and to give more presence/quality 
  
  
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  LOCAL PEER RECOERY MODELS
  
  
  Peer-Run Organizations – Sonoma County
  Wellness & Advocacy Center:
  Free, self-help, peer-run program at 3400 Chanate Road, Santa Rosa
  Highlights of the program include: Art Program, Organic Garden, Career Services, Music, Movies, Monthly Groups, and Computer Lab. Mission Statement: “Together, we are moving toward mental health recovery in a sage, non-judgmental peer community.”
  www.wellnessandadvocacy.org
  Petaluma Peer Recovery Project:
  A volunteer-run program funded by Sonoma County Behavioral Health Division located at 1360 North McDowell Blvd, Petaluma.
  Highlights include: support and activity groups, one-on-one peer support (Spanish and English), and information and referral to other community resources.
  Open Monday, Wednesday, and Thursday 10 am – 3pm
  https://www.gire.org/filelibrary/PetalumaPeerRecoveryProject.pdf  
  Russian River Empowerment Center:
  Self-help, drop-in center for people who identify as having mental health challenges. Highlights include: groups, field trips, workshops, volunteer opportunities, and resource referrals
  http://cfsa-sonoma.org/
  Corinne Camp Action Network, CCAN:
  Peer-Run advocacy and resource network that promotes the empowerment of mental health consumers in Sonoma County. Current projects include: reaching out to diverse groups of people in Sonoma County, educating the community and reducing stigma through their Speaker’s Bureau, and a proposal for a Friendship Line (anyone can call and talk in order to receive support)
  www.ccansonomacounty.org
  National Empowerment Center:
  NEC is a consultation resource for consumer-run organizations. They keep an updated list of consumer-run organization and advocacy groups in all 50 states. Staff provides nation-wide training, lectures, and resources based recovery, empowerment, advocacy, and self-help. The center focuses on shifting our current mental-health system to include more recovery-oriented and consumer- and family-driven approaches.
  NEC has a toll-free information and referral line: 800-POWER2U (800-769-3728)
  http://www.power2u.org/crisis-alternatives.html

Assessment Presentation: TAT

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Thematic Apperception Test

(TAT)

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"The Creators"

Henry A. Murray

• First worked in the medical field (trained with more technical research work).
• Admired and studied with Carl Jung, thus his main theoretical orientation was psychoanalytical
• He desired to expand perception tests, focus on apperception.
• Invested an incredible amount of time to research on the TAT, so that it could "withstand the scientific world", rather he didn't believe the scoring was necessary to the psychotherapist using the tool.
• Intended the TAT to be utilized with different theoretical orientations.
• The TAT wasn't intended to "diagnose" but to gain a better understanding of the patient.

 Christiana Morgan

• Given co-aurhorship, although this controversial
• Art background
• Contributed the set of drawings for the TAT
• She administered one of the earliest versions of the test to one of the first diagnosed anorexic patients in Boston
• As years past she, her credits dissipated
  
  "Morgan was an artist, writer, and lay psychoanalyst fascinated by depth psychology. Part of the Introvert/Extrovert Club in New York City in the 1920s, she traveled to Zurich to consult Carl Jung. When Carl Jung met Christiana he considered her the manifestation of the perfect feminine... (wikipedia.org)".

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Why I enjoy projective measures…
(Perhaps it's my S.A.R.)

• Interactive!
• Emphasis on a dialogue
• Spotlight is less on patient
• Externalizes a story (although fictional, we often project our experiences into creative storytelling)

While many of the projective measures have roots in psycholanlytic, I believe that the TAT and CAT connect to Narrative Therapy as well.  

The idea of our own constructed stories and constructing fictional stories can sometimes intertwine.

Creating Dialogue

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BACK TO THE TAT…
Some of the lingo:

Hero - the protagonist or whom the patient identifies closest with
Needs -the motivating forces or drives coming from the hero
Press -the external influences (environmental/situations)
Outcome -interaction of press and needs, results in emotional "outcome"
Thema -identifies the behavior that stems from the needs, press, and outcome

The interpreter is looking for patterns of Thema throughout the story

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So, how does it work?  

There's a set of 31 cards but the therapist only shows (traditionally) 20 scenes.

Traditionally, Murray intended the therapist to split the 20 cards/images into two 1.5 hour sessions, showing the patient 10 cards in each time.

Story cards can be separated based on gender, age, etc.

The patient is directed to tell a story from their imagination, with what happened before the drama, during, and what might happen after.  It asks that you consider what the people are thinking, doing, their motives, etc.

The therapist is looking for patterns of behavior or words (thema) across stories.

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Your Turn!!

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There's a formal way to score words usage, tone, which groups into the example below:
http://www.utpsyc.org/TATintro/

LIWC dimension	Your data	Male average	Female average
Need for Achievement	5.14	5.8	5.6
Need for Affiliation	1.29	1.1	1.3
Need for power	1.61	1.7	1.8
Self-references (I, me, my)	1.29	0.5	0.8
Social words	12.86	11.4	12.0
Positive emotions	3.54	1.8	2.1
Negative emotions	0.64	1.5	1.6
Big words (> 6 letters)	16.72	18.7	17.7

Overall, you wrote 311 words in the 10 minutes.

Need for Achievement. The typical person generally scores between 4.5 and 8.5, with an average of 5.7. The higher your number, the more you wrote about achievement-related themes.

Need for Affiliation. Because this picture typically elicits themes associated with achievement, most people don't pay too much attention to human relationships in their story. In fact, the typical person scores around 1.2 on this dimension. Indeed, 30% of participants score 0.00.

Need for Power. Most people score between 0.8 and 2.7, with the average being 1.7. High scores on the need for power dimension hint that the writer is concerned with who is or is not in control andwho has the most status.

One thing that is interesting about this kind of exercise is that language analyses can tell us many things about the writer that go far beyond power, achievement, and affiliation. Look at the table below. In it, you can determine some features of your own writing and can get a sense of your writing style compared with others:

Self-references: People who use a high rate of self-references tend to be more insecure, nervous, and possibly depressed. They also tend to be more honest.

Social words: Social words are words that make reference to other people (e.g., they, she, us, talk, friends). Generally, people who use a high level of social words are more outgoing and more socially connected with others.

Positive emotion words: The more that people use positive emotion words (e.g. happy, love, good), the more optimistic they tend to be. If you feel good about yourself, you are more likely to see the world in a positive way.

Negative emotion words: Use of negative emotion words (e.g., sad, kill, afraid) is weakly linked to people's ratings of anxiety or even neurotic. People who have had a bad day are more likely to see the world through negatively-tinted glasses.

Big words (words with more than 6 letters): Use of big words is weakly related to higher grades and standardized test scores. People who use a high rate of big words also tend to be less emotional and oftentimes psychologically distant or detached.

http://www.slideshare.net/blessmaramag/thematic-apperception-test

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Research and uses:

• 1000's of research papers written on the TAT (i.e., reading compresion and the tat, patients with dissassociation taking the tat, children with psychosis…)
• Among the top 6(reported) tests by clinicians (Giersons).
• Utilized in governmental positions for screening (i.e., military, hospitals, etc).
• 
  

Murray placed an emphasis that therapists rely on more than the "data".  He felt the test provided an opportunity for observing nonverbal cues, behavior responses, and allow for active interaction during the process.  He didn't like that it was a "test" and would rather it be called a "technique".

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Critiscisms/Barreiers

• Language acquisition and through computer (writing/typing) 
• Validity? Reliability? Some science-minded professionals argue:

                  the scoring potentially not relevant (you cannot "measure" the unconscience)
                  Clinicians continuously fail to implement the test in the manner Murray 

                  intended, thus jeopordizing Murray's validity

                  

• Over patholigize, or misinterpretation
• Although, there have been many arguments against the "dated" drawings, they continued to be used.  An attempt to use photographs was used but it was discovered the drawings elicity more details or "story"
• Some critics report gender bias.
• Cultural: Murray and other clinicians originally saw this as a cross cultural device (one of the few of the times), but some studies concocted describe cultural setbacks (i.e., Navaho men groups compared, little affect), there was a follow-up instrument geared toward cultural perspectives called "make a story"

My thoughts:

Use your judgement

Ask yourself, "what's my purpose?"

Check in with the client

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CAT

Children's version

Animal pictures for young children, rather than humans, administered orally versus written.

References

http://www.cssforum.com.pk/css-interview-psychological-tests/psychological-tests/59211-thematic-apperception-test-whole-set-images.html

Gieser, L., & Stein, M. I. (1999). An overview of the Thematic Apperception Test. In L. Gieser, M. I. Stein, L. Gieser, M. I. Stein (Eds.) , Evocative images: The Thematic Apperception Test and the art of projection (pp. 3-11). Washington, DC, US: American Psychological Association. doi:10.1037/10334-016

Murray, H. A. (1935). Thematic Apperception Test.

http://www.utpsyc.org/TATintro/

https://en.wikipedia.org/wiki/Thematic_Apperception_Test

Ethics Presentations

Interview:

County Position: 
Treatment & Substance Program
Clients: Felony Probation, Incarcerated, Waiting for Judgement
Currently 95 Clients

• Ethics are CLEAR within system
•  Example: Testing
• 9/10 approx rate of client change
• optimism
• Doesn't Self-Disclose
• Strong Boundaries 
• embedded in the program/Justice system
• Values:
• Entered profession with clear understanding that her values would already be very different
• Example of single incidence where was direct (value related)towards client
• Consults

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 Agency Visit: TLC

Visit the TLC website Here

"True to Life Children's Center"
 This encompasses the vision of the programs at TLC that understand compassion and authenticity, in relationships, are the grounds for deep work among youth.

*Discuss Founder
 
Population:  Foster Youth, Displaced Youth, Families

Programs: 
Major Mental Health Service Oriented
"Connections Model:

 Connection to self

Connection to others

 
Connection to community

3 group homes

• 1 male structured
• 1 female structured
• 1 co-ed less structured, more indepedent

Foster Youth Placement
Adoption Services
High-School (nonpublic)
Outpatient Mental Health Services
Transitional Housing Services for "of age" youth

• Example

Words to Describe "feeling"
 

warm

safe-haven
parental
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Sitting in on a classroom, guest speaker....