Tailoring Treatment

It’s great to be back at the MARRCH Annual Conference & Expo after a several year hiatus. This year, I’ll be speaking on tailoring treatment using the transtheoretical model (26 October, 12:30 p.m.). You can find my PowerPoint here.

The transtheoretical model is seemingly central to addiction treatment, but do we effectively use it?

  • Do we accurately stage patients upon admission and during their course of care?
  • Does our interpersonal stance match each patient’s stage of change?
  • Do we use appropriate processes of change for each patient’s stage of change?
  • Does it even matter?!

I’ll tackle these questions and much more. ✸

They Might Be Faking

It was great to gather again for the Minnesota Sheriffs’ Association’s annual Correctional Health Division conference. This year, I presented on non-psychiatric (“medical”) malingering. Here’s my PowerPoint:

We could perhaps tackle psychiatric malingering next year (hint, hint). In some ways, this is easier to deal with as presentations seldom require urgent off-site transport. Standardized tests also make determinations more secure.

Many thanks to Holly Compo, Tom Wells and Randy Willis for inviting me to participate, and for onsite support. ✸

This Is Water

Last weekend, I lead a residential wellbeing retreat at the Dan Anderson Renewal Center on the Center City, Minn., campus of the Hazelden Betty Ford Foundation. We examined the origin and nature of suffering, and some potential solutions.

We used David Foster Wallace’s This Is Water as our core text. Here are my PowerPoints that explore some related ideas:

Many thanks to Paul Anderson for inviting me to lead the retreat. And a huge thanks to Peg Schroeder for assistance with planning and onsite support.

Based on positive evaluations, it seems likely that we will offer the retreat again to all comers (not just health professionals). ✸

Adjust Your Own Mask

No, not *that* kind of mask! I’m thinking about the airline safety announcement. It’s a great metaphor for health professionals—it’s hard to help others when we’re struggling ourselves.

Please join me for a weekend retreat at Hazelden Betty Ford Foundation’s aptly named Renewal Center, located on its beautiful Center City, Minn., campus. I’ll be bringing together a decade of work on burnout, resilience and wellbeing, with a big emphasis on acquiring new self-care skills.

Anyone working in healthcare welcome. And, yes, Hazelden Betty Foundation is known for addiction treatment—but you don’t need to have a personal history of addiction to attend the retreat. ✸

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Postscript. The retreat’s title—This Is Water—is a riff on a small but profound book by David Foster Wallace.

SIMS Season — 2022

I’m privileged to serve as faculty for another season of Hazelden Betty Ford Foundation’s Summer Institute for Medical Students (SIMS). This page contains links to my teaching materials and some additional resources.


Many thanks to Kari Caldwell for involving me in SIMS and also the Professionals in Residence (PIR) program!


PowerPoints
Screening, Brief Intervention & Referral to Treatment (v. 05/11/2022)
Motivational Interviewing Skills Session (v. 11/09/2022)

Key Readings [Mindy & Kari will provide copies]
Alcohol Use Disorder (textbook chapter)
Taboo Topics in Addiction Treatment: An Empirical Review of Clinical Folklore (J Subst Abuse Treat 1993;10(3):303-16. PMID: 8315704)
The 10 Most Important Things Known About Addiction (Addiction 2010;105(1):6-13. PMID: 19712126)

Patient Assessment
The ASAM Criteria Assessment Interview Guideline (Adult)
Tailoring Treatment (transtheoretical model)

Patient Resources
DBT Skills Training Handouts and Worksheets (see: Chain Analysis of Problem Behavior, p. 31)
Motivational Interviewing Workbook
REBT Pocket Companion for Clients
Rethinking Drinking (consumer health website)
Tips for Cutting Down on Drinking


I’ve long advised medical students and residents to acquire some psychotherapy skills, regardless of their eventual specialty. Motivational interviewing (MI) and cognitive behavioral therapy (CBT) are relatively easy to learn and have broad clinical utility.

Some MI resources include:

  • Miller WR, Rollnick S. Motivational Interviewing, 3d ed. New York: Guilford Press, 2013 [classic textbook]
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 1—brief intervention and motivational interviewing. Aust Fam Physician 2009;38(11):885-888 (PMID: 19893835; and here)
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 2—motivational interviewing approaches. Aust Fam Physician 2009;38(12):986-989 (PMID: 20369152; and here)
  • Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques—facilitating behaviour change in the general practice setting. Aust Fam Physician 2012;41(9):660-667 (PMID: 22962639; and here)
  • Searight HR. Counseling patients in primary care: evidence-based strategies. Am Fam Physician 2018;98(12):719-728 (PMID: 30525356)

In terms of CBT, I highly recommend the professional trainings at the Albert Ellis Institute, starting with the primary certificate practicum. Some other resources include:

  • DiGiuseppe RA, Doyle KA, Dryden W, Backx W. A Practitioner’s Guide to Rational Emotive Behavior Therapy, 3d ed. Oxford: Oxford University Press, 2014 [classic textbook]
  • Harden M. Cognitive behaviour therapy—incorporating therapy into general practice. Aust Fam Physician 2012;41(9):668-671 (PMID: 22962640; and here)
  • Stuart MR, Lieberman JA. The Fifteen Minute Hour, 6th ed. Boca Raton: CRC Press, 2019 [please see, in particular, Chapter 4]
  • Frenz DA. Another Arrow for Your Quiver: REBT for SUD. Minneapolis: David A. Frenz, M.D., 2018 [PowerPoint presentation]

Vital Signs Are Truly Vital

I’m looking forward to presenting at the Minnesota Sheriffs’ Association’s Correctional Health Division Conference on October 13th. I’ll be discussing the use of clinical decision rules in assessing inmates for chest pain, head injuries and other high-risk presentations. You can find my PowerPoint here.

My title is a riff on the National Early Warning Score (NEWS), which has good negative predictive for really bad stuff like cardiac arrest, ICU admissions and death. I previously wrote about it for Today’s Hospitalist (and PDF version here).

Many thanks to Heather Qunell and the other conference organizers for inviting me to participate! ✸

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Postscript [10/18/2021]. Here’s a PDF of the final program.

Eat Move Sleep

I recently contributed a “lunch and learn” to PreferredOne’s annual health fair. We talked about some key topics related to behavioral change, including process thinking, end-gaining, means-whereby and indirect methods. Please see my PowerPoint for more.

The health dimension is a 30-day challenge based on Tom Rath’s Eat Move Sleep (book) and companion website. I encouraged the audience to make some small choices that could lead to big changes in both their quality and quantity of life.

Many thanks to Donna Larson, Shelley Markve, Susan Bernstein and PreferredOne’s Wellbeing Committee for pulling together the event and making the book available to employees. ✸

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Postscript [10/07/2021]. Nell Hurley brought my attention to James Clear’s Atomic Habits (book). Looks like fantastic read that syncs of up with Rath’s work. BTW, Nell was recently featured in a Star Tribune article on the contemporary sober movement.

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Postscript [10/10/2021]. For those intrigued by the Alexander Technique, I suggest booking a few lessons with Brian McCullough or another qualified teacher in your area.

Summer Institute for Medical Students

I’m privileged to serve as faculty for another year of Hazelden Betty Ford’s Summer Institute for Medical Students (SIMS). Here are my PowerPoints and some additional resources.

Many thanks to Kari Caldwell for involving me in SIMS and also the Professionals in Residence (PIR) program!


Postscript [07/30/2021]. I’ve long advised medical students and residents to acquire some psychotherapy skills, regardless of their eventual specialty. Motivational interviewing (MI) and cognitive behavioral therapy (CBT) are relatively easy to learn and have broad clinical utility.

Some MI resources include:

  • Miller WR, Rollnick S. Motivational Interviewing, 3d ed. New York: Guilford Press, 2013 [classic textbook]
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 1—brief intervention and motivational interviewing. Aust Fam Physician 2009;38(11):885-888 (PMID: 19893835; and here)
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 2—motivational interviewing approaches. Aust Fam Physician 2009;38(12):986-989 (PMID: 20369152; and here)
  • Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques—facilitating behaviour change in the general practice setting. Aust Fam Physician 2012;41(9):660-667 (PMID: 22962639; and here)
  • Searight HR. Counseling patients in primary care: evidence-based strategies. Am Fam Physician 2018;98(12):719-728 (PMID: 30525356)

In terms of CBT, I highly recommend the professional trainings at the Albert Ellis Institute, starting with the primary certificate practicum. Some other resources include:

  • DiGiuseppe RA, Doyle KA, Dryden W, Backx W. A Practitioner’s Guide to Rational Emotive Behavior Therapy, 3d ed. Oxford: Oxford University Press, 2014 [classic textbook]
  • Harden M. Cognitive behaviour therapy—incorporating therapy into general practice. Aust Fam Physician 2012;41(9):668-671 (PMID: 22962640; and here)
  • Stuart MR, Lieberman JA. The Fifteen Minute Hour, 6th ed. Boca Raton: CRC Press, 2019 [please see, in particular, Chapter 4]
  • Frenz DA. Another Arrow for Your Quiver: REBT for SUD. Minneapolis: David A. Frenz, M.D., 2018 [PowerPoint presentation]

Some Thoughts About Thinking

I recently did a corporate “lunch and learn” on metacognition, which is our singular ability to think about our thoughts (as far as I can tell, my dog has no such capacity). This would appear abstract and likely impractical but it is actually the key to mental health.

I’m happy to work at the level of things and thoughts. The former generally involves practical solutions (problem solving) while the latter consists of philosophical solutions (e.g., cognitive behavioral therapy). But I’m much more interested in the thinker—that’s where the ultimate solution lies.

The “thinker” in this context is consciousness or awareness, which is always present but seldom appreciated. As Rupert Spira counsels, “Allow the experience of being aware to come into the foreground of experience, and let thoughts, images, feelings, sensations and perceptions recede into the background. Simply notice the experience of being aware. The peace and happiness for which all people long reside there.” Elsewhere, he advises, “Be knowingly the presence of awareness.”

You can find my PowerPoint here or by clicking on the image above. ✸


P.S. If this sounds like mindfulness, it might be. Mindfulness has become one of those everyday words that now lacks meaning, or at least a shared understanding. For an interesting perspective, please see Stephan Bodian’s Beyond Mindfulness:

“For all its wonderful benefits, the practice of mindfulness has another downside: it tends to maintain the subject–object split, the gap between the one who’s being mindful, the act of being mindful, and the object of mindful attention. In other words, no matter how mindful you become, there’s always a you that has to practice being mindful of an object separate from you. As a result, mindfulness perpetuates the very sense of separation it’s designed to overcome.”

Chasing Your Tail

Years ago, in one of my former lives, Scott Hinrichs, HealthEast’s vice president for mission, bioethics and spiritual care, tapped me to speak at its annual President’s Prayer Breakfast. I’m not sure that the audience walked away with much, however, the event was a tremendous gift to me. Absent the commitment, I doubt that I would have reflected on my spiritual journey.

The PowerPoint has generally aged well. I’m not sure that I would add much today—except, perhaps this Lars Kenseth cartoon, which I saw over the weekend, and some stuff from Stephan Bodian’s Beyond Mindfulness. By all means laugh, but then puzzle for a few minutes over the deeper meaning.

What’s that part of you that’s been there all along?

Lars Kenseth. Originally published in Wired on Wednesday, March 4th, 2020.


Postscript. I didn’t immediately realize that today marks the 10th anniversary of my presentation. More than coincidence? ✸