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Symbols — No. 1

For a few years, our family attended a Christian church that met in a Jewish community center. I’d often get bored with the service and hung out in its art gallery instead.

And so it was that I was playing hooky on February 15th, 2015. I came upon a placard that encouraged me to take a key out of a large jar nearby.

I encourage you to do the same — find a key and “think about what you would unlock in your your personal life to ensure a better future.” Add it to your key chain or maybe keep it on your person as a constant reminder of your “truest self.” ✸

I regret that I didn’t capture the artist’s name at the time. I believe that it was either Aviva Klein (and here) or the Jewish Family and Children’s Service of Minneapolis. I’m happy to update this post if someone provides me with better attribution.

Carl G. Jung. Man and His Symbols. New York: Anchor Press, 1964

CBT Cookies

No, not CBD! CBT, as in, cognitive behavioral therapy.

I fished this out of a fortune cookie last night:

—
Inspired, I’m thinking about ordering some custom cookies to hand out during sessions. The fortunes would take the form of rational emotive behavior therapy (REBT):

  • What was the activating event (A)?
  • What was the emotional and/or behavioral consequence (C)?
  • What did you tell yourself (B) about A to cause C?
  • Is that belief (B) logical? Empirical? Pragmatic?

I somehow think that Albert Ellis, who made therapy playful and engaging, would approve. ✸

Postscript. How do I know that Ellis was playful and engaging? I’ve read published transcripts of his sessions, and they are masterpieces. During one session, he advised a client thus: “Every time a human being gets upset—except when she’s in physical pain—she has always told herself some bullshit the second before she gets upset” (p. 228). That not only got the client’s attention, I can guarantee the lesson stuck.

Rural Recovery Resources

Mental illness and addiction are big issues everywhere — but especially in rural areas like Osceola, Wisconsin, that lack local treatment resources. As my partner, Nicole Smith, M.D., said well, “What we lack at Osceola, is we don’t have integrated behavioral health, we don’t have therapists on staff. For better or for worse, Osceola doesn’t have mental health beds.”

All of that is about to change!

Exist Media Company — Lakeland, Minn.

Osceola Medical Center (OMC), a rural health clinic and critical access hospital, has committed to rapidly creating local services for mental illness and addiction. The Osceola Community Health Foundation (OCHF) recently raised $61,000 at its annual gala to launch an integrated behavioral health program. And OMC’s board of directors just prioritized creating “psych safe” hospital beds so we can stop boarding patients in the emergency department and transferring them far from home.

“We want to be known as the people who show up in the best and worst of times for our patients and their families,” said Kelly Macken-Marble, OMC’s chief executive officer.

Many thanks to Jill Leahy, Director of the OCHF; Exist Media Company; and countless others for imaging a better future for our community. ✸

The Books Before the Big Book

About 20 years ago, I ran across this in an essay by C.S. Lewis:

Every age has its own outlook. It is specially good at seeing certain truths and specially liable to make certain mistakes. We all, therefore, need the books that will correct the characteristic mistakes of our own period. And that means the old books.*

Photo Credit: PBA Galleries

Lewis argued, “I do not wish the ordinary reader to read no modern books. But if he must read only the new or only the old, I would advise him to read the old.” He also offered this suggestion: “It is a good rule, after reading a new book, never to allow yourself another new one till you have read an old one in between.”

My reading habits immediately changed. I started reading old books—in many cases, very old books.

And so it is that we will be considering Richard R. Peabody’s The Common Sense of Drinking, which was published in 1931, at an upcoming residential recovery retreat at Hazelden Betty Ford’s Dan Anderson Renewal Center. The book contains ideas and phrases that were later popularized by Alcoholics Anonymous such as “once a drunkard always a drunkard” and “halfway measures are of no avail.”†

Many thanks to Kim Albers and Peg Schroeder for inviting me back!

* C.S. Lewis. Undeceptions. London: Geoffrey Bles, 1971, p. 161–166.
† The first edition of the Big Book appeared in 1939.

Just Me Again

I had the privilege of authoring the chapter on Alcohol Use Disorder in Conn’s Current Therapy 2023, the venerable textbook that has now been through 75 (!!) annual editions. With a little luck, you should be able read it via Google Books (Section 10: Psychiatric Disorders, Page 823).

As promised last year, I included some important new-ish research on non-abstinent recovery (“progress, not perfection”) in the 2023 edition. I also added a section on motivational enhancement therapy (a/k/a motivational interviewing) and cognitive behavior therapy (CBT), which can be conducted during brief sessions like office visits in primary care.

I’ve been asked to return for the 2024 edition. If space permits, I may include a section on ambulatory medically managed withdrawal (“detoxification”), which is feasible for many patients.

Many thanks to Rick Kellerman, M.D., for involving me in this most rewarding project! ✸

Postscript [03/03/2023]. It’s always fun to receive the physical copy in the mail. The book weighs in at around 9 pounds per the label on the box in which it arrived.

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. ✸