Interactive Journaling; Balancing Evidence-Based Practices; Child-like

savvy

There is increasing pressure to use Evidence-Based Practices (EBPs) and Evidence-Based Treatments (EBTs) and it makes sense to have the best-proven tools in your clinical toolkit.  However, as William Miller of Motivational Interviewing (and Senior Advisor for The Change Companies) says: “perhaps the proper attitude toward EBTs is one of respect not reverence.” (Miller, Zweben & Johnson, 2005).  There is too much “reverence” for EBP and EBT these days, which squeezes out innovation and encouragement to nurture “promising” practices.  If you want to see more on EBPs, take a look at the August 2007 edition of Tips and Topics.

The challenge for the field is to find the right balance between EBPs and the therapeutic alliance that:

·      Honors person-centered, shared decision-making

·      Engages people starting where the client is at, not where you want them to be.

·      Facilitates a self-change process which follows the client’s pace of change, not  that of some predetermined manualized treatment protocol

I read a January 2014 paper by William Miller on “Interactive Journaling as a Clinical Tool”(Miller, 2014).  Bill articulated it well: “interactive journaling (IJ) as a clinical tool combines elements of bibliotherapy (the presentation of therapeutic material) with structured reflective writing.” (Miller, 2014, p. 33).

Interactive Journaling brings the balance:

The Evidence-Based Practices part

IJ presents treatment-relevant information that incorporates EBPs like MI, cognitive behavioral therapy (CBT), and stages of change work.  This is presented using graphics and text that is colorful and engaging.

The Therapeutic Alliance part

Throughout each journal, there are frequent, structured exercises where the client can draw, write and interact with the material to apply it to their life.  This respects their stage and pace of change.

TIP 1

What is Interactive Journaling (IJ)?

You can see lots more on what IJ is and how it works, as well as comments from Bill Miller, Stephanie Covington, Claudia Black and others.

https://www.changecompanies.net/ij.php

Or take a look at the video on “what we do”:

https://www.changecompanies.net/whatwedo.php

Here are a few points:

1. Interactive Journaling® is a structured and experiential writing process motivating and guiding participants toward positive life change.  Clients receive a lot of information in psychoeducational lectures and material.  How is IJ different? The journals have specifically-designed interactive exercises that emphasize real-life application. These encourage participants to ask, “What does this mean to me?”

2.  Interactive Journaling® puts the participant in the driver’s seat to make real and accountable change. But each journal has structure and consistency in the material presented. To enhance the therapeutic alliance, the journals are designed to help individuals achieve their change goals, be easy to follow and to keep participants engaged. This is done through use of color graphics, page design and placement of text that makes the interactive exercises interesting and enjoyable.

3. Interactive Journaling® is evidence-based.

·      In the October 2010 edition of Tips and Topics, I referenced Gwendolyn Bounds’ Wall Street Journal article: “How Handwriting Trains the Brain. Forming Letters Is Key to Learning, Memory, Ideas”. The Wall Street Journal. October 5, 2010 Writing by hand is more than just communication. It engages the brain in learning.

·      “Spoken language is the primary medium of counseling and psychotherapy. The therapeutic value of written language has also been studied extensively, both to provide self-help information and to elicit personal reflection. Interactive journaling (IJ) is a guided writing process that combines both of these functions…… Experimental and quasi-experimental evaluations support a link between IJ and behavior change.  Research on motivational interviewing offers evidence-based guidelines for structuring IJ materials to elicit language favoring change, as well as testable hypotheses linking writing processes with outcomes. Implications for counseling practice and research are considered.” (Miller, 2014, Abstract of “Interactive Journaling as a Clinical Tool”)

·      IJ is included in The National Registry of Evidence-based Programs and Practices (NREPP) – a “searchable online database of mental health and substance abuse interventions. All interventions in the registry have met NREPP’s minimum requirements for review and have been independently assessed and rated for Quality of Research and Readiness for Dissemination.” See more detail on IJ in NREPP: http://nrepp.samhsa.gov/ViewIntervention.aspx?id=333

References:

Gwendolyn Bounds: “How Handwriting Trains the Brain. Forming Letters Is Key to Learning, Memory, Ideas”. The Wall Street Journal. October 5, 2010

Write to Gwendolyn Bounds at wendy.bounds@wsj.com

Miller, W.R., Zweben, J., & Johnson, W.R. (2005): “Evidence-based Treatment: Why, what, where, when, and how?” Journal of Substance Abuse Treatment, 29:267-276.

Miller, W.R (2014): “Interactive Journaling as a Clinical Tool” Journal of Mental Health Counseling, Volume 36, Number 1

Available from MetaPress and Amazon (at half the price)

skills

If you look at the hundreds of journals on a wide variety of topics available atwww.changecompanies.net, it would be easy to be overwhelmed. But how can you know where to start? I turned to a couple of experts at The Change Companies to help with this.

TIP 1

What are the most popular Journals that providers and agencies buy and find most helpful for their clients?

Impaired Driving classes

Addiction Treatment Settings

–> Self-management: A Guide to Your Feelings, Motivations and Positive Mental Health: Addiction Treatment Edition. (Miller, Mee-Lee, 2010).

Mental Health Treatment Settings

Criminal Justice Settings
For Probation Officers

–> The Courage to Change (adult)   

–> RDAP (Residential Drug Abuse Program)

For Drug Courts

–> Drug Court Journal

For Probation and Parole

–> Breaking the Cycle (non-residential program)    

–> Forward Thinking (youth).

For Adolescents

Special Topic: Gambling

Special Topic: Veterans

–> Coming Home – a two-part Interactive Journal series designed to provide veterans with skills for their transition to a full, meaningful civilian life.

• A picture is worth a thousand words….so if it is easier for you to visualize these journals take a look at https://www.changecompanies.net/products/.
• You can click on a journal and then the magnifying glass to see a few pages electronically. Happy hunting!

TIP 2

Why can’t programs and clinicians just photocopy some of the exercises and hand these out in group?

Besides the fact that the journals are copyrighted, there are some good reasons not to photocopy pages and hand flimsy black and white pages to clients:

• The importance of color – Color increases comprehension and retention over 70%.
• Heavy weight paper – The thickness of the paper promotes permanency. Individuals keep their journals. Many treasure them and refer back to them in continuing care.
• Ownership in participants’ recovery – Participants are engaged more accountably when given a quality full color Journal they interact with in an experiential way. Many take pride in their own journal rather than loose pages of exercises.
• Journals are priced to be affordable – By the time you photocopied in full color on heavy weight paper, the cost would be the same, if not more, when you take into account, paper, ink and staff time.
• Walking the Talk – If you are photocopying copyrighted materials, what message are you sending to your clients? “Do as I say: take responsibility to follow the law and society’s expectations of you at home, school and work. But don’t do as I dobecause I’m an exception to the rule and I don’t need to obey the law.” Sounds like some criminogenic thinking and poor role-modeling doesn’t it?

TIP 3

Is Interactive Journaling difficult to teach to prepare facilitators to use IJ with their clients?

Very easy to teach. Facilitator Guides provide insight into the key concept on each page of the Journal with facilitation strategies for 1 to 1 individual work and in group work. Additional activities are presented for homework or application of skills between sessions.

–> There are “Training for Trainers” sessions on Interactive Journaling so agencies and programs don’t eat up all of their resources sending staff off each time for training on the Journals.

–> All IJ Facilitators don’t need to be licensed clinicians or counselors. Probation and correctional personnel, teachers and educators, Federal Bureau of Prisons mentors (lay people), ministers can be trained to facilitate IJ. Even fellow criminal justice inmates have been trained as facilitators.

–> IJ can be used/facilitated in a range of settings with a variety of provider skill sets. IJ Facilitators can be lay individuals doing mentoring or coaching; probation officers and paraprofessionals; or licensed clinicians and physicians.

–> There are a variety of methods to receive training: eTraining modules, coaching from The Change Companies, or telephone trainings. 90-minute sessions via the internet are becoming more popular.

–> The most effective trainings are still multi-day live trainings with practicums with feedback. Over the years it has been very consistent on how many individuals say they are seasoned facilitators highly proficient in stages of change work, MI and CBT. However they often cannot demonstrate the skills when asked. Journals provide a standardized delivery system of narrative writing, stages of change, motivational enhancement and cognitive-behavioral skill building that can enhance the abilities of all change agents.

success story

In the October 2012 edition, I asked Ashleigh Simon, Clinical Director, The Bridge, Inc. to share how she and her team were making the shift to more individualized services, away from fixed program-driven care.

Since I knew they have been using Interactive Journaling, I wondered how this was working for them in their ongoing shift to person-centered care.  Here’s how Ashleigh responded:

“Over the past several years at The Bridge Addiction Treatment Centers, we’ve transformed our services from program-driven to client-centered, outcome-informed treatment. We’ve converted forms, altered service levels and changed our way of thinking to ensure the client is a partner in the treatment process. Throughout this change process, the one constant has been The Change Companies Interactive Journaling series. The journals serve as a tether that keeps us grounded in a structure that enables our therapists to deliver individualized treatment.

The Change Companies journals empower our therapists who engage the client in treatment through developmentally-appropriate core concepts such as peer pressure, self-image and family systems. Grounded in principles of Motivational Interviewing, Transtheoretical Model of Change and The ASAM Criteria, these journals address patterns of behavior in our clients while utilizing an evaluative process of coping strategies for high-risk situations.

By encouraging clients to choose the journal that corresponds with their treatment plan goals, treatment becomes individualized, thereby shifting our focus from fixed lengths of stay and programmatic services to achieving outcomes based on each individual’s process of recovery. Regardless of the constant changes with evidence-based practices and evolving business systems tied to the Patient Protection and Affordable Care Act (PPACA), The Change Companies journals remain the common core for our clinicians.”

Ashleigh Simon, MS, CAADP, LPC, NCC, ACS

Clinical Director, The Bridge, Inc., Gulf Coast Campus

Mobile, Alabama

E-mail: a_simon@bridgeinc.org

(Founded in 1974, The Bridge provides substance abuse treatment and behavioral rehabilitation programs for adolescents (ages 12-18). We provide services in residential, intensive outpatient, drug court and community-based programs. Our programs are staffed with caring and qualified professionals using proven, evidence-based practices. Our commitment to quality and excellence is evident throughout the organization as we continue to seek ways to enhance and broaden our services.)

soul

What I’m talking about is how kids:

·      Live and play in the moment

·      Play without worrying what work they should be doing instead

·      Are totally tuned into what they feel, want, like, don’t like

·      Have no trouble asking (demanding) for what they want

·      Express emotions easily and unambivalently

·      Give and get love affectionately and flowingly

And the list could go on.

The thing is, though, that a lot of adults pay large sums of money and spend countless hours in individual or group therapy, workshops, retreats, self/mutual help meetings, and numerous self-help, self-improvement books, CDs and DVDs…….all so they can get back to being like a kid again.

I’m not saying that is bad.  I’m as much a result of whatever it is we do “growing up” that seems to squeeze out the essence of the joy of living that children do naturally.

So it was interesting as I we were recently organizing old photos and scrapbooks, to come across several of my childhood essays that were published in the Sunday newspaper, children’s section. I had won a prize every year from age 11 to 16.  I even won a wristwatch for best essay one year and received my prize on the local TV station.

The newspaper published my little essays with riveting “headlines”: “City Boy Who Worked Sheep“, “From Atoms to Oxygen“, “Finish was best part of cross-country race” and “Whirlwind in School Grounds“.

It is fun to look back and recognize the childhood roots of Tips and Topics and all those papers, articles and book chapters listed in my Curriculum Vitae. Actually SOUL is the adult version of those childhood essays in the newspaper.

So maybe there are still remnants of my childhood joy seeping through……..while I keep working on getting back to playing without worrying what work I should be doing instead!

sharing solutions

You would think I would know all the resources we have at The Change Companies to help you use The ASAM Criteria and the two ASAM co-branded journals onUnderstanding the Dimensions of Change and Moving Forward.

   But I actually just discovered The ASAM Resource User Guide.       

Not only does it help you use the journals to implement The ASAM Criteria in your clinical work, but it has two informative charts.

See page 8 for adults; and page 9 for adolescent treatment, which shows the journals that key to specific ASAM Criteria assessment dimensions.

Here’s how to get it:

Go to http://www.asamcriteria.org

Click on Resources & Training.

On the right hand side, notice: “Download the ASAM Resource User Guide”