SCE Pittsburgh: Constructive approaches to engaging patients, addressing trauma

Presenters at the Summit for Clinical Excellence event on Tuesday in Pittsburgh implored attendees to tap into their inner Columbo, consider implementing mindfulness techniques into even day-to-day activities such as brushing teeth, and help patients reshape their belief systems after traumatic life events have left them susceptible to suicidal ideation.

The art of questioning

Donald Meichenbaum, PhD, research director of the Melissa Institute for Violence Prevention in Miami, discussed motivational interviewing techniques as a means to strengthen a patient’s commitment to engaging in treatment and avoid relapse.

“Your most valuable skill, from my perspective, is the art of questioning,” Meichenbaum said.

Meichenbaum referenced the interviewing techniques of Columbo, the detective on the classic television series of the same name, and endorsed the use of “how” and “what” questions over those that ask “why.” The most effective questions, he said, are solution-focused and highlight patients’ strengths. Examples of effective questions in motivational interviewing:

• How are things in your life right now, and how would you like them to be?
• How can we help you get there?
• What have you tried? What works? What doesn’t?
• How can we know if we’re making progress? What will we see change in? What will others notice?
• Can you envision anything that might get in the way of progress that we can address?

Everyday mindfulness

Jamie Marich, PhD, a trauma therapy specialist based in Ohio, discussed the value of mindfulness—the practice of coming back to awareness—especially within the context of the 12 Step model, which tells those in recovery to “stay in the moment.”

“Too often, we have told people to do that, but we have not shown them how,” Marich said. “The practices might seem elementary, but it’s how we teach people to build that here and now model. It takes practice.”

Marich guided attendees through a series of mindfulness practices, including grounding, various breathing combinations, body scanning and mindful movement. She also shared a series of considerations for practitioners working with patients on implementing mindfulness techniques into their recovery:

• Clarify misconceptions and misinformation about what mindfulness and meditation means.
• Let patients know how long the exercise, specifically periods of silence, will last. Leaving patients in silence for unknown lengths can create counterproductive feelings of anxiety.
• Be open to variations in practice. Mindfulness techniques can be implemented into other activities, such as drawing or dancing, or even mundane parts of your daily routine, such as brushing your teeth, washing the dishes or going for a walk.

Lastly, Marich recommended attendees develop their own mindfulness practices to help deal with the stresses they encounter during the day. This also helps with modifying worksheet-based mindfulness activities for clients as needed.

Addressing suicidality

Suicide is currently the 10^th leading cause of death in the U.S., and more than 1 million U.S. adults reported having attempted suicide within the past year. The World Health Organization predicts that by 2020, depression will be the second-leading cause of death unless immediate steps are taken to improve treatment and awareness.

Rita Schulte, MA, NCC LPC, a private practitioner who specializes in the treatment of mental health disorders, discussed the assessment, treatment and management of suicide risk. Clients can exhibit warning signs of being at risk for suicidal ideation in their words, behaviors and moods, Schulte said. Examples of the latter include feelings of humiliation, anxiety and guilt/shame, often stemming from stressful or traumatic life events, Schulte said.  

Schulte advocated working with clients showing these signs to identify the meaning the client has attached to the trauma or critical life event they have experienced—do they feel responsible for the event? Among the techniques to help clients overcome these feelings and begin to reshape their shaken belief systems is introducing the seeds of possibility. Is it possible the traumatic event wasn’t your fault? What would it mean if you could embrace the idea there was nothing you could have done?

“The big thing is what meaning does the client attach to whatever it is that happened to them,” Schulte said. “I want to help them create a new story. What meaning do they attach to whatever the tragedy was? They have attached belief systems around that. I want to know what those are and help them create a new story.”