Men's Treatment Griffin

Dan Griffin, MA
TADCP 2012 Trauma and Justice Initiative
The Missing Peace
My Friend Tom
Copyright 2011, Covington, Griffin, and Dauer
The Missing Piece(s)

Impact of male socialization on recovery Relational needs of men
Abuse and trauma (experienced and perpetrated)
Its not that men dont want help or services.
We are often just not talking directly to.
THEM
Helping Men Recover
Helping Men Recover
Inspired by Dr. Covingtons Helping Women Recover.
Published by Jossey-Bass, January 2011.

Authors: Dr. Stephanie Covington, Dan Griffin, Rick Dauer.
Community and Criminal Justice versions.

Four Modules: Self Relationships Sexuality Spirituality
Using the Facilitator Guide

Chapter One Theoretical Foundation Chapter Two Guidelines for Facilitators
Module Summary Session Summary and Structure Facilitator Notes Suggested Dialogue
Copyright 2011, Covington, Griffin, and Dauer 9
Core Elements
Recovery Check-In and Check-Out Small group discussions Interactive lectures Grounding and self-soothing exercises Kinesthetic activities Creative activities A Mans Workbook
Trauma-Informed
Helping Men Recover is not primarily a program for RESOLVING trauma; it is a trauma-informed program for treating addiction.
Helps to identify traumatic experiences
Provides safe space for beginning exploration Offers Stage 1 stabilization strategies
Often requires referrals to professionals specializing
in the treatment of trauma disorders.

A Mans Way through the Twelve Steps
Replicated masters research
Similar structure to Dr. Covingtons A Womans Way Through the Twelve Steps
Interviewed over 25 men Ages 25 to 59 Periods of sobriety from 1 year to 42 years
First gender-responsive and traumainformed book for men in recovery focused on mens unique issues and needs
Core Issues Emotional Awareness, Relationships, Grief, Anger, Violence, Abuse, and Trauma
12
Grounding Exercise
Advanced Breathing
13
Group Exercise from Session II
The Rules of Being a Man
The Principles of Recovery
14
Session II Exercise
This exercise embodies and demonstrates the theoretical and practical foundations of Helping Men Recover.
The ultimate goal is for each participant to write new rules for himself. Rules that allow for a full and healthy expression of masculinity, consistent with living a sober and pro-social life.
15
Men are not the problem How men have been socialized is the problem
16
17
Mens Integrated Treatment

Male psychological development
Addiction
Trauma
18
Evolving Treatment Approaches
19
Gender-Responsive Treatment
Creating
an environment through:
site selection staff selection
program development
content and material
that
reflects an understanding of the realities of women/men and girls/boys, and addresses and responds to their strengths and challenges.
Source: Covington, S.S., & Bloom, B.E. (2006). Gender-responsive treatment and services in correctional settings. In E. Leeder (Ed.), Inside and out: Women, prison, Copyright 2011, Covington, Griffin, and Dauer and therapy. Binghamton, NY: Haworth.
20
21
Emerging Paradigm - Values-Based Services
Genderresponsive
Recoveryoriented
Valuesbased services
Culturally competent
Traumainformed
22
Addiction: A Holistic Health Model
Physiological
Emotional

Social Spiritual Environmental Political

What We Have Learned

Brain chemistry Stages of change Client-centered Strength-based Solution-oriented
Managing a chronic disease

The Three-Legged Stool
ADDICTION
MENTAL HEALTH
TRAUMA
25
26
The Theory of Mens Psychosocial Development

Central Tenets of Relational Cultural Theory
All humans yearn for connection All growth occurs in connection through and towards relationships Relational competence allows for connection
27
RCT and Men

Dr. Stephen Bergman
* Self in Relation vs. Individuated Self * Male relational dread
* Agents of disconnection
* Power dynamics
28
Men in Treatment
While all men have relationships, and these get some attention in treatment, we do not typically focus on mens relationships helping them develop the skills necessary to have healthy relationships.
29
Male Relational Dread

Characteristics of Healthy Relationship?
Intimacy Honesty Vulnerability Compromise Trust Sharing Emotions
30
Understanding the intersection of trauma and intimacy forces us to rethink domestic violence and the efficacy of current best practices
31
Lets (NOT) Talk About Sex

Sexuality is rarely addressed directly in addiction treatment, despite being a fundamental aspect of male and female identity and behavior.
32
Addressing Sexuality
Traditionally taboo in treatment

If covered, often done in a perfunctory way Candid and safe conversation
Often avoided as a result of OUR discomfort PORN!!!
Key factor in many relapses Sex Addiction

We may overestimate mens comfort and understanding of sex because we buy into their bravado
Homophobia and Misogyny
Are frequently the underlying cause of male violence Impede mens relationships with women and other men Lead men to deny, reject, or feel shame about essential aspects of their true nature
Men in Treatment
Spirituality was traditionally a core element in most addiction treatment programs, but has been marginalized since CBT became the predominant therapeutic approach.
A Return to Spirituality
Quality recovery is, at its core, the result of a spiritual transformation.

Because spirituality is difficult to define, elusive, and not concretely goal-oriented, many men discount its value.
Many men view spirituality as a feminine idea

We have not done the best job of educating payors and others about the difference between spirituality and religion.
37
Definition of Trauma
The diagnostic manual used by mental health providers (DSM IV-TR) defines trauma as, involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to ones physical integrity; or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. The persons response to the event must involve intense
fear, helplessness or horror (or in children, the response

must involve disorganized or agitated behavior).(American Psychiatric Assoc. [APA] 2000, pg. 463)
The Theory of Trauma
Post-Traumatic Stress Disorders are an individuals response to abuse, violence, or some other overwhelmingly negative experience. It is the subsequent set of maladaptive behaviors and beliefs that should be addressed in treatment.
39
Process of Trauma
TRAUMATIC EVENT
Overwhelms the Physical & Psychological Systems Intense Fear, Helplessness or Horror
RESPONSE TO TRAUMA
Fight or Flight, Freeze, Altered State of Consciousness, Body Sensations, Numbing, Hyper-vigilance, Hyper-arousal
SENSITIZED NERVOUS SYSTEM CHANGES IN BRAIN
CURRENT STRESS
Reminders of Trauma, Life Events, Lifestyle
PAINFUL EMOTIONAL STATE

RETREAT SELF-DESTRUCTIVE ACTION ADDICTIVE DISORDERS EATING DISORDER DELIBERATE SELF-HARM SUICIDAL ACTIONS
DESTRUCTIVE ACTION
ISOLATION DISSOCIATION DEPRESSION ANXIETY
AGGRESSION VIOLENCE RAGES
* Source: Stephanie Covington
40

Big
T and Little T trauma
Complex
PTSD Attachment Layered trauma Trauma

Iatrogenic
ACE Study
ACE Study Kaiser Permanente from 1995 to 1997 17,000 participants Each participant completed a confidential survey containing questions about:
childhood maltreatment and family dysfunction items detailing their current health status and
behaviors.
This information was combined with the results of their physical examination to form the baseline data for the study.
ACE Study
(Adverse Childhood Experiences)
Before age 18:
Recurrent and severe emotional abuse Recurrent and severe physical abuse Contact sexual abuse Physical neglect Emotional neglect
43
ACE Study
Growing up in a household with:
An alcoholic or drug-user A member being imprisoned A mentally ill, chronically depressed, or institutionalized member The mother being treated violently Both biological parents not being present
(N=17,000)
44
ACE Study
Results
ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness. Smoking Alcoholism Injection of illegal drugs Obesity
(Felitti, V.J.: Origins of Addictive Behavior: Evidence from the ACE Study. 2003 Oct:52(8): 547-59. German. PMID: 14619682 (PubMed-indexed for MEDLINE).
ACE Study
(continued)
Men 16% Sexual Abuse Men 30% Physical Abuse Women 27% Sexual Abuse
(Feletti and Anda, 2010)
46
Trauma-Informed Care
Trauma-informed services:
Take the trauma into account.
Avoid triggering trauma reactions and/or traumatizing the individual.

Adjust the behavior of counselors, other staff, and the entire organization to support the individuals coping capacity. Allow survivors to manage their trauma symptoms successfully so that they are able to access, retain and benefit from the services.
(Fallot & Harris)
Effective Stage 1 Healing Strategies

Safety Stabilization Structure Affect regulation Self-soothing and grounding techniques Restoring a sense of competency Focus on the survival, not the trauma event (move narrative from victim survivor)
Core Principles of Trauma-Informed Care

Safety: Ensuring physical and emotional safety Trustworthiness: Maximizing trustworthiness, making
tasks clear, and maintaining appropriate boundaries

Choice: Prioritizing consumer choice and control Collaboration: Maximizing collaboration and sharing of power with consumers Empowerment: Prioritizing consumer empowerment and
skill-building
(Fallot & Harris, 2006)
50
Safety in Criminal Justice Settings

Three
types of safety: the physical and emotional safety of the men in the group the physical safety of the facilitators.
Trauma-Informed Responses & Criminal Justice Interventions

Structure Consistency Predictability Safety Therapeutic Healing and Growth Collaborative Responsive Exploration Empowerment Trust Mutuality Flexible
Structure Consistency Predictability Accountability Punitive Behavioral Correction Directive Reactive Restriction Deterrence Fear Hierarchy Rigid
Trauma-Informed
Criminal Justice
52
CBTis Just Alright With Me! (OH YEAH!)
Not very effective as the predominant approach Pre-frontal cortex goes offline Trauma resides in the body as much as in the mind
How many men in system have TBI?

54
55

A fundamental belief that trauma is pervasive in mens lives and there are gender differences in:
How men experience trauma
How men respond to trauma
How men exhibit the symptoms of
trauma-based disorders How men heal from trauma

THERE IS
NO
GENDER NEUTRAL
Process of Trauma
TRAUMATIC EVENT
Overwhelms the Physical & Psychological Systems Intense Fear, Helplessness or Horror
RESPONSE TO TRAUMA
Fight or Flight, Freeze, Altered State of Consciousness, Body Sensations, Numbing, Hyper-vigilance, Hyper-arousal
SENSITIZED NERVOUS SYSTEM CHANGES IN BRAIN
CURRENT STRESS
Reminders of Trauma, Life Events, Lifestyle
PAINFUL EMOTIONAL STATE

RETREAT SELF-DESTRUCTIVE ACTION ADDICTIVE DISORDERS EATING DISORDER DELIBERATE SELF-HARM SUICIDAL ACTIONS
DESTRUCTIVE ACTION
ISOLATION DISSOCIATION DEPRESSION ANXIETY
AGGRESSION VIOLENCE RAGES
* Source: Stephanie Covington
58
Psychiatric Diagnoses
Who is your least favorite (or favorite, if you are a masochist) female client to work with?
Borderline Personality Disorder
Clinical features also common in the diagnosis of
complex PTSD
Challenging the diagnosis
Psychiatric Diagnoses
What diagnosis for men would most likely mimic/mask the symptoms of complex PTSD?
60
ANTI-SOCIAL PERSONALITY DISORDER
61
Interactive Lecture
Verbal abuse Emotional abuse
Physical abuse
Sexual abuse
Ending Mens Violence

We will not end the cycle of boys childhood trauma and mens violence until we treat men with compassion as well as accountability.
Men, Addiction, and Crime
The ways that men have historically been raised in our society is a contributing factor in the problematic behaviors and attitudes that underlie both addiction and criminal behavior.
The majority of men that commit crimes do so in an attempt to prove their manhood. (Sabo, 2002)
Universal Precautions
Histories of abuse and trauma should be expected, not considered the exception. Many treatment failures may well have unresolved trauma disorders. We can do a MUCH better job at talking about the trauma that men experience and the abuse that they perpetrate.
65
A paradigm shift From: What is wrong with you? To: What happened to you?
66
What can GRE do for you?
Implementation Training on HMR

Two Day Three Day
Consulting for Improving Services for Men

Trauma-Informed Gender-Responsive General Improvement for Engaging Men
Invite Dan to Speak at your next conference, event, or birthday party!

Contact Information
Dan Griffin
www.dangriffin.com dan@dangriffin.com
612-701-5842
Facebook:
http://www.facebook.com/TwelveStepsForMen

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Dan Griffin, MA

TADCP 2012 Trauma and Justice Initiative

The Missing Peace

Copyright 2011, Covington, Griffin, and Dauer

The Missing Piece(s)

Impact of male socialization on recovery Relational needs of men

Abuse and trauma (experienced and perpetrated)

Copyright 2011, Covington, Griffin, and Dauer

Its not that men dont want help or services.

Copyright 2011, Covington, Griffin, and Dauer

We are often just not talking directly to.

Copyright 2011, Covington, Griffin, and Dauer

Helping Men Recover

Copyright 2011, Covington, Griffin, and Dauer

Helping Men Recover

Inspired by Dr. Covingtons Helping Women Recover.

Published by Jossey-Bass, January 2011.

Community and Criminal Justice versions.

Copyright 2011, Covington, Griffin, and Dauer

Using the Facilitator Guide

Copyright 2011, Covington, Griffin, and Dauer 9

Copyright 2011, Covington, Griffin, and Dauer 10

Often requires referrals to professionals specializing

in the treatment of trauma disorders.

A Mans Way through the Twelve Steps

Replicated masters research

Copyright 2011, Covington, Griffin, and Dauer

Copyright 2011, Covington, Griffin, and Dauer

Group Exercise from Session II

The Rules of Being a Man

The Principles of Recovery

Copyright 2011, Covington, Griffin, and Dauer

Copyright 2011, Covington, Griffin, and Dauer

Copyright 2011, Covington, Griffin, and Dauer

Copyright 2011, Covington, Griffin, and Dauer

Mens Integrated Treatment

Copyright 2011, Covington, Griffin, and Dauer

Evolving Treatment Approaches

Copyright 2011, Covington, Griffin, and Dauer

site selection staff selection

Copyright 2011, Covington, Griffin, and Dauer

Emerging Paradigm - Values-Based Services

Addiction: A Holistic Health Model

Social Spiritual Environmental Political

What We Have Learned

Brain chemistry Stages of change Client-centered Strength-based Solution-oriented

Managing a chronic disease

The Three-Legged Stool

Copyright 2011, Covington, Griffin, and Dauer

Copyright 2011, Covington, Griffin, and Dauer

The Theory of Mens Psychosocial Development

Copyright 2011, Covington, Griffin, and Dauer

RCT and Men

Copyright 2011, Covington, Griffin, and Dauer

Male Relational Dread

Copyright 2011, Covington, Griffin, and Dauer

Copyright 2011, Covington, Griffin, and Dauer

Lets (NOT) Talk About Sex

Copyright 2011, Covington, Griffin, and Dauer

Traditionally taboo in treatment

Often avoided as a result of OUR discomfort PORN!!!

Key factor in many relapses Sex Addiction

Homophobia and Misogyny

Men's Treatment Griffin

Men's Treatment Griffin