The result of hoping and then experiencing deep disappointment can be a profound poisoning of hope. You recoil from hope, because hoping risks another disappointment. In this situation, hope appears tainted, so you stop hoping altogether.

Dr. Ross Ellenhorn calls this “Fear of Hope”. He joined a team at Rutgers University to study it, developing a Fear of Hope Scale, showing that fear of hope is a valid variable in people’s lives. In his talk he discusses this research, the theories behind it, and how they apply to the lives of individual diagnosed and treated for psychiatric and addiction issues.

You’re eager to make the change. You know all the ways the change will benefit you. You plan to make the change. And then…you don’t follow through.

That change does not happen is not due to the inherent weakness or laziness of human beings. The “how to” concept found in self-help books makes perfect sense when we apply it to fixing things, such as a leaky faucet. However, as we’ve learned from over a century of psychotherapeutic thought, change isn’t as superficial as learning skills or following steps.

“The 10 Reasons Not To Change” is a much-needed corrective and alternative to self-help materials offering the “secret” to making personal change, then leaving the reader unchanged. Dr. Ellenhorn offers an engaging, well-researched presentation that the audience will benefit from and enjoy.

Cracks in the medical model of addiction are forming. And that’s a good thing. It means the chance for greater creativity, treatment choice, and freedom in decisions on what to do about substances in one’s life. It potentially means a decrease in stigma, and a much more nuanced view of the use of substances. It fractures a cookie-cutter approach to the use of substances and the engagement in other habits, allowing for care, if one wants it, to be truly individualized. We are heading towards a paradigm shift.

We can see the outlines of the next model, one based on psychotherapeutic values, a non-judgmental curiosity about why a person might engage in seemingly self-destructive behavior, a belief that a person is making the bests choices they can when they use, a total respect for the autonomy of the individual, and a firm belief that lasting change never happens through confrontation or coercion. This talk reviews both the ways in which the previous paradigm is shifting and how to locate the new forms of thinking.

Repeatedly, research on the therapeutic factors leading to change shows that the most effective therapeutic relationships are collaborative ones. Many individuals who enter treatment, however, do so either because they suffer from a basic distrust of the world, or out of compliance with the demands of others. For them, the very idea that we start treatment with a partnership seems suspect and dangerous. Try as we might to offer them the nutrients of a therapeutic alliance, they likely won’t metabolize what we offer.

Our talk examines the science of collaboration, therapeutic stances that promote a partnering relationships, and collaborative treatment tools.

Mental health professionals have been trained in the benefits and limitation of inpatient and outpatient services that have provided the dominate settings for mental health care services for years. More recently Community Integration has emerged as an additional model of mental health care service that incorporates evidence-based therapies that engage patient centered care in the promotion of functional growth of people with mental health struggles.

This talk will inspire participants to engage in thinking and exploring how innovative programs and services can fill in the gap between traditional inpatient and outpatient care models.

Additionally, talk addresses the issue of stigma as reflected in mental health practice and in society at large, examining how community integration initiatives impact social and internal ostracism that can result in devastating isolation for persons with mental health struggles.

In this talk, Dr. Ellenhorn argues that the term “co-occurring” for simultaneous substance abuse and mental health issues is often a misnomer. In its place, he proposes a model in which the problem is actually tri-occurring, the third element in this triangle being, what he calls, psychosocial trauma. Through repeated attempts at treatment, the experience and internalization of stigma, and often a succession of personal problems caused by their psychiatric experiences, people diagnosed with psychiatric issues often lose hope in their future and doubt their own fortitude to face problems. With this in mind, addictions treatment for people who also suffer from psychiatric issues should aim for the triad of clinical, addiction and psychosocial recovery. In fact, Dr. Ellenhorn describes addictive behavior and psychosocial pain as the key relationship in this triad — seeing the loss of hope, connection, purpose and belief in a future caused by social losses as the overwhelming determinants in a person’s willingness to change.

Importantly, the Substance Abuse and Mental Health Services Administration (SAMHSA) agrees. Their proposed evidence-based best practice for co-occurring disorders is the Integrated Dual Disorder Treatment (IDDT) approach, a model that integrates psychosocial recovery goals as a central part of treatment, and views pursuing such goals as a kind of medicine for addiction, as opposed to goals to work toward once a person is well on their path to recovery. Thus, in this model, “readineess” is seen quite differently than in previous views. With a sufficiently strong community team around them, a person is ready to return to work, school and their communities when they say they are. As part of this talk, Dr. Ellenhorn describes the IDDT model, showing how it is an excellent means of addressing the triad of issues confronting people typically described as suffering co-occurring issues.

Most people agree that psychiatric patients are hurt by stigma, and that putting people in institutions can cause them harm. Much has been written about these problems, as social critics bemoan the dark side of mental health care. But these important observations often stop too short. Missing is the kind of deep examination we associate with medicine, one that looks for the site of the injuries, and how they occur. In this talk, Dr. Ellenhorn provides this much-needed examination.

Dr. Ellenhorn describes, both on a theoretical level and through numerous powerful true stories, the often-disabling impact of being labeled as suffering psychiatric symptoms and being treated for them. Just as the medical approach begins with where the problem occurs (the brain), what the problem looks like (for example, misfiring synapses or problems with dopamine), and then describes how the problem causes dysfunction (mood swings, hallucinations), this talk provides a model that shows where, what and how stigma and institutionalization injure people, causing symptoms often misinterpreted as stemming from the original psychiatric disorder.

Dr. Ellenhorn identifies the location of injury often caused by mental health treatment as the self, that difficult-to-find location not bound by the skull, but nonetheless real, and vital to living. Calling this injury psychosocial trauma, he shows how being identified and treated as a psychiatric patient disturbs a person’s social standing, sense of security among others, and core psychology. Psychosocial trauma, in other words, is multilayered, and Dr. Ellenhorn systematically illustrates its social, social- psychological and psychological effects. This multilayered trauma causes people to fear hope and dread human connection — the very nutrients of a meaningful existence. Social isolation and apathy are the what of this trauma. Psychosocially traumatized people live on the sidelines, disengaging from family, friends, work and school, and giving up on their dreams and future. Dr. Ellenhorn argues that psychosocial trauma affects a person’s willingness to actively move forward [not needed – understood, and adds density] as much as, or even more than do psychiatric symptoms.

Shared decision-making (SDM) is an approach in medicine in which patients and doctors review evidence and data together to make decisions about the patient’s care. In this process, doctors work with patients to weigh the pros and cons of a given treatment approach, deliberating not only about physical health, but over such issues as personal autonomy, personal values and ethical/legal issues.

The use of shared decision-making, and the tools of SDM, are growing in the behavioral health professions. In this talk, Dr. Ellenhorn describes SDM as both a new, more helpful style of treatment planning, and as a type of treatment in itself. He reviews the different models and tools for SDM, and discusses their value in mental health treatment.