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Tips from the Unconvention

David Mee-Lee, M.D., talked about Universal Human Needs at the 2011 Unconvention. For those of you unfamiliar with Dr. Mee-Lee, he is a leading expert in co-occurring substance use and mental disorders with over 30 years experience in person-centered treatment and program development. Some of you will remember him from the training he provided to our system in June of 2007. His Unconvention topic centered on the idea that “there are some things that just apply to everybody” and it doesn’t matter if the person is sick or addicted, it applies.

Recently, I spoke to a case coordinator from a different county who had a difficult time understanding the need for a client to have only one staff who spends time discussing more personal issues, rather than numerous staff who could all address the person’s needs. This was the belief until I asked, “Would you like to tell your most personal business to four different people?” I agree there are some Universal Human Needs. Dr. Mee-Lee also stated, “There are no resistant clients only inflexible clinicians.” He explained that many clients do not have the skills to get their needs met and, as a result, they exhibit “attention seeking and annoying” behaviors trying to express their needs but because “we aren’t listening” they are labeled and treated as such. He encouraged us to all be honest and admit that we all want special attention. We all want VIP, we all want to be able to cut to the front of the line and we all want someone to go out of their way for us. However, as clinicians we may take it personally and begin to threaten discontinuing services for being “resistant”. When this happens, we are essentially stating, “I will threaten to cut you off because I can’t hear you.”

It’s also very important to use appropriate language when describing these behaviors. Using language like “adherence” can feel less judgmental. Dr. Mee-Lee explained, “If a person is not compliant, you probably have a lousy plan.” We don’t want people to “comply,” to adhere is better. Treatment is much more successful when both the person and the clinician agree to what, why, when, where and how they would like their problem to be solved.

Do not work with the identified person if they do not want to be there (Pre-Contemplation). Instead, work with the person that brought them. If the treatment plan is not working, redo the plan. Do not call the person resistant, change the words on the plan or the behavior to realign the plan. This is a great opportunity to point out discrepancies between what the person reports as their goal, and their behaviors which may not lead to obtaining that goal.

In order to establish therapeutic alignment, follow these elements in order. First establish the client/clinician Relationship, then instill Hope, provide Empowerment and then encourage Responsibility. Dr. Mee-Lee says, “If you expect one of these before the other, you’ll have a problem.” Let’s face it; if the person likes you, they will come back. If you provide hope, they will want to work. If they want to work, they will accept the responsibility.

Written by Eric Moss an C.C Felix

Tips and Topics from David Mee-Lee, M.D. obtained by Eric Moss at the 2011 Unconvention and Dr. Mee-Lee’s Website @

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