Dr. Jenifer Talley – Harm Reduction in Clinical Psychotherapy and the Stigma of Substance Use


In this episode, Kyle interviews Dr. Jenifer Talley, Clinical Psychologist and Assistant Director at the Center for Optimal Living that does harm reduction in psychotherapy. Topics include the current stigma of substance use and the benefits of using a harm reduction approach.

3 Key Points: Dr. Jenifer Talley is a Clinical Psychologist at the Center for Optimal Living who practices harm reduction with her psychotherapy clients. Substance abuse is typically a symptom of a bigger issue. Jenifer uses a model called the 7 Therapeutic Tasks that helps build a safe relationship with her clients in adjusting their substance abuse mindset. There is a stigma on substance use, and shifting away from the current model into a harm reduction framework could help users be more receptive to change and healing.

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Show Notes About Dr. Jenifer Talley Jenifer grew up outside of DC and moved up to New York area for her internship and was working with female survivors of trauma and substance use at St. Luke’s Hospital. Dr. Tatarsky has founded the Center for Optimal Living and she is the Assistant Director The Center for Optimal Living is known best for their work with substance use and harm reduction Substance Abuse Jenifer says that ‘abstinence only’ or ‘abstinence first’ approach doesn’t really work It’s all about determining the relationship the patients want to have with a substance People really struggle with vulnerability and trauma is a player as to why someone wants to use a substance “Substance use is a symptom of a bigger issue” – Jenifer It’s unfair to ask someone to change without asking the whole system to change 7 Therapeutic Tasks The Therapeutic Alliance – Letting the client know they can trust them The Therapeutic Relationship Heals – Jenifer says they are sensitive about creating a safe therapeutic relationship with clients Enhancing Self Management Skills – How to better help with coping skills, shifting how people relate to cravings “What’s driving my urge to go for a drink right now?” Loneliness, boredom and sadness are reasons for craving Assessment as Treatment – What was the craving, how did they respond to that craving, how did they give into the craving, how did they feel afterward When Friday night rolls around, can the client picture the guilt and shame of Monday morning in that moment? Embracing Ambivalence – The client might have different parts of themselves, one part of them may want to really work on healing and change, and the other part of them might never want to change Goal Setting – helping clients think through bigger lifestyle changes they want to make, such as diet, self care activities, and specific substance use related goals Personalized Plan for Change – asking people to really evaluate their use Substance Use Stigma How do we not be judgmental about someone’s substance use, and care about their safety? Jenifer says she feels very protective about people she works with, and is very sensitive to her clients because of the shame about their drug use Clients Under the Influence Jenifer asks herself “does this person need medical attention right now?” She had a client that came in intoxicated but they were able to have a conversation still But she didn’t let him go home because the fact that he drank She gave him food and water and waited until he was able to get home safely She thought about it from a compassionate approach and thought “what is that telling us about his use?” and the next time the client came in they said their drinking was hardly manageable Harm Reduction Model There is a gap in training as clinicians as providers In the US specifically, the 12 step process and abstinence are used which are a part of the disease model There is a lot of stigma and shame in calling someone an addict The fear about the harm reduction model is that it is thought to lead to decriminalization The other issue is that the harm reduction model is thought to not include abstinence Jenifer says it does include abstinence, she just doesn’t lead with the abstinence approach Kyle mentions that a common thought for clinicians is “How do I incorporate a hard reduction approach without condoning drug use?” Jenifer says the drug use is happening already The first step is noticing your own biases first, and then getting informed about the model Andrew Tatarsky’s Book Patt Denning and Jeannie Little – Over the Influence Shifting to the Harm Reduction Model Help clients build a life that they are happy with 3 day training coming up The training goes into the history and why there needs to be a paradigm shift in looking at addiction The second and third days really go into the 7 Therapeutic…