Outline for Treatment Plan: The Two Modes in Schizophrenia

People have remarked on the fact that many of the activities that we facilitate seem to be superficial or prosaic, and therefore lacking in having an enduring impact on the individual. It is true that we support the use of “natural” activities such as playing games, having parties, or going for a walk. These activities have the value of being part of the person’s repertoire (it can be easy or enjoyable to do what comes naturally). In response to these observations, we wanted to emphasize that our treatment approach is personalized for each individual. While there are some general activities, such as those listed above, that can have an impact on the individual, the greatest therapeutic benefit occurs when the individual engages in activities that have a particular meaning for them.

In order to determine which activities are likely to be most beneficial to an individual, it is important to base the treatment plan on a formulation of the individual’s assets, weaknesses, goals, and avoidances. The concrete specified activity may be one that was meaningful in the past but this is not necessary. For example, one individual had great satisfaction when he was in the boy scouts. This topic became the focus of the conversation and led to the individual demonstrating how to tie knots etc. For the most part, however, the facilitated activities center on the specified goals, values, and needs. Note, it is not the action itself that produces the satisfaction; it is the meaning of the activity and it’s relevance to values and goals. In addition to specifying the positive beliefs, the formulation should include the dysfunctional beliefs and behaviors such as expectations of failure, rejection, and distress. Also, maladaptive behaviors such as avoidance and withdrawal should be specified. One should address the following questions: What challenges or goals in the past were meaningful to the individual? What short term and long term goals and values are present and how can the individual satisfy these goals and values? What kinds of activities produce a positive affect: pleasure, a feeling of empowerment, enthusiasm, a feeling of fulfillment, and compassion? What dysfunctional beliefs drive the negative Page 2of 2ATB/MF 10-6-17Outline for Treatment Plan: The Two Modes in Schizophreniabehaviors and what activities can be employed to neutralize these? What activities can modify negative self-image (devalued, undesirable, inadequate)?

The figures below diagram the sequences of the two modes.