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 superficialor prosaic, and thereforelacking inhaving an enduring impacton 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 individualengages in activities that have a particular meaningforthem.

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 satisfactionwhen he was in the boy scouts. This topic became the focus of 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 isthe meaning of the activity andit’s relevance to values and goals .In addition to specifying the positivebeliefs,the formulation shouldinclude thedysfunctional beliefsand behaviors such as expectations of failure, rejection and distress. Also, the maladaptive behaviors such as avoidance and withdrawal should be specified. One should address the following questions: What challengesor 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 producea positive affect: pleasure, a feeling of empowerment, enthusiasm, a feelingof fulfillment, and compassion? What dysfunctional beliefs drive the negative behaviors and what activities can be employed to neutralize these? What activities can modify the negative self-image (devalued, undesirable, inadequate)?

The figure below diagram the sequences of the two modes: