overarching Lessons in CT-R

Dear All,

Let me know whether or not you agree with the statements below. By the way, I saw only two or three responses to my previous delusions memo. Not a good record.

Background: In working with the Montana group, Ellen has emphasized what we have long acknowledged. Namely, that our approach is cross-diagnostic (that is, it is applicable to the broad spectrum of mental disorders). The category of mental disorders seems to be based on the amount of care required by the individual and/or the amount of restriction.

What I have learned from our experience in the various behavioral systems:

1.Emphasis on intangible phenomena versus observable behavior phenomena: By this I mean thinking of the individual in terms of intangible human entities such as purpose in life, significance and value of activities, self-confidence, self-esteem, control, and autonomy as opposed to the emphasis on observable behavioral strategies such as reinforcement, social skills training, and cognitive remediation.

2.Our idiographic approach: In order to get the person involved, it is important to provide an opportunity to participate in an activity that has a specific value for the individual. For example, Ellen described to me an approach to an autistic individual in Montana. This individual had a number of dysfunctional mannerisms and behaviors which turned people off. Social skills training did not get very far in correcting the dysfunctional behaviors. However, when the individual was enticed into participating in building birdhouses with other individuals, he became more animated and to everybody’s surprise his interpersonal behaviors became more adaptive.

3.Generalizing from the specific period when an important focus has purpose and meaning also generalizes to the rest of the human spirit: self-confidence, optimism, etc. The generality principal also applies across the spectrum of mental disorders. The same hook might apply to a wide number of individuals with widely different diagnoses.

4. Aspirations: We have been finding that simply talking to individuals about their goals does not seem to animate them at all. However, when the staff focuses more on aspirations, the individuals come up with aspirations that the staff had no prior knowledge of.For the aspiration to take, it requires the following: a) it must be authentic, no what the staff wants to hear, b) it must be accompanied positive affect, c)it must lead to doing something right now that will lead eventually to the fulfillment, and d) imagining fulfillment of the aspiration should be practiced in imagery.In a later memo, we will give examples of some of these explicitly stated aspirations.

-ATB