Different Approaches to Treating Severely Mentally Ill

  1. Behaviorism and the Token Economy: This approach is based on the behavioral principle of positive reinforcement. It consist of the individuals receiving credit for the various participating in variousactivities and being rewarded by going shopping etc. when they reach a certain number of credits the obvious drawback is that the systems works with the high functioning and highly motivated individuals but does not touch the typical low motivation individuals who are not tempted by extrinsic rewards.
  2. The Mall System: A number of rooms are set aside basically for skills training and provides individual or group work in art, social skills, anger management, mindfulness etc. The problem here is that individuals have difficulty in knowing what activity interests them (for the most part, nothing interests them).
  3. CT-R: This system is based on more abstract principles dealing with intangibles such as purpose, trust, aspirations, hope, and meanings. The individual typically moves through a number of stages such as engagement, determining aspirations, behavioral experiments (to correct misconceptions)etc. We have found that certain activities such as music and dancing, participation in sports or walking in a group,determining what they want to get out of life, etc. serve as motivating forces. Participation in activities outside of the residence or hospital constitutes part of the treatment program and represent and advanced step.

To assess whether a particular activity is effective, the clinician looks for signs of a switch from the psychotic mode to the adaptive mode.