Assertive Community Treatment (ACT)
ACT is one of the most well-defined and well-researched treatment models for adults with severe mental illnesses (Bond, Drake et al., 2001). The ACT model employs a team approach with shared caseloads and frequent staff meetings, intensive community-based services, and a focus on assistance with daily living skills. ACT is an effective treatment for people with SMI, particularly in reducing hospitalizations and maintaining stable housing (Bond, Drake et al., 2001; Mueser, Bond, Drake, & Resnick, 1998). Moreover, ACT is cost-effective for people with extensive hospitalization use (Latimer, 1999). Overall, ACT is an effective way to deliver structured, intensive services to meet the multiple, individualized needs of clients as they increase their involvement in the community in roles that they define as important and meaningful.
“Motivational Interviewing is a particular kind of conversation about change.”
Motivational interviewing is a form of collaborative conversation for strengthening a person’s own motivation and commitment to change.
It is a person-centered counseling style for addressing the common problem of ambivalence about change by paying particular attention to the language of change.
It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.
Cognitive Processing Therapy
Cognitive Processing Therapy (CPT) is an evidence-based, step-by-step treatment protocol that has been found effective for the treatment of posttraumatic stress disorder (PTSD) and related symptoms following traumatic events. It focuses on how the traumatic event has been perceived and coped with by a person who is trying to regain a sense of mastery and control in his or her life.
Even when clients are reluctant to go into detail about their trauma, CPT has been shown to provide benefit. CPT can be conducted in as few as 12 once-a-week sessions. CPT has been proven effective in treating PTSD across a variety of populations—including veterans and individuals with co-morbidity. CPT has worked well for individuals who have experienced combat, sexual, or childhood trauma, as well as other types of traumatic events.
The focus is on identifying how traumatic experiences change a person’s thoughts and beliefs, and how those thoughts will often negatively influence current feelings and behaviors. An important part of the treatment is addressing the unhelpful ways of thinking that can keep a person “stuck” and get in the way of recovery from symptoms of PTSD and other problems.
The CPT treatment protocol entails the following four phases:
Psychoeducation: client and therapist use cognitive therapy techniques to learn how inaccurate self-statements (“stuck points”) disrupt the recovery process.
Processing the trauma: client identifies and allows for the dissipation of the natural emotions related to the trauma as well as those emotions around “stuck points”. Through open-ended questions the therapist and client begin to challenge identified stuck points, focusing initially on thoughts about self-blame and futile attempts to “rewrite” or undo the actual event.
Cognitive restructuring: client learns to identify trauma stuck points around the issues of safety, trust, power and control, self-esteem, and intimacy. The client takes over at this stage and becomes his/her own therapist while the clinician acts more as a consultant.
Review: client and therapist review the journey and plan for the future, which may include sessions to prevent relapse.
CPT can be conducted in both individual and group settings or a combination of the two.
Dialectical Behavioral Therapy
Dialectical Behavior Therapy (DBT) is an evidence-based, cognitive-behavioral approach recommended to treat Borderline Personality Disorder (BDP) and other conditions that result in severe emotional difficulties. DBT emphasizes the psychosocial aspects of treatment.
People who are diagnosed with BDP experience extreme swings in their emotions and don’t have any methods for coping with these sudden, intense surges of emotion, which often lead to experiences of invalidation during childhood. DBT balances empathy and warm acceptance with an unwavering focus on changing problem behaviors. The combined strategies of validation and problem-solving are interwoven throughout the therapeutic process.
Through a combination of individual sessions and skills classes, clients receiving DBT learn and practice the following skills:
Mindfulness: the capacity to pay attention, non-judgmentally, to the present moment; about living in the moment, experiencing one’s emotions and senses fully, yet with awareness and perspective.
Distress Tolerance: the ability to accept—in a non-evaluative and nonjudgmental fashion—both oneself and the current situation, calmly recognizing negative situations and their impact. Rather than becoming emotionally overwhelmed, individuals can make wise decisions about whether and how to take action.
Emotional Regulation: laying the groundwork for positive emotional states by learning to identify and label emotions, increase mindfulness of current emotions, and reduce vulnerability to emotions.
Interpersonal Effectiveness: maximizing the chances that a person’s goals in a specific interpersonal situation will be met—while neither damaging the relationship or the person’s self-respect—by saying no, asking for what one needs, and coping with the possible conflicts.
Expected outcomes for individuals participating in Dialectical Behavioral Therapy include the following:
- Decrease in suicidal thinking and behaviors
- Decrease in ER visits and hospital admissions
- Decrease in arrests
- Decrease in substance use issues
- Decrease in homelessness
- Increase in job and school performance
- Decrease of intense feelings of anger, shame, and rage
- Increased ability to manage emotions