MDT Brief Training

1. Mode Deactivation Mode Deactivation
TherapyTherapy
Jack A. Apsche, Ed.D., ABPPJack A. Apsche, Ed.D., ABPP

2. "For every complex
problem there is an
answer that is clear,
simple, and wrong."
H.L. Mencken

3. Adverse
Childhood
Experiences
(ACEs)
U
n
b
a
la
n
c
e
d
P
e
r
c
e
p
t
io
n
s
Others’ Response to Resident’s
Behavior
Beliefs
L
e
a
r
n
in
g
&
O
r
g
a
n
ic

P
r
o
b
le
m
s
Triggers
(Unconscious)
(T
2
s)
Triggers
(Conscious)
(T
1
s)
Avoids
(Things that make me feel
bad- I do anything to
avoid)
Fears
Temperament
(Mood)

4. Evidence Based TreatmentsEvidence Based Treatments

5. RESEARCH THERAPYRESEARCH THERAPY CLINIC THERAPYCLINIC THERAPY
RECRUITED CASERECRUITED CASE CLINIC REFERREDCLINIC REFERRED
(Less severe, study volunteers)(Less severe, study volunteers)(More severe, some coerced)(More severe, some coerced)
HomogeneousHomogeneous HeterogeneousHeterogeneous
Lab or school settingsLab or school settings Multi-problem focusMulti-problem focus
Researchers/AssistantsResearchers/Assistants Clinics or HospitalsClinics or Hospitals
Small caseloadsSmall caseloads CliniciansClinicians
Pre-therapy preparationPre-therapy preparation Large caseloadsLarge caseloads
Focused treat-ment methodFocused treat-ment methodLittle PreparationLittle Preparation
BehavioralBehavioral Multi-method, eclecticMulti-method, eclectic
Pre-planned, Pre-planned, Non-behavioralNon-behavioral
Highly StructuredHighly Structured Flexible, adjustableFlexible, adjustable
((manual, close monitoring of therapists)manual, close monitoring of therapists)

6. MDT Will show us the
way!

7. Where has MDT been Where has MDT been
shown to be effective? shown to be effective?

8. Axis I MDT Percentile
Conduct Disorder 39 40.2%
Oppositional Defiant Disorder 10 10.3%
Post Traumatic Stress Disorder 25 25.8%
Major Depression 17 17.5%
Other Axis I Disorder 6 6.2%
Axis II
Mixed Personality Disorder 22 55%
Borderline Personality Traits 12 30%
Narcissistic/ Antisocial Personality Traits 6 15%
Dependent Personality Traits 0 0
Avoidant Personality Traits 0 0
Race
African American 97 77.8%
European American 38 20.9%
Hispanic/Latino American 6 .05%
Other 2
Total 142
Average Age 16.2
Demographic data of population treated with MDT, diagnosed disorder and
race.

9. Theoretical Constructs Theoretical Constructs
of MDTof MDT

10. Theory of ModesTheory of Modes
1.1. The multiplicity of related symptoms encompassing the cognitive, affective, motivational and The multiplicity of related symptoms encompassing the cognitive, affective, motivational and
behavioral domains in psychopathological conditions. behavioral domains in psychopathological conditions.
3.3. Evidence of systematic biases across many domains suggesting that a more global ad complex Evidence of systematic biases across many domains suggesting that a more global ad complex
organization of schemas is involved in intense psychological reactionorganization of schemas is involved in intense psychological reaction
5.5. The findings of a specific vulnerability (or diathesis) to specific stressors that are congruent The findings of a specific vulnerability (or diathesis) to specific stressors that are congruent
with particular disorder.with particular disorder.
7.7. The great variety of “normal” psychological reactions evoked by the myriad of life’s The great variety of “normal” psychological reactions evoked by the myriad of life’s
circumstances.circumstances.
9.9. The relation of content, structure and function in personality.The relation of content, structure and function in personality.
11.11.Observations of the variations in the intensity of an individuals’ specific reaction to a given set Observations of the variations in the intensity of an individuals’ specific reaction to a given set
of circumstances over time.of circumstances over time.
Beck, A.T. (1996)Beck, A.T. (1996)

11. 1.1. The phenomena of sensitization (“kindling phenomenon”): successive recurrences of a The phenomena of sensitization (“kindling phenomenon”): successive recurrences of a
disorder (e.g. Depression) triggered by progressively less intense experiences.disorder (e.g. Depression) triggered by progressively less intense experiences.
3.3. The remission of symptoms by either pharmacotherapy or psychotherapy.The remission of symptoms by either pharmacotherapy or psychotherapy.
5.5. The apparent continuity of many psychopathological phenomena with personality.The apparent continuity of many psychopathological phenomena with personality.
7.7. The relevance of the model to normal “moods.”The relevance of the model to normal “moods.”
9.9. The relationship among consciousness and unconscious processing of information.The relationship among consciousness and unconscious processing of information.
Beck, A.T. (1996)Beck, A.T. (1996)
Theory of ModesTheory of Modes

12. Theory of ModesTheory of Modes
Modes are a network of cognitive, affective, Modes are a network of cognitive, affective,
motivational, and behavioral components. The motivational, and behavioral components. The
modes, consisting of integrated sectors or sub-modes, consisting of integrated sectors or sub-
organizations of personality, are designed to deal organizations of personality, are designed to deal
with specific demands or problems.with specific demands or problems.

13. Theory of Modes- ActivationTheory of Modes- Activation
ChargesCharges
FearFear««Avoids ParadigmAvoids Paradigm

14. Why this is so crucial for our kidsWhy this is so crucial for our kids
Beck (1996) described modes as a network of Beck (1996) described modes as a network of
cognitive, affective, motivational and behavioral cognitive, affective, motivational and behavioral
components. He suggests that modes are components. He suggests that modes are
consisting of integrated sectors of sub-consisting of integrated sectors of sub-
organizations of personality that are designed to organizations of personality that are designed to
deal with specific demands to problems. They deal with specific demands to problems. They
are the sub-organization that help individuals are the sub-organization that help individuals
adopt to solve problems such as, the adaptation adopt to solve problems such as, the adaptation
of adolescents to strategies of protection and of adolescents to strategies of protection and
mistrust when they have been abused.mistrust when they have been abused.

15. Mode Step-by-StepMode Step-by-Step
Orienting Schema:Orienting Schema: the danger, fear, threat, signal or the danger, fear, threat, signal or
charge.charge.
Event:Event: the actual situation that takes place that produces the the actual situation that takes place that produces the
fear experienced.fear experienced.
Anticipated Event:Anticipated Event: the unconscious process of anticipating a the unconscious process of anticipating a
fear evoking event.fear evoking event.
n Preconscious Processing:Preconscious Processing: the cognitive unconscious the cognitive unconscious
based on the experiences of danger charged fears.based on the experiences of danger charged fears.
 Perception Fear:Perception Fear: the sense of fear that fully charges the the sense of fear that fully charges the
mode system.mode system.

16. Mode Step-by-StepMode Step-by-Step
nPhysiological System:Physiological System: the physical responses to the physical responses to
fear, arousal or charges.fear, arousal or charges.
Activation:Activation: the process of the cognitive schemas the process of the cognitive schemas
processing of fear evoked beliefs or thoughts.processing of fear evoked beliefs or thoughts.
Meaning AssignmentsMeaning Assignments, , Memories, Beliefs:Memories, Beliefs: the the
activation of the Compound Core beliefs.activation of the Compound Core beliefs.
Affective Schema:Affective Schema: the emotional component. the emotional component.
Behavioral Schemas:Behavioral Schemas: the behavior that is the behavior that is
evolved.evolved.

17. Mode Step-by-StepMode Step-by-Step
nMotivation Schema:Motivation Schema: the signal of the increasing the signal of the increasing
need to escape the fear.need to escape the fear.
2.2.Attack: Attack: the response to eliminate the threat by the response to eliminate the threat by
aggression.aggression.
3.3.Avoid:Avoid: the escape from the fear in a non-contact the escape from the fear in a non-contact
form.form.

18. Mode De-ActivationMode De-Activation
There are four areas where a mode can be There are four areas where a mode can be
deactivated prior to an aggressive act or other deactivated prior to an aggressive act or other
forms of emotional dysregulation. forms of emotional dysregulation.
Orienting SchemaOrienting Schema
PerceptionPerception
Physiological SystemPhysiological System
AvoidsAvoids

19. Look for the ElevatorLook for the Elevator
Beck’s Elevator Phobia: A young man, suffers Beck’s Elevator Phobia: A young man, suffers
from an elevator phobia.from an elevator phobia.
We look for the elevator in each adolescent and We look for the elevator in each adolescent and
MDT helps identify their elevatorMDT helps identify their elevator

20. Adolescent-Onset Personality Adolescent-Onset Personality
DisorderDisorder

Johnson, Cohen, Smailes, Kasen, Oldham, Skodol, Brook (2000)
Of 12 categories of DSM-IV Personality Disorder (PD) Of 12 categories of DSM-IV Personality Disorder (PD)
symptoms, 10 were associated with childhood neglectsymptoms, 10 were associated with childhood neglect
Family instability and lack of parental affection and supervision Family instability and lack of parental affection and supervision
were found to predict dependent and passive-aggressive PDs.were found to predict dependent and passive-aggressive PDs.
PersonsPersons whowho experienced childhood abuse or neglect are experienced childhood abuse or neglect are
considerably more likely to have PDs or elevated PD considerably more likely to have PDs or elevated PD
symptoms.symptoms.
Sexual abuse seems related to BPD.Sexual abuse seems related to BPD.
Physical abuse seems related to antisocial PD.Physical abuse seems related to antisocial PD.
Johnson, Cohen, Brown, Smailes and Bernstein (1999) Johnson, Cohen, Brown, Smailes and Bernstein (1999)
Abuse as associated with elevated borderline P.D. symptom and Abuse as associated with elevated borderline P.D. symptom and
neglect was associated with elevated symptoms of antisocial, neglect was associated with elevated symptoms of antisocial,
avoidant, borderline, narcissistic, and passive aggressive P.D.avoidant, borderline, narcissistic, and passive aggressive P.D.

21. Conduct DisorderConduct Disorder
Conduct Disorder is multi-determinedConduct Disorder is multi-determined
Conduct Disorder manifests in multiple waysConduct Disorder manifests in multiple ways

22. Reactive and Proactive Reactive and Proactive
AggressionAggression
Reactive adolescents had a significant tendency to come Reactive adolescents had a significant tendency to come
from backgrounds of physical abuse and harsh from backgrounds of physical abuse and harsh
discipline.discipline.
41% of all children that had been identified as 41% of all children that had been identified as
physically abused in the first 5 years of life, met criteria physically abused in the first 5 years of life, met criteria
of RA 4 years later…in contrast with only 15% of non-of RA 4 years later…in contrast with only 15% of non-
abused youngsters.abused youngsters.
Dodge, Lochman, Harnish, Bates & Pettit, 1997

23. Reactive and Proactive Reactive and Proactive
Aggression Aggression
It is possible to identify reliable subgroups of antisocial It is possible to identify reliable subgroups of antisocial
youngsters based on the type of aggressive behavioryoungsters based on the type of aggressive behavior
These reactive children display aggressive behavior that appears These reactive children display aggressive behavior that appears
to be related to developmental histories and abuse that results in to be related to developmental histories and abuse that results in
information processing pattern of antisocial beliefs and information processing pattern of antisocial beliefs and
behaviors.behaviors.
Reactive Conduct Disorder, like ADHD, was found to be Reactive Conduct Disorder, like ADHD, was found to be
strongly related to attention problems and impulsivity.strongly related to attention problems and impulsivity.

24. Reactive and Proactive Reactive and Proactive
AggressionAggression
Reactively violent youngsters (in contrast with the PV Reactively violent youngsters (in contrast with the PV
group) show a pattern of emotional dysregulation that group) show a pattern of emotional dysregulation that
includesincludes
somatization, depressive symptoms, sleep disorder symptoms, and somatization, depressive symptoms, sleep disorder symptoms, and
personality disorderspersonality disorders
..
Dodge et.al. findings are consistent with the hypothesis Dodge et.al. findings are consistent with the hypothesis
that, these reactive disorders, such as chronic violence that, these reactive disorders, such as chronic violence
have their origins in early life experienceshave their origins in early life experiences
(such as early traumas of parental rejection, exposure to family violence, (such as early traumas of parental rejection, exposure to family violence,
and family instability).and family instability).

25. Cognitive distortions tend to be Cognitive distortions tend to be highly invalidatinghighly invalidating
Attempting to treat the diagnoses, not the underlying Attempting to treat the diagnoses, not the underlying
issuesissues
Why not use CBT?Why not use CBT?

26. MDT CBT DBT FAP Schema Therapy ACT

(Apsche and
Ward Baily, 2003)
(Beck, et al.,
1990)
(Linehan,
1993)
(Kohlenberg and
Tsai, 1993)
(Young et al., 2003)(Hayes et al.,
1999)
Designed for
Adolescents
Yes No No No No Yes
Goal oriented
treatment
Yes Yes Yes Yes Yes Yes
Focus of
treatment
Present, in-vivo
work in session
Initially present
focused
Present Present Present Present
Session
structure
Yes, but flexible Yes Yes Yes Yes Yes
Session
Limitation
Aims to be time
limited
Aims to be time
limited
Cognition Unconscious and
Conscious
Conscious Conscious Conscious Conscious Conscious
Goals for
therapy
Yes – Empower
patient to modify
underlying beliefs
to thereby change
moods and
behaviours
(deactivate
modes).
Yes – Uses variety
of techniques to
change thinking,
moods, and
behaviours
Yes – Skills
training to better
manage
symptoms
Yes – Uses within-
session
contingencies to
change behaviour
Yes – Identify and
modify maladaptive
mode schemas

27. Collaboration
between therapist
and client
Yes Yes No Yes Yes
Therapeutic
alliance important
Yes Yes Yes Yes Yes Yes
Addresses
resistance
Yes
No – Assumes
patients will comply
with treatment
Yes No Yes No
Empowers client
to be own
therapist
Yes Yes No No Yes No
Thoughts/beliefs
as dysfunctional
No – Beliefs are not
thought of as
dysfunctional, which
invalidates the patient’s
experience. Beliefs are
validated as being
created out of a patient’s
experience, then are
balanced to deactivate
modes.
Yes – Teach patient
to identify, evaluate,
and respond to their
dysfunctional
thoughts and beliefs
with schema
assumptions
(scanning)
Yes – Balance
through change
and acceptance.
Yes Yes – Maladaptive mode
schemas
Yes
Clear, direct and
concrete session
for adolescent
Yes No - Uses cognitive
distortion and adult
oriented
No - Uses esoteric
and skills training
for adult
mindfulness
No No - Adult oriented No - Uses
metaphors and
Jargon
Cognitive
distortions
No – thoughts/beliefs are
not distortions since they
are based on past
experience
Yes No Yes Yes – Maladaptive mode
schemas
No
Dialectical
thinking
Yes – Focus on
balancing
No Yes – Focus on
the dialectical
pattern/process
No No No

28. Case
conceptualization
Yes – ever-evolving
and drives treatment
Yes – ever-evolving
formulation of the
patient’s problems in
cognitive terms
Yes – important Yes – case
formulation
Yes Yes
Case
conceptualisation
is specific
typology driven
Yes No No No No No
Acceptance and
validation in the
moment
Yes No Yes No No Yes
Modes Yes – Perceptions
trigger physiological
cues, which trigger
beliefs (entire process
is mode activating)
No No No No No
Triggers important Yes – Learning the
triggers is key to
preventing activation
of modes
No - Learned
behaviors
Client’s
perceptions
important
Yes – Perceptions
trigger modes
No – Perceptions are
distorted
Yes – Perceptions
are based on past
experiences
No No No
Reducing anxiety,
addressing trauma
Yes – Uses exposure
to fear cue to
decrease perception
of fear
No – Focuses on
thought feeling-
behaviors connection
No No No No
Fear_avoids
paradigm
Yes No No No No No
Data suggest -
evidenced based
effectiveness with
adolescent males
Yes No No No No No

29. MDTMDT was developed to treat the was developed to treat the
aberrant typologies of reactive aberrant typologies of reactive
conduct disorder and personality conduct disorder and personality
disorders more effectively than disorders more effectively than
traditional CBT strategies….by traditional CBT strategies….by
offering a new script to the client.offering a new script to the client.

30. Questions?Questions?

31. The MDT MethodThe MDT Method
Case ConceptualizationCase Conceptualization

32. The MDT MethodThe MDT Method
Therapeutic AllianceTherapeutic Alliance
Complete all assessmentsComplete all assessments
a.a.Typology SurveyTypology Survey
c.c.Fear AssessmentFear Assessment
e.e.CCBQ (Compound Core Belief CCBQ (Compound Core Belief
Questionnaire)Questionnaire)
Remember:
"For every complex problem
there is an answer that is
clear, simple, and wrong."

33. Typology SurveyTypology Survey
1.1. Identifying informationIdentifying information
2.2. Family information Family information
3.3. Substance abuse Substance abuse
4.4. Medical Medical
5.5. EducationalEducational
6.6. Emotional Emotional
7.7. Physiological Physiological
8.8. Interpersonal Relationship/ SocialInterpersonal Relationship/ Social
9.9. OffensesOffenses
10.10. History of Physical and Sexual AbuseHistory of Physical and Sexual Abuse
11.11. History of other AbuseHistory of other Abuse
12.12. Expectations of TreatmentExpectations of Treatment
Across three strata:Across three strata:
The clientThe client
The parentThe parent
The referral sourceThe referral source

34. Fear AssessmentFear Assessment
You select the version to administerYou select the version to administer
60 question assessment 60 question assessment
5 subcategories of beliefs5 subcategories of beliefs
Explain the types of questions you will be askingExplain the types of questions you will be asking
Ascertain the youth’s definition of words like “trust” or Ascertain the youth’s definition of words like “trust” or
“retaliation.”“retaliation.”
Use real life examples and/or scenarios, etc. Use the Use real life examples and/or scenarios, etc. Use the
skills you have to use this exercise as a rapport/ trust skills you have to use this exercise as a rapport/ trust
building tool. building tool.

35. Administering the Fear AssessmentAdministering the Fear Assessment
DoDo
Be relaxed and patientBe relaxed and patient
Make eye contact when Make eye contact when
appropriateappropriate
Be observantBe observant
Give scenariosGive scenarios
Be supportive Be supportive
Don’tDon’t
Read the assessment Read the assessment
verbatimverbatim
Move to fast through the Move to fast through the
assessmentassessment
Answer for the individualAnswer for the individual
Lead the individual to Lead the individual to
answer answer

36. Fear Assessments AvailableFear Assessments Available
Fear Assessment Revised Fear Assessment Revised
Fear Assessment ProFear Assessment Pro
Fear Assessment Pro-IIFear Assessment Pro-II
Difficulty Assessment RevisedDifficulty Assessment Revised
Difficulty Assessment ProDifficulty Assessment Pro
Difficulty Assessment Pro-IIDifficulty Assessment Pro-II

37. Conglomerate of Beliefs and Conglomerate of Beliefs and
Behaviors (COBB)Behaviors (COBB)
209 Question Assessment of Beliefs209 Question Assessment of Beliefs
96 Question Assessment of Beliefs (Short Version)96 Question Assessment of Beliefs (Short Version)
Assesses the underlying cognitive belief structure Assesses the underlying cognitive belief structure
of the client’s mode. of the client’s mode.
Closest we come to a traditional schema focusClosest we come to a traditional schema focus

38. The Case Conceptualization:The Case Conceptualization:
Hierarchies of Target Behaviors within Target Classes Hierarchies of Target Behaviors within Target Classes
in Outpatient Individual Therapyin Outpatient Individual Therapy (Linehan, M.M. (Linehan, M.M.
(1995). Treating borderline personality disorder: The (1995). Treating borderline personality disorder: The
dialectical approach. New York, NY: Guilford Press.)dialectical approach. New York, NY: Guilford Press.)
3.3.Suicidal behaviors:Suicidal behaviors:
4.4.Therapy-interfering behaviors:Therapy-interfering behaviors:
5.5.Quality-of-life interfering behaviors: Quality-of-life interfering behaviors:
6.6.Increasing behavioral skills:Increasing behavioral skills:

39. The Case Conceptualization:The Case Conceptualization:
Personal Reactive-External FearsPersonal Reactive-External Fears
AvoidsAvoids
Remember:
"For every complex problem
there is an answer that is clear,
simple, and wrong."

40. Fears and Avoids:Fears and Avoids:
FEARS AVOIDS
Failing Trying new behaviors
Anger Confrontation, being victim
Hurting someone physically Relationships, trust
Feelings
Close relationships

41. The Case Conceptualization:The Case Conceptualization:
Personal Reactive-External FearsPersonal Reactive-External Fears
AvoidsAvoids
TriggersTriggers
Remember:
"For every complex
problem there is an answer
that is clear, simple, and
wrong."

42. TriggersTriggers
Trigger 1 (conscious trigger):Trigger 1 (conscious trigger):
Anything the youth may be aware of that would trigger or activate the Anything the youth may be aware of that would trigger or activate the
fear, avoidance, and compound core beliefs. Trigger 1 is the experiential, fear, avoidance, and compound core beliefs. Trigger 1 is the experiential,
which manifests in what the youth avoids.which manifests in what the youth avoids.
Trigger 2 (unconscious trigger):Trigger 2 (unconscious trigger):
Anything the youth is not aware of, but can be identified through Anything the youth is not aware of, but can be identified through
observable behaviors to trigger or activate the fear, avoidance, compound observable behaviors to trigger or activate the fear, avoidance, compound
core beliefs. Trigger 2 is the information processing (cognitive core beliefs. Trigger 2 is the information processing (cognitive
component) of what the youth avoids. Unconscious triggers are many component) of what the youth avoids. Unconscious triggers are many
times what the youth avoids. times what the youth avoids.

43. Trigger 1Trigger 1
Conscious Conscious
ProcessingProcessing
Trigger 2Trigger 2
Unconscious Unconscious
processingprocessing
FearsFears AvoidsAvoids
Compound Compound
Core BeliefsCore Beliefs
Unfamiliar situationsUnfamiliar situationsSituations that Situations that
trying, (failing) trying, (failing)
vulnerablevulnerable
FailingFailing Trying new Trying new
BehaviorsBehaviors
I am inadequate; I I am inadequate; I
will do whatever I will do whatever I
must to hide it.must to hide it.
Trust versus betrayalTrust versus betrayalSituations of trust or Situations of trust or
counting on counting on
someone someone
(vulnerability)(vulnerability)
Hurting someone Hurting someone
physicallyphysically
Relationships-trustRelationships-trustIf I trust someone If I trust someone
today, they will today, they will
betray me later.betray me later.
DisrespectDisrespect VulnerabilityVulnerability My AngerMy Anger Confrontation Being Confrontation Being
a victima victim
Whenever I hurt Whenever I hurt
emotionally, I do emotionally, I do
whatever it takes it whatever it takes it
feel better. feel better.
When I am angry, When I am angry,
my emotions are my emotions are
extreme and out of extreme and out of
controlcontrol

44. Trigger 1Trigger 1
Conscious Conscious
ProcessingProcessing
Trigger 2Trigger 2
Unconscious Unconscious
processingprocessing
FearsFears AvoidsAvoidsCompound Compound
Core BeliefsCore Beliefs
Pressure situations Pressure situations
(confrontation, (confrontation,
consequences, consequences,
anything that anything that
triggers victim triggers victim
stuff)stuff)
TrustTrust
(Victim)(Victim)
No one will No one will
believe mebelieve me
Trusting othersTrusting othersEveryone betrays Everyone betrays
my trust.my trust.
In relationships, if In relationships, if
the other person the other person
is not with me, is not with me,
then they are then they are
against me.against me.
Showing Showing
weaknessesweaknesses
Emotions (hurt, Emotions (hurt,
betrayal) betrayal)
VulnerabilityVulnerability
Something is Something is
wrong with mewrong with me
Showing emotions Showing emotions
(especially hurt (especially hurt
and anger)and anger)
I try to control I try to control
my feelings and my feelings and
not show my not show my
grieving, loss, grieving, loss,
sadness; but it sadness; but it
eventually eventually
comes out in a comes out in a
rush of rush of
emotionsemotions

45. Compound Core Belief and Corresponding Compound Core Belief and Corresponding
Behavior(s)Behavior(s)
BORDERLINE PERSONALITY BORDERLINE PERSONALITY
DISORDERDISORDER
1.1.Everyone betrays my Everyone betrays my
trust…always.trust…always.
2.2.If I trust someone today, If I trust someone today,
they will betray me they will betray me
later…always.later…always.
3.3.Whenever I hope, I will Whenever I hope, I will
become disappointed…become disappointed…
always.always.
4.4.When I am angry, my When I am angry, my
emotions are extreme and emotions are extreme and
out of control…always,out of control…always,
Behavior(s)Behavior(s)
Doesn’t trust people or Doesn’t trust people or
engage in relationships.engage in relationships.
Reserved, distanced, and Reserved, distanced, and
blunted in relationships.blunted in relationships.
Gives up and becomes Gives up and becomes
negative at any “bump” negative at any “bump”
or disappointment.or disappointment.
Dysregulates, displays Dysregulates, displays
anger quickly.anger quickly.

46.  BORDERLINE PERSONALITY BORDERLINE PERSONALITY
DISORDERDISORDER
1.1.When I hurt emotionally, I When I hurt emotionally, I
do whatever it takes to feel do whatever it takes to feel
better…always. better…always.
2.2.Life at times feels like an Life at times feels like an
endless series of endless series of
disappointments followed disappointments followed
by pain…always.by pain…always.
3.3.I try to control my feelings I try to control my feelings
and not show my grieving, and not show my grieving,
loss, sadness, but eventually loss, sadness, but eventually
it comes out in a rush of it comes out in a rush of
emotions…always.emotions…always.
4.4.In relationships, if the other In relationships, if the other
person is not with me, then person is not with me, then
they are against me…always.they are against me…always.
Behavior(s)Behavior(s)
Dysregulates, displays Dysregulates, displays
anger quickly.anger quickly.
Will clown or “mess Will clown or “mess
around,” or disengage.around,” or disengage.
Feels and acts depressed.Feels and acts depressed.
After disturbing family After disturbing family
phone calls, becomes phone calls, becomes
angry and aggressive.angry and aggressive.
Vacillates through all or Vacillates through all or
nothing thinking.nothing thinking.

47. Compound Core Belief and Corresponding Behavior(s)Compound Core Belief and Corresponding Behavior(s)
DEPENDENT PERSONALITY DEPENDENT PERSONALITY
DISORDERDISORDER
1.1.If I am not loved, I am If I am not loved, I am
unhappy…always.unhappy…always.
2.2.I am helpless and cannot I am helpless and cannot
make it on my own…alwaysmake it on my own…always
AVOIDANT PERSONALITY AVOIDANT PERSONALITY
DISORDERDISORDER
1.1.I am inadequate; I will do I am inadequate; I will do
whatever I must to hide it…whatever I must to hide it…
always.always.
2.2.I would rather do anything I would rather do anything
to avoid failing because I to avoid failing because I
cannot succeed…always.cannot succeed…always.
Behavior(s)Behavior(s)
Emotion vacillates, between Emotion vacillates, between
extremes of idealization and extremes of idealization and
devaluation..devaluation..
Sadness, angerSadness, anger
Distances self, anger and Distances self, anger and
aggression.aggression.
Anger, outbursts, emotional Anger, outbursts, emotional
dysregulation.dysregulation.
(but accepts responsibility for his (but accepts responsibility for his
sexual offending behaviors). sexual offending behaviors).

48. Compound Core Belief and Corresponding Behavior(s)Compound Core Belief and Corresponding Behavior(s)
ANTISOCIAL PERSONALITY ANTISOCIAL PERSONALITY
DISORDERDISORDER
1.1.Unless you have a videotapes of Unless you have a videotapes of
me, you cannot prove I did me, you cannot prove I did
it….always.it….always.
2.2.If he/she can’t take care of If he/she can’t take care of
themselves, they get what they themselves, they get what they
deserve…always.deserve…always.
HISTRIONIC PERSONALITY HISTRIONIC PERSONALITY
DISORDERDISORDER
1.1.I am so exciting, others want to be I am so exciting, others want to be
around me…always.around me…always.
2.2.When I am bored, I need to When I am bored, I need to
become the center of attention…become the center of attention…
always.always.
3.3.If I act silly and entertain people, If I act silly and entertain people,
they won’t notice my weakness…they won’t notice my weakness…
always.always.
Behavior(s)Behavior(s)
Denial of small areas of Denial of small areas of
responsibilities.responsibilities.
High opinion of self.High opinion of self.
Anger, silliness.Anger, silliness.
Silly in groups and other Silly in groups and other
tense situations.tense situations.

49. The Case Conceptualization:The Case Conceptualization:
Personal Reactive-External FearsPersonal Reactive-External Fears
AvoidsAvoids
TriggersTriggers
Situational AnalysisSituational Analysis
Remember:
"For every complex problem
there is an answer that is clear,
simple, and wrong."

50. Situational AnalysisSituational Analysis
1.1.Situation:Situation:
2.2.Automatic Thought:Automatic Thought:
3.3.Meaning of Automatic Thought:Meaning of Automatic Thought:
4.4.Physiological:Physiological:
5.5.Emotions:Emotions:
6.6.Behaviors:Behaviors:

51. Questions?Questions?

52. The MDT MethodThe MDT Method
TreatmentTreatment

53. Functionally Based TreatmentFunctionally Based Treatment
IDENTIFY NEW
BELIEF SYSTEM
IDENTIFY
HEALTHY
ALTERNATIVE
THOUGHTS
FUNCTIONAL
ALTERNATIVE
COMPENSATORY
STRATEGY
FUNCTIONAL
REINFORCING
BEHAVIOR(S)
SPECIFIC
FUNCTIONAL
TREATMENT
INDIVIDUAL
THERAPY TO
MILIEU
VALIDATE/
CLARIFY/
REDIRECT
(VCR)
I can trust some people
some times.
I am adequate.
I can balance myself.
When I hurt
emotionally I can
balance myself.
My anger can be
balanced.
If others disagree, they
may not be against me.
I can take a risk to feel.
I can balance my pain.
I can deactivate my
anger.
I will take small steps
and measure others…
trust level.
I accept others’ faults;
they accept mine.
Practice rational
thought and balance.
Identify physiological
triggers, rank –
identify cognitions and
anticipated events.
Work on scales of trust
with therapist to
develop alliance.
Work on balance of
belief scales.
Identify my balance
thoughts.
Practice through
imagined exposure to
all physiological &
cognitive triggers
Try to trust one staff,
Ms. Margaret.
Pick one issue and take
a risk one step at a
time, in group.
Identify issues that
cause pain and practice
balance.
Practice mode
activation with staff in
vivo.
Identify when
physiological triggers
initiate.
Identify continuum of
fear activation.
Identify when beliefs
go out of balance.
It’s okay to not trust
some people at times,
identify one person he
does trust some of the
time and use scale of
trust to measure trust
daily
It’s okay to make
mistakes, help him
identify areas of
adequacy and use
belief scales to balance
It’s okay to feel
overwhelmed by
emotions, identify
thoughts/ beliefs to
balance emotions
It’s okay to feel angry,
identify physiological
system and beliefs to
slow down, prevent, or
reduce escalation
Use belief scales to
balance beliefs

54. Functionally Based TreatmentFunctionally Based Treatment
Identify New Belief SystemIdentify New Belief System
Identify Healthy Alternative ThoughtsIdentify Healthy Alternative Thoughts
Functional Alternative Compensatory Functional Alternative Compensatory
StrategiesStrategies
Functional Reinforcing BehaviorsFunctional Reinforcing Behaviors
Specific Functional Treatment, Individual Specific Functional Treatment, Individual
Therapy to MilieuTherapy to Milieu
Validate/ Clarify/ Redirect (VCR)Validate/ Clarify/ Redirect (VCR)

55. Validation:Validation:
Defined by Linehan (1997) as the therapist Defined by Linehan (1997) as the therapist
communicating to the client that the client’s communicating to the client that the client’s
responses make sense and are understandable within responses make sense and are understandable within
the client’s current life context or situation. The the client’s current life context or situation. The
therapist has to uncover the validity within the therapist has to uncover the validity within the
client’s response, sometimes amplify it, and then client’s response, sometimes amplify it, and then
reinforce it. Linehan goes further to note this reinforce it. Linehan goes further to note this
importance of understanding that validation is about importance of understanding that validation is about
acknowledging that which is valid and that acknowledging that which is valid and that
something may be valid even if it is not scientific or something may be valid even if it is not scientific or
empirical. The focus is on the client’s experience. empirical. The focus is on the client’s experience.
Balance the validation of truth with the possibility of Balance the validation of truth with the possibility of
the other person’s truth. the other person’s truth.

56. Validation:Validation:
Levels of ValidationLevels of Validation. .
Level 1Level 1.. Active Observing. Active Observing.
Level 2Level 2.. Reflecting the Observed. Reflecting the Observed.
Level 3Level 3.. Articulating the Unobserved. Articulating the Unobserved.
Level 4Level 4.. Validating in Terms of the Past or of Validating in Terms of the Past or of
Biology. Biology.
Level 5Level 5.. Validation in Terms of the Present. Validation in Terms of the Present.

57. Redirect:Redirect:
Youth’s belief Youth’s belief Other’s belief or Other’s belief or

source of conflictsource of conflict
DysregulationDysregulation
Youth’s belief #1 Youth’s belief #2Youth’s belief #1 Youth’s belief #2
DysregulationDysregulation
Dichotomous beliefDichotomous belief

58. Identify New Identify New
BeliefBelief
SystemSystem
Identify Identify
Healthy Healthy
Alternative Alternative
ThoughtsThoughts
Functional Functional
Alternative Alternative
CompensatoCompensato
ryry
StrategyStrategy
Functional Functional
Reinforcing Reinforcing
Behavior(s)Behavior(s)
Specific Specific
Functional Functional
Treatment Treatment
Individual Individual
Therapy to Therapy to
MilleuMilleu
Validate/Validate/
Clarify/ Clarify/
Redirect (VCR)Redirect (VCR)
I can trust I can trust
some people some people
some times.some times.
If others If others
disagree, disagree,
they may they may
not be not be
against me.against me.
I will take I will take
small steps small steps
and and
measure measure
others…others…
trust level.trust level.
Work on Work on
scales of scales of
trust with trust with
therapist to therapist to
develop develop
alliance.alliance.
Try to trust Try to trust
one staff, one staff,
Ms. Ms.
Margaret.Margaret.
It’s okay to not It’s okay to not
trust some people trust some people
at times, identify at times, identify
one person he one person he
does trust some does trust some
of the time and of the time and
use scale of trust use scale of trust
to measure trust to measure trust
dailydaily
I am I am
adequate. I adequate. I
can balance can balance
myself.myself.
I can take a I can take a
risk to feel.risk to feel.
I accept I accept
others’ others’
fault; they fault; they
accept mineaccept mine
Work on Work on
balance of balance of
belief scales.belief scales.
Pick one Pick one
issue and issue and
take a risk take a risk
one step at a one step at a
time, in time, in
group.group.
It’s okay to It’s okay to
make mistakes, make mistakes,
help him help him
identify areas of identify areas of
adequacy and adequacy and
use belief scales use belief scales
to balance.to balance.

59. Therapeutic MindfulnessTherapeutic Mindfulness
1.1.AwarenessAwareness
2.2.Of present experienceOf present experience
3.3.With acceptanceWith acceptance
Each component supports the other (like a three Each component supports the other (like a three
legged stool, if you remove one the it will fail.) legged stool, if you remove one the it will fail.)

60. MindlessnessMindlessness

61. Mindfulness Can Help Mindfulness Can Help UsUs
To see and accept things as they are.To see and accept things as they are.
To loosen our preoccupation with “self”. To loosen our preoccupation with “self”.
To experience the richness of the To experience the richness of the
moment .moment .
To become free to act To become free to act skillfully.skillfully.

62. Mindfulness of AnxietyMindfulness of Anxiety
1.1.Noticing prevalence of anxious thoughts Noticing prevalence of anxious thoughts
and feelingsand feelings
2.2.Seeing the component parts Seeing the component parts
3.3.Noticing future-oriented catastrophizing Noticing future-oriented catastrophizing
4.4.Noticing aversion responses Noticing aversion responses
5.5.Staying with experience is exposure Staying with experience is exposure
treatmenttreatment

63. The MDT Client WorkbookThe MDT Client Workbook
Table of Contents
Chapter 1. Commitment To Treatment- Mindfulness
Chapter 2. Responsibility
Chapter 3. Belief Analysis (Compound Core Beliefs)
Chapter 4. Modes
Chapter 5. MDT and Reactive Anger, Aggression and Impulse Control
Chapter 6. Beliefs and Problem Behaviors
Chapter 7. Problem Behaviors and MDT
Chapter 8. Substance Abuse
Chapter 9. Developing Empathy
Chapter 10. Becoming a Survivor

64. Chapter 1:Chapter 1: Commitment to Treatment Commitment to Treatment
What is treatment?What is treatment?
______________________________________________________
______________________________________________________
______________________________________
Rate your level of commitment to Rate your level of commitment to
treatment using the following scale: treatment using the following scale:
1-100% (1%=no commitment; 1-100% (1%=no commitment;
100%=total commitment). Rate 100%=total commitment). Rate
your level of commitment on a your level of commitment on a
__________ basis (this will be __________ basis (this will be
determined by your therapist).determined by your therapist).
DAY/ DATEDAY/ DATE LEVEL OF LEVEL OF
COMMITMENTCOMMITMENT
DAY/ DAY/
DATEDATE
LEVEL OF LEVEL OF
COMMITMENTCOMMITMENT

65. Chapter 1:Chapter 1: Commitment to Treatment Commitment to Treatment
Trust ScalesTrust Scales
What does trust mean to you? What does trust mean to you?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Rate your level of trust for three Rate your level of trust for three
significant people in your life significant people in your life
(identified with your therapist) using (identified with your therapist) using
the following scale: 1-10 (1=no trust; the following scale: 1-10 (1=no trust;
10=total trust). Rate your level of trust 10=total trust). Rate your level of trust
for each person on a __________ for each person on a __________
basis (this will be determined by your basis (this will be determined by your
therapist).therapist).
Person # 1Person # 1
Name:Name:
Person #2Person #2
Name:Name:
Person #3Person #3
Name:Name:
DayDay
DateDate
rr
aa
tt
ee
Why?Why? rr
aa
tt
ee
Why?Why? rr
aa
tt
ee
Why?Why?
Level of TrustLevel of Trust

66. Chapter 1:Chapter 1: Commitment to Treatment Commitment to Treatment
MDT DAILY RECORDMDT DAILY RECORD
Daily RecordDaily Record
Use the following scale to rate each of the Use the following scale to rate each of the
categories:categories:
Never/or Not Intense - 0 1 2 3 4 5 - Always/or IntenseNever/or Not Intense - 0 1 2 3 4 5 - Always/or Intense
Rate DailyRate Daily

Day/Day/
DateDate
Re-Re-
OffendOffend
Y/NY/N
Hurt Hurt
Some-Some-
oneone
Y/NY/N
UrgesUrges
Y/NY/N
Hurt or Hurt or
PainPain
Y/NY/N
AfraidAfraid
Y/NY/N
AngryAngry
Y/NY/N
Other Other
FeelingFeeling
TruthTruth
Y/NY/N
Used Used
Relaxa-Relaxa-
tion tion
Skill Skill
SetsSets
Y/NY/N
HelpedHelped
Y/NY/N

67. Chapter 1:Chapter 1: Commitment to Treatment Commitment to Treatment
Daily RecordDaily Record
Please rate the individual therapy session:Please rate the individual therapy session: Not Helpful - 0 1 2 3 4 5 – Very Helpful Not Helpful - 0 1 2 3 4 5 – Very Helpful
Use the scale to the rightUse the scale to the right
Before the session: How helpful did you think the session would be?Before the session: How helpful did you think the session would be?
After the session: How helpful was the session?After the session: How helpful was the session?
Please list beliefs that have been activated this week:Please list beliefs that have been activated this week:

68. Chapter 2:Chapter 2: Responsibility Responsibility
I am I am % % responsible responsible My victim is My victim is % % responsible responsible
LIST OF MY RESPONSIBILITYLIST OF MY RESPONSIBILITY LIST OF MY VICTIM’S (OR LIST OF MY VICTIM’S (OR
OTHER’S) RESPONSIBILITYOTHER’S) RESPONSIBILITY
Example: I accept responsibility Example: I accept responsibility
for provoking my peer.for provoking my peer.
My peer should have ignored me, My peer should have ignored me,
rather than assaulting me.rather than assaulting me.

69. Chapter 3.Chapter 3. Belief Analysis Belief Analysis
1. Write down beliefs related to your 1. Write down beliefs related to your
thoughts (at any given time).thoughts (at any given time).
THOUGHTSTHOUGHTS BELIEFSBELIEFS
2. Write in the space below your
beliefs and behaviors at any given
time.
BELIEFSBELIEFS BEHAVIORSBEHAVIORS

70. Chapter 3.Chapter 3. Belief Analysis Belief Analysis
TFAB (Triggers, Fears, Avoids, TFAB (Triggers, Fears, Avoids,
Beliefs)Beliefs)
8. The triggers to my fears, worries, 8. The triggers to my fears, worries,
anxieties are as follows (complete with anxieties are as follows (complete with
your therapist):your therapist):
Trigger 1(T1)Trigger 1(T1)
Things you know that Things you know that
make you anxious or make you anxious or
scared.scared.
Trigger 2 (T2)Trigger 2 (T2)
Things you don’t know Things you don’t know
(but others identify) that (but others identify) that
make you anxious or make you anxious or
scared. This is often what scared. This is often what
you avoid.you avoid.
FearsFears

71. Chapter 4.Chapter 4. Modes Modes
ModesModes
What is a Mode?What is a Mode?
A mode is different than your mood. A mood is how you feel. A mode is different than your mood. A mood is how you feel.
It is your emotions and feelings. A mode is your entire self. It is your emotions and feelings. A mode is your entire self.
It includes your thoughts, feelings, beliefs and underlying It includes your thoughts, feelings, beliefs and underlying
physiological self.physiological self.
A mode includes the total of all of your life experiences that A mode includes the total of all of your life experiences that
create part of how you understand life. These experiences create part of how you understand life. These experiences
create a – or way you see, interpret and understand life. create a – or way you see, interpret and understand life.
These experiences create an unconscious interpretation of These experiences create an unconscious interpretation of
life’s events.life’s events.
So, you mood is only one aspect of your mode.So, you mood is only one aspect of your mode.

72. Chapter 5.Chapter 5. MDT and Reactive Anger, MDT and Reactive Anger,
Aggression, and Impulse ControlAggression, and Impulse Control
Aggression and ViolenceAggression and Violence
Often teenagers and adults say, “I just got mad – it just happened,
I got real angry and hit him.”
YET EVERYTHING YOU DO STARTS WHEN YOUR
MODES ARE ACTIVATED.
There are two types of aggression:
5)planned way ahead AND
2) thought created on-the-spot (or short-thoughted).

73. Chapter 5.Chapter 5. MDT and Reactive Anger, MDT and Reactive Anger,
Aggression, and Impulse ControlAggression, and Impulse Control
MDT and Reactive Anger, Aggression and Impulse ControlMDT and Reactive Anger, Aggression and Impulse Control
What were your activated beliefs?What were your activated beliefs?
1.__________________________________________________________1.__________________________________________________________
________________________________________________________________________________________________________________________
__
2___________________________________________________________2___________________________________________________________
________________________________________________________________________________________________________________________
Now, were these beliefs tied to past experiences?Now, were these beliefs tied to past experiences?
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
How were these beliefs related to your memories of past events in your life?How were these beliefs related to your memories of past events in your life?
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

74. Chapter 6.Chapter 6. Beliefs and Problem Beliefs and Problem
BehaviorsBehaviors
Core Belief Balancing ExerciseCore Belief Balancing Exercise
Balancing beliefs is about accepting what is there and learning to balance, not change Balancing beliefs is about accepting what is there and learning to balance, not change
your beliefs. First identify your compound core belief, then balance it.your beliefs. First identify your compound core belief, then balance it.
Compound Core Belief: Compound Core Belief:
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
________________________________________________________________________________________
New Balanced Belief:New Balanced Belief:
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
________________________________________________________________________________________

75. Chapter 6.Chapter 6. Beliefs and Problem Beliefs and Problem
BehaviorsBehaviors
SUPPORT OF SUPPORT OF
COMPOUND CORE COMPOUND CORE
BELIEFBELIEF
SUPPORT OF NEW SUPPORT OF NEW
BALANCED BELIEFBALANCED BELIEF
% Of Belief of Old Compound Core % Of Belief of Old Compound Core
Belief Belief % %
% Of Belief of Alternative Belief % Of Belief of Alternative Belief
%%

76. Chapter 6.Chapter 6. Beliefs and Problem Beliefs and Problem
BehaviorsBehaviors
Beliefs, Feelings, and Behaviors Beliefs, Feelings, and Behaviors
WorksheetWorksheet
At the beginning of a session, your At the beginning of a session, your
therapist will prompt you to discuss therapist will prompt you to discuss
beliefs, feelings, and behaviors.beliefs, feelings, and behaviors.
Your therapist will help you identify Your therapist will help you identify
how compound core beliefs can how compound core beliefs can
produce self-defeating feelings, leading produce self-defeating feelings, leading
to self-destructive behaviors.to self-destructive behaviors.
Complete the form based on the Complete the form based on the
previous event/ discussion.previous event/ discussion.
Continue the session using the Continue the session using the
previous example to demonstrate how previous example to demonstrate how
the process works.the process works.
Homework – Complete the new form Homework – Complete the new form
based on the results of the session.based on the results of the session.

77. Chapter 7.Chapter 7. Problem Behaviors and MDT Problem Behaviors and MDT
Problem Behaviors and MDTProblem Behaviors and MDT
You will now learn how to apply MDT to your You will now learn how to apply MDT to your
problem behaviors.problem behaviors.
Use your completed work from your Mode Use your completed work from your Mode
Chapter (Chapter 4), as well as your Problem Chapter (Chapter 4), as well as your Problem
Behavior Compound Core Beliefs (Chapter 3).Behavior Compound Core Beliefs (Chapter 3).
Review your TFAB from the previous chapter:Review your TFAB from the previous chapter:

78. Chapter 7.Chapter 7. Problem Behaviors and MDT Problem Behaviors and MDT
T1T1 T2T2 FF AA BB

79. Chapter 8.Chapter 8. Substance Abuse Substance Abuse
Drugs, Alcohol, SubstancesDrugs, Alcohol, Substances
If you were involved in drinking, smoking, snorting, shooting, If you were involved in drinking, smoking, snorting, shooting,
huffing….or whatever method you use/used to get high. Drugs huffing….or whatever method you use/used to get high. Drugs
and addictions involve many pathways to get high. We are going and addictions involve many pathways to get high. We are going
to address your use of addiction from the MDT methodologies. to address your use of addiction from the MDT methodologies.
This is considered a support to your other substance abuse This is considered a support to your other substance abuse
therapy, not a substitution. therapy, not a substitution.
Let’s begin by examining your drug of choice. Please list the Let’s begin by examining your drug of choice. Please list the
substances that you have taken.substances that you have taken.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________

80. Chapter 8.Chapter 8. TFAB TFAB
(TRIGGERS, FEARS, AVOIDS, BELIEFS)(TRIGGERS, FEARS, AVOIDS, BELIEFS)
Which Triggers, Fears, Avoids and Beliefs relate Which Triggers, Fears, Avoids and Beliefs relate
to substances? Please use the CD column to to substances? Please use the CD column to
write down your ideas.write down your ideas.
T1T1 T2T2 FEARSFEARS AVOIDSAVOIDSCCBCCB CDCD

81. Chapter 9.Chapter 9. Developing Empathy Developing Empathy
There are many types of abuse or neglect that can change There are many types of abuse or neglect that can change
the course of your life. Abuses such as the following; sexual the course of your life. Abuses such as the following; sexual
abuse, physical abuse, emotional abuse, neglect, and abuse, physical abuse, emotional abuse, neglect, and
bullying and intimidation.bullying and intimidation.
Each of these types of abuse has similarities and some Each of these types of abuse has similarities and some
difference. Any or all of these abuses hurts you and difference. Any or all of these abuses hurts you and
changes how you think, feel and see the world.changes how you think, feel and see the world.
Victims of abuse go through three separate periods of Victims of abuse go through three separate periods of
adjustment – immediate, intermediate and long-term – in adjustment – immediate, intermediate and long-term – in
which each period has a set of painful problems.which each period has a set of painful problems.

82. Chapter 9.Chapter 9. Developing Empathy Developing Empathy
IntroductionIntroduction: This section presents six interviews : This section presents six interviews
with young males who were abused in different with young males who were abused in different
ways. They includes victims of sexual abuse, ways. They includes victims of sexual abuse,
emotional abuse, physical abuse, and bullying. emotional abuse, physical abuse, and bullying.
Listen to the interview with each victim and Listen to the interview with each victim and
respond to the questions in the exercises which respond to the questions in the exercises which
follow them. When you read and listen to these follow them. When you read and listen to these
interviews, use the empathy skills that you are interviews, use the empathy skills that you are
developing. Listen as if it were you were the victim developing. Listen as if it were you were the victim
telling the story – putting yourself in the victim’s telling the story – putting yourself in the victim’s
place.place.

83. Chapter 10.Chapter 10. Becoming a Survivor Becoming a Survivor
Use a cassette tape recorder (obtain one from your Use a cassette tape recorder (obtain one from your
advocate or therapist) and tell your story. Use your advocate or therapist) and tell your story. Use your
work in the Empathy chapter and the “tellings” as work in the Empathy chapter and the “tellings” as
your guide. Talk about your life, as you remember, your guide. Talk about your life, as you remember,
prior to your victimization(s). Try to discuss the prior to your victimization(s). Try to discuss the
particulars of your problem behavior. Include particulars of your problem behavior. Include
information such as: your perpetrator, how old you information such as: your perpetrator, how old you
were, who you could or could not tell, how you were, who you could or could not tell, how you
held things inside of yourself, how learned to shut held things inside of yourself, how learned to shut
down your emotions, your anger, how your down your emotions, your anger, how your
problem behavior led to your perpetration.problem behavior led to your perpetration.

84. Chapter 10.Chapter 10. Becoming a Survivor Becoming a Survivor
Treatment GoalTreatment Goal
Now your victim work has only begun. With Now your victim work has only begun. With
your therapist you need to develop a treatment your therapist you need to develop a treatment
goal, and in individual and group therapy you goal, and in individual and group therapy you
need to continue work on your treatment.need to continue work on your treatment.
Examine your TFAB and with your therapist, Examine your TFAB and with your therapist,
understand how your fears were developed from understand how your fears were developed from
your victimization. Your fears are responses to your victimization. Your fears are responses to
trauma that was inflicted on you by your abuser.trauma that was inflicted on you by your abuser.