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Treatment outside the therapy room: An experiential learning approach to PD awareness
- 1. Treatment outside the therapy room: an experiential learning approach to PD awareness Westgate Dangerous and Severe Personality Disorder (DSPD) Unit, November 2009
- 14. Lapsing and Relapse in WMC
- 18. The Teeter Totter Challenge (( Traits (( (( Teamwork
- 20. Insight as the first step in the change process
- 27. Complete the Teeter Totter Challenge (( Traits (( (( Teamwork
- 28. Feedback
- 32. Experiential Learning Cycle Concrete Experience Observe Plan Conceptualise
- 33. Experiential Learning Cycle (somewhat) simplified. Experience This stage involves the actual ‘doing’ of the skill. The practicing of whatever it is that the learner is trying learn.
- 34. Experiential Learning Cycle (somewhat) simplified. Experience Observe Plan After the experience of the skill, the learner ‘observes’ the consequences of their actions. What happened when the skill was practiced?
- 35. Experiential Learning Cycle (somewhat) simplified. Experience Observe Conceptualise Making sense of what happened: Relating it to previous experience and knowledge Searching for understanding Generalising, abstracting principles
- 36. Experiential Learning Cycle (somewhat) simplified. Experience Observe Plan Reflect Conceptualise Considering the practical implications of new understanding. Planning how you will put your new knowledge into practice when you next attempt the skill.
- 37. Experiential Learning Cycle (somewhat) simplified. Experience Observe Plan Reflect Conceptualise Applying new understanding or knowledge to one’s actions. Testing your ideas
- 38. Debriefs: Applying the ELC Concrete Experience Conceptualise Observe Plan PT DEBRIEF PT MAIN EXERCISE
- 49. How can we promote skills?
- 56. How do we maintain change?
Notas do Editor
- The Westgate Unit is an 80 bed purpose built DSPD unit. Contains own healthcare, education, horticulture, gymnasium We are going to be talking about something today called Parallel Therapy. This is therapy that occurs in a range of environments at the unit to complement CBT-based offending behaviour work. Today we are going to use ourselves as a model of what we expect from our prisoners. We are going to try to generalise the skills we have developed in a high secure environment to a novel environment where there is little scope for us to predict or control what is going to happen.
- Given what we have said about the WMC, and the means of assessing movement through the change process, there is a clear need to establish a more dynamic treatment environment to simulate ‘real life’ as far as possible.
- Blud, Thornton & Ramsey Heimmermann (2003) - Individuals with many psychopathic traits are likely to benefit from cognitive skill treatment programmes in the short term… … they are less likely to generalise and maintain these skills in the longer term. Goldstein and Glick (1994) - failures to generalise skills outside the learning environment stem from an assumption amongst clinicians that attendance on offender treatment programmes would in some way “inoculate” participants against future lapses.
- This criterion has evident significance given the population we are applying the WMC to. Given the largely controlled, and closely monitored environment on the unit, there is limited capacity to demonstrate behavioural changes in ‘high-risk’ situations. As an individual progresses through treatment, we would hope that their high risk situations can be collaboratively identified and documented for future treatment providers (WWIRE sites?)
- The WMC explicitly represents the potential to regress to earlier stages, without having to ‘start again from square one’. An isolated change in behaviour (with maintained recognition of the need area as problematic) is considered a lapse . This is signified on the diagram by the feedback arrows to the behavioural stages. A “cognitive shift” indicates relapse. This can be characterised by either: a continuing awareness on the part of the participant of the benefits of change, but ambivalence expressed towards continuing this process (i.e. a return to contemplation); or, the participant’s experience of thoughts likely to promote and maintain the need area. For example, such a relapse would be evident where an individual justifies an assault on another prisoner on the basis that “it's how I've always done things, and probably how I always will” (indicating a return to the pre-contemplation stage). Marlatt & Witkiewitz (2005) concluded “it is critical that clients are taught to restructure their negative thoughts about lapses”. They identify that “the individual who views a lapse as a learning experience is more likely to experiment with alternative coping strategies in the future, which may lead to more effective responses in high-risk situations”.
- The essence of the session is that it gives a nugget of shared experience and prompts the question “how does my personality manifest itself? How can I express what these problems are?”. We don’t tip-toe around the traits that may impact on future behaviour, because we think that insight into problems is a key component of doing something about them. The exercise does challenge people to come out of their comfort zone, which can be anxiety provoking. The style of delivery has to be warm, upbeat and fun.
- This is the Lewin/Kolb four stage model of Experiential Learning. For those of you who have been trained in the Parallel Therapy component, this should hopefully be familiar to you as the model around which that service is based. It represents a theoretical explaination of the process of learning through experience. Other people may be familiar with this from their experience of psychology or education. As such, some of you might be comfortable with the language used here…if so that fine… … but for those who aren’t so familiar with it we’ll run through the basics of the model now, with the terms simplified a bit…hopefully this will make them a bit more meaningful and easier to remember.
- Add that each of the four stages are intrinsic to the learning process… … but that potentially, the learning cycle can start at any of the four stages. CHECK UNDERSTANDING OF POINTS COVERED THUS FAR.
- During WITNAP participants have a debrief to give them further opportunities to reflect on the sessions.
- Participants in the research felt that whilst there were strong benefits to PT, there were perhaps better ways that they could be encouraged to begin to generalise skills.
- As already highlighted, given the way in which progress is assessed, it is vital that participants are given every opportunity to both develop and demonstrate new skills. Parallel Therapy is great for this. We love it.