TREATMENT PROGRAM
Change Theory. Treatment phase objectives are based on Declimente’s and Prochaska’s work with stages of change, and Wansburg’s and Milkman’s work in “Criminal Conduct and Substance Abuse Treatment”. At CTTC we break down our treatment phases into; Challenge to Change, Commitment to Change, and Ownership of Change. The objectives of these phases are monitored by the treatment team (counselors, RCSOs, intake coordinator, Director and Assistant Director). A written progress review checklist is used to ensure continuity and consistency between residents as they move through the phases.
Cognitive Change Theory. Thinking For a Change is the basis for the Center’s cognitive programming. It is based on the following basic premises:
o Its not what happens to you that makes you miserable, but rather, its what you think about what happened to you that upsets you, emotionally, and gets you into trouble.
o Many people hold irrational thoughts that cause much pain and discord in our lives.
o When irrational thoughts are identified, disputed, and replaced with rational thoughts, much of the emotional upset leaves our lives
o Thoughts, feelings, and attitudes control the way people act.
o By employing the 3 steps of cognitive self change, people can change their thoughts, feelings and attitudes, and consequently, their behavior:
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Observe our thinking and feeling
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Recognize the risk that our thinking and feelings may lead to trouble
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Use new thinking to reduce that risk.
Each resident completes all 22 Thinking for a Change lessons. Those lessons are re-enforced by assigning thinking reports as additional work when rules are broken or conduct is inappropriate. Additional reinforcement is provided during group counseling and one-on-one encounters between staff and residents. All staff members have been given at least rudimentary training in Thinking For a Change to ensure appropriate interactions between staff and residents.
Social Learning Theory. In addition to the formal lessons taught in Thinking for a Change and Moral reconation Therapy, much learning takes place within the residential community. At the Center, treatment team members and other staff approach social learning intentionally and with purpose. Every situation, every group holds an opportunity to learn and teach by observing and then modeling appropriate behavior.
The social learning theory of Bandura emphasizes the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others. He states: “Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behavior is learned observationally through modeling: from observing others one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action.” Social learning theory explains human behavior in terms of continuous reciprocal interaction between cognitive, behavioral, an environmental influences.
The component processes underlying observational learning are: (1) Attention, including modeled events (distinctiveness, affective valence, complexity, prevalence, functional value) and observer characteristics (sensory capacities, arousal level, perceptual set, past reinforcement), (2) Retention, including symbolic coding, cognitive organization, symbolic rehearsal, motor rehearsal), (3) Motor Reproduction, including physical capabilities, self-observation of reproduction, accuracy of feedback, and (4) Motivation, including external, vicarious and self reinforcement.
Because it encompasses attention, memory and motivation, social learning theory spans both cognitive and behavioral frameworks. Its basic Principles include:
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The highest level of observational learning is achieved by first organizing and rehearsing the modeled behavior symbolically, and then enacting it overtly. Coding modeled behavior into words, labels or images results in better retention than simply observing.
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Individuals are more likely to adopt a modeled behavior if it results in outcomes they value.
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Individuals are more likely to adopt a modeled behavior if the model is similar to the observer and has admired status and the behavior has functional value.
Moral Development Theory. Moral Reconation Training is the method by which residents are challenged to develop morally. MRT has been successful in reducing recidivism in correctional setting primarily because it provides a place and a way for offenders to confront their moral values and change them where necessary in order to remain crime free. We believe that moral thinking develops in stages through a specific sequence. We base our thinking primarily on the work of Lawrence Kohlberg (1969, 1984) as presented in his 6 stages and 25 “basic moral concepts.” This approach focuses primarily on moral values, such as fairness, justice, equity, and human dignity. It is assumed that students invariantly progress developmentally in their thinking about moral issues. They can comprehend one stage above their current primary stage and exposure to the next higher level is essential for enhancing moral development. MRT facilitators attempt to stimulate students to develop more complex moral reasoning patterns through the sequential stages.
Choice Theory. A recent addition to the Center’s repertoire of treatment theories is Choice Theory, a refinement of Reality Therapy. Choice Theory, developed by William Glasser, MD., provides an explanation of motivation which is markedly different from what many of us have been taught. A central aspect of Choice Theory is the belief that we are internally, not externally motivated. While other theories suggest that outside events “cause” us to behave in certain predictable ways, Choice Theory teaches that outside events never “make” us to do anything. What drives our behavior are internally developed notions of what is most important and satisfying to us. Our “Quality World Pictures,” these internally created notions of how we would like things to be, are related to certain Basic Needs built into the genetic structure of every human being. The Basic Needs which provide the foundation for all motivation are: to be loving and connected to others; to achieve a sense of competence and personal power; to act with a degree of freedom and autonomy; to experience joy and fun; and to survive.
Another major concept in Choice Theory is the notion that we always have some choice about how to behave. This does not mean that we have unlimited choice or that outside information is irrelevant as we choose how to behave. It means that we have more control than some people might believe and that we are responsible for the choices we make.
The Ten Axioms of Choice Theory
1. The only person whose behavior we can control is our own.
2. All we can give another person is information.
3. All long-lasting psychological problems are relationship problems.
4. The problem relationship is always part of our present life.
5. What happened in the past has everything to do with what we are today, but we can only satisfy our basic needs right now and plan to continue satisfying them in the future.
6. We can only satisfy our needs by satisfying the pictures in our Quality World.
7. All we do is behave.
8. All behavior is Total Behavior and is made up of four components: acting, thinking, feeling and physiology.
9. All Total Behavior is chosen, but we only have direct control over the acting and thinking components. We can only control our feeling and physiology indirectly through how we choose to act and think.
10. All Total Behavior is designated by verbs and named by the part that is the most recognizable.
12-Step Support. Twelve Step objectives include working the first five steps of Alcoholics Anonymous. Residents attend daily 12-step meetings for the first two weeks of their stay and attend 5 meetings per week thereafter. They receive step work written materials to assist them in analyzing their thinking in regard to the steps, and they process their step work in small groups, receiving feedback and advice from residents who have already done the work. Video presentations on the steps are also available for individual or group viewing.
v First Step - The first step states, “We admitted we were powerless over alcohol – that our lives had become unmanageable.” This step prepares residents to humble themselves before their criminal conduct and substance abuse. They are encouraged to look carefully at their history of criminal conduct and substance abuse and determine the price they paid for it.
v Second Step - “We came to believe that a Power greater than ourselves could restore us to sanity.” This step helps the residents become less self-centered, a characteristic that is prevalent in this population. It helps them ask for help and opens their minds to the feedback from others.
v Third Step - “We made a decision to turn our will and our lives over to the care of God as we understood Him.” This step encourages residents to seek answers and comfort from outside sources. It enables them to begin exploring the spiritual aspects of their lives.
v Fourth Step - “We made a searching and fearless moral inventory of ourselves.” This step helps them list their character defects. These problems cannot be dealt with until they are identified.
v Fifth Step - “We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.” This step moves them toward public confession of their misdeeds and acceptance of their culpability regarding their criminal conduct and substance abuse.