Mode Deactivation Therapy: A theoretical case analysis (Part I).

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This is the first part of a case study presenting a single case analysis of an 18 year-old African -American male. It also presents a theoretical analysis of the case implementing Mode Deactivation Therapy (MDT) (Apsche, Ward, & Evile, 2002). MDT is a form of CBT that combines the balance of DBT with a methodology to address the adolescents' belief system. MDT has been shown to be effective in a descriptive study with CBT (Apsche & Ward, 2002). The analysis of MDT while reviewing this case presents an opportunity to understand the development of mdt, while reviewing it's effectiveness with this case. The individual in this case, John, was a troubled youngster. He had been the recipient of severe and pervasive physical abuse by his mother and father. He and his sister were neglected and abandoned as children at the age of 5 years old. John developed a complex system of personality disorder beliefs to cope with his world. These beliefs had led John to commit numerous violent acts as a sexual offense. This theoretical case study represents the beginning of mode deactivation therapy from theory to clinical practice. He was treatment savvy and was able to define basic cognitive therapy techniques but would engage in dialectical debates about distortions and would negatively engage his therapist who suggested that he distorted information. ********** INTRODUCTION The development of Mode Deactivation Therapy (MDT) as an applied CBT methodology has been a challenge. The difficulty begins in the attempt to treat adolescents with complicated history and multi-axial diagnoses. Many of the adolescents that we treat are victims of sexual, physical, and/ or emotional abuse. These individuals have developed survival coping strategies. Many of these survival mechanisms translate into personality traits and/or disorders. These personality traits and/or disorders are not cluster bound. Meaning that they are translated into beliefs and schemas that are inclusive of beliefs from all three clusters. Often it has been thought that individuals stay true to their cluster, this is not so, with the adolescent typology that we treat. The concepts of mode deactivation therapy (MDT) are derived from many aspects of functional analytic behavioral therapy (FAP), dialectical behavior therapy (DBT), and cognitive behavior therapy (CBT). The focus of MDT is largely based on Beck's recent area of research and application, the system of modes (Beck, 1996, Alford and Beck, 1997). Functional analytic psychotherapy (FAP) (Kohlenberg & Tsai, 1993) theory states people act based on reinforcement contingencies. Although FAP takes into consideration that cognitions are involved, the focus is on the deeper unconscious motivations that were formed as a result of past contingencies. Perception is based on past contingencies, therefore, reality and the concept of reality reflects what has been experienced in the past. Considering reinforcement history in the context of a person provides a more complete assessment of a person and specific behaviors. By restructuring beliefs, MDT addresses underlying perceptions that may be applicable to setting in motion the mode related charge of aberrant schemes, that enable the behavior integration of DBT principles, (Linehan, 1993) of treating of sex offending or aggressive behaviors. Many of Linehan's teachings describe radical acceptance and examining the "truth" in each client's perceptions. This methodology of finding the grain of truth in the perception of the adolescent is at the crux of MDT. We also "borrow" radical acceptance in the form of helping the youth accept who he is based on his beliefs. The other major similarity between DBT and MDT is the use of balancing the dichotomous or dialectical thinking of the client. Often CBT as viewed by "arguing" the concepts of cognitive distortions fails with these youngsters. They do not respond to being in a one-down position, no matter how aligned they are with their therapist. …