Mode deactivation therapy (MDT): A theoretical case analysis on a suicidal adolescent.

Abstract

This case study presents a case study of the effectiveness of Mode deactivation therapy (MDT) (Apsche, Bass, Jennings, Murphy, Hunter, and Siv, 2005) with an adolescent male, with reactive conduct disorder, PTSD and 8 lethal suicide attempts. The youngster was hospitalized four times for suicide attempts, three previous placements in residential treatment centers. MDT is a form of cognitive behavioral therapy (CBT) that combines the balance of dialectical behavior therapy (DBT) (Linehan, 1993), the importance of perception from functional analytic psychotherapy (FAP) (Kohlenberg & Tsai, 1993), and A.T. Beck's (1996) mode theory 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 this case will illustrate the potential effectiveness of MDT as applied an actively suicidal adolescent. Keywords: Adolescent, MDT, Suicide, Conduct Disorder, Personality Disorder. ********** Introduction Mode deactivation therapy (MDT) as an applied CBT methodology was developed for adolescents with reactive conduct disorder and/or personality disorders/ traits. MDT is targeted for adolescents with a complicated history of abuse, neglect, and multi-axial diagnoses. Many of these adolescents are victims of sexual, physical, and/ or emotional abuse, as well as neglect. They have developed personality traits as survival coping strategies. These personality disorders and/or traits are not true to their cluster, or are cluster bound, meaning that they are translated into beliefs and schemas that are inclusive of beliefs from all three personality disorder clusters. Often it has been thought that individuals with personality disorders stay true to their cluster (Beck, Freeman, and Associates, 1991), which is not true with the adolescent typology as represented by Charles case in this case analysis. Often CBT, as viewed by arguing or challenging the concepts of cognitive distortions, fails with these youngsters (Beck, Freeman, Davis and Associates, (1994). Freeman, A., Preter, J., Fleming, B.A, and Simion, K. M., (1990) Cognitive therapy as normally practiced will eventually trigger a negative reaction by the reactive youngsters. They perceive the therapist as another person attempting to change them from a system of defenses that has been developed to protect them. MDT was developed in response to the need for more effective treatment for this specific adolescent typology. MDT has been shown to be more effective than standardized normalized CBT in a descriptive study (Apsche and Ward, 2002). MDT has also been demonstrated as effective in a series of case studies (Apsche, Ward, Evile, 2002 a & b; Apsche and Ward Bailey, 2003) and a empirical study (Apsche, Bass, Siv, 2005). Mode Deactivation Therapy (MDT) Mode deactivation therapy (MDT) (Apsche and Ward Bailey, 2003) as an applied CBT methodology aims to address reactive conduct disorders and personality disorders/ traits. MDT is based on A.T. Beck's (1996) mode model, with aspects of other therapies, including functional analytic psychotherapy (FAP) (Kohlenberg and Tsai, 1993) and dialectical behavior therapy (DBT) (Linehan, 1993). Additionally, there are areas of MDT which reflect concepts of schema therapy (Young, Klosko, and Weishaar, 2003). The theoretical underpinnings of mode deactivation therapy are based on A.T. Beck's model of modes. In his article Beyond Belief: A Theory of Modes, Personality, and Psycho-pathology (1996), A.T. Beck defines modes as specific suborganizations of the basic systems of the mind. Specifically, suggesting that people learn from unconscious experiential components and cognitive structural processing components. Functional analytic psychotherapy (FAP) (Kohlenberg and Tsai, 1993) theory focuses on the deeper unconscious motivations that were formed as a result of past contingencies of reinforcement. …