1. Self Work
1.1. Empathy
1.1.1. When you're closed to your own suffering, it's hard to be receptive to the suffering in others
1.1.2. Notice the actions of others, sense the feelings of others, track the thoughts of others, check back, and receive empathy yourself (pg 140)
1.1.3. Say only what is well-intended, true, beneficial, timely, expressed without harshness or malice,, and ideally, what is wanted
1.2. Compassion
1.2.1. The root of compassion is compassion for oneself
1.2.2. Brings caring to assertion, while assertion helps you feel comfortable giving compassion
1.2.3. Widens the circle of "us" while assertion protects and supports everyone inside the circle
1.2.4. Compassion is the with that things not suffer, kindness is the wish that they be happy
1.2.4.1. Compassion responds to suffering, kindness is all the time
1.3. Darts
1.3.1. The first dart is the inescapable physical or mental discomfort/reaction
1.3.2. The second darts are emotional reactions to the first dart, which often trigger more darts through associative neural networks
1.3.2.1. Often due to implicit memories that color our perception
1.4. Feelings and the brain
1.4.1. When you understand why you feel nervous, annoyed, hassled, driven, blue, or inadequate, those feelings have less power over you
1.4.1.1. Desire isn't the root of suffering, craving is. You can wish for or intend something without craving the results
1.4.1.2. Neither pleasure nor pain are worth claiming as your own or identifying with, nor defining yourself by
1.4.1.3. Tranquility: not acting based on the feeling tone
1.4.1.3.1. Happiness becomes increasingly unconditional and not based on a good breeze instead of a bad one
1.4.2. We are better at making negative associations than positive ones--the brain is drawn to bad news
1.4.3. The brain simulated reality (perception is reality)
1.4.3.1. Implicit memories: traces of past experiences that exist beneath conscious awareness
1.4.3.2. Explicit memories: clear records of what actually happened
1.4.4. The wolves of love and hate
1.4.4.1. The wolf of hate is based on loyalty and protection toward "us" and fear and aggression toward "them"
1.4.4.2. The wolf of love practices compassion and empathy
1.5. Strategies
1.5.1. Taking in the good
1.5.1.1. Healing pain--talking about hard things with someone who is supportive can be healing. Then the painful feelings and memories can be infused with the comfort and encouragement and closeness you experience with that person
1.5.1.2. Not about putting a happy shiny face on everything or turning away from the hard things in life. It's about nourishing well-being, contentment, and peace that are refuges you can always come from and return to
1.5.2. Pulling weeds, planting flowers
1.5.2.1. If you call up positive emotions and perspectives while implicit or explicit memories are active, those wholesome influences will slowly be woven into the fabric of those memories
1.5.3. Cooling the fires
1.5.3.1. Meditation! pg 86 of Buddah's Brain, mindfulness meditation
1.5.3.1.1. Many ways to feel strong, pg 105
1.5.3.2. Relaxation--diaphragm breathing, progressive relaxation, big exhalation, mindfulness of the body, imagery
1.5.4. Write a personal code
1.5.5. Don't attribute intentions!!!
1.5.6. Practicing kindness and compassion
1.5.6.1. pg 165--The Ten Thousand Things
1.5.6.2. pg 171--A meditation on loving-kindness
1.5.7. Awareness of the self
1.5.7.1. pg 207, Taking the body for a walk
1.5.8. Mindfulness: having control over your attention
1.5.8.1. Mindfulness meditation, pg 201
2. Facilitation
2.1. Transdiagnostic Theory
2.1.1. The diagnosis is not the point, focuses on symptoms and how to fix them
2.1.1.1. Cognitive, behavioral, and affective features and patterns that maintain the illness
2.1.2. Univsrsalization
2.1.2.1. The idea that pts who share psychosocial stressors can relate to one another -- they don't feel so alone
2.1.2.2. Using transdiagnostic theory can enhance on-task behaviors, vicarious learning, and treatment compliance
2.1.3. Labeling
2.1.3.1. Focus on a diagnosis can lead to stigmatization and sustained illness by impacting self-concept, help-seeking behaviors, and social outcomes
2.1.3.2. "It is often more important to know what kind of patient has the disorder than to know what kind of disorder the patient has."
2.1.3.3. The public's misunderstanding of mental illness perpetuates stigma, treatment delays, and social progress
2.1.4. Box 8.4, pg 149 (Silverman), Recommendations for Clinical Objectives
2.1.5. Psych and Substance abuse
2.1.5.1. Integrated dual disorder treatment: recovery defines so pt learns to manage both illnesses (mental disorders and substance abuse) at the same time and can pursue meaningful life goals
2.1.5.1.1. Box 10. 2, pg 205 (Silverman), 8 IDDT Treatment Principles
2.1.5.1.2. IDDT Essential practices: Staged interventions, motivational interventions, counseling, social support, and assertive outreach (Table 10.1, pg 206)
2.1.5.1.3. Box 10.4, pg 211; MT treatment areas for IDDT
2.1.5.1.4. Box 10.2, pg 205; 8 IDDT treatment principles
2.1.5.2. Table 10.2, pg. 207; Quadrant Model for co-occuring psych disorders
2.2. Therapeutic Alliance
2.2.1. Building rapport-- the quality and strength of collaborative relationship between a therapist and patient
2.2.2. 80% of positive treatment outcomes are a result of the client believing in the therapist's ability
2.2.3. Three alliance components
2.2.3.1. 1. Quality of the interpersonal bond between pt and therapist
2.2.3.2. 2. Pt agreement with MT that therapeutic tasks address the behavior problems
2.2.3.3. 3. Agreement on goals for treatment
2.2.4. Box 8.6, pg. 153 (Silverman), Techniques for developing working alliance
2.2.5. Therapist characteristics associated with positive tx outcomes: warmth, caring, higher levels of empathy, authenticity
2.2.5.1. The person delivering tx tends to have a greater effect on therapeutic outcomes than the type of tx being delivered!
2.2.5.2. Mechanisms for therapeutic change broken into 3 groups
2.2.5.2.1. Cognitive: Universalization, insight, and modeling
2.2.5.2.2. Affective: Acceptance, altruism, and transference
2.2.5.2.3. Behavior: reality testing, ventilation, interaction
2.2.6. The quality and aesthetic properties of live music used by MT may contribute to ab enhanced sense of competence and ensuring pt outcomes
2.3. Prodromal symptoms
2.3.1. Early signs of mental illness--with early intervention, courses of illness and outcomes can be changed
2.3.2. CBT can be used for treatment because pts accept it, there is little stigma attached because no label has been assigned, and has no pharmacological side effects
2.3.2.1. Box 5.1, pg 89; CB strategies for at-risk pts
2.3.3. Box 5.2, pg. 91; Techniques to identify and manage prodromal symptoms
2.4. Psychoeducational Approach to Treatment
2.4.1. Educational MT can empower clients, support self-efficacy, and teaches clients to "be their own therapists" and proactively manage their illness
2.4.2. The mind is what the brain does--thought patterns can be shaped
2.4.2.1. Short-term interventions are effective long-term -- single sessions can work!
2.4.3. Strategies
2.4.3.1. Connect the use of medications to pt goals and aspirations to increase compliance
2.4.3.2. Teach to anticipate triggers and find coping skills for that stress to maintain wellness and prevent rehospitalization
2.4.3.3. Boxes 8.7 and 8.8, pg 154; Three-step and six-step problem solving
2.4.4. MT is a treatment that is complementary and integrational, rather than alternative. Can be used in conjunction to reinforce and synthesize, but not to replace other therapies and medications
2.4.4.1. Standard pharmacological treatment should be accompanied by group psychoeducation to increase compliance and improve treatment outcomes
2.4.5. Requires frequent repetition and reinforcement to promote compliance
2.4.6. Aim is to increase knowledge and illness management skills with an emphasis on instruction (not analytic therapy) and promotes social skills, pleasant activities, positive thinking, and relaxation.
2.4.6.1. Subjects to cover
2.4.6.1.1. Avoiding use/abuse
2.4.6.1.2. Stress management
2.4.6.1.3. Coping and leisure skills
2.4.6.1.4. Communication
2.4.6.1.5. Assertiveness training
2.4.6.1.6. Increasing quality of life
2.4.6.1.7. Relapse prevention
2.4.6.1.8. Medication compliance
2.4.6.1.9. Social skills
2.4.6.1.10. Symptom management
2.4.6.1.11. Problem solving
2.4.6.1.12. Self-awareness and observation
2.4.6.1.13. Pt rights and responsibilities
2.4.6.2. Box 8.9, pg 155; Homework assignments
2.4.6.2.1. Name one thing you can do toady to make tomorrow better
2.5. Continuum model of MT
2.5.1. Use more music when pt is functioning at a lower level--the qualities of music are used for communicative interactions to help reach and engage the pt.
2.5.1.1. More therapy when overt psychiatric symptoms have dissapated
2.5.2. Regardless of population and clinical objective, MTs use music as the medium to address client deficit areas
2.5.3. Table 4.1, pg 72; Continuum of MT procedures for adult psychiatric pts
2.5.3.1. MT as activity therapy: goals achieved through music-based interventions rather than through insight (ex: using music to increase attention span, communication, socialization
2.5.3.2. Insight MT with re-educative goals: music used to elicit emotional, cognitive, and/or behavioral reactions necessary for therapy (group songwriting about reasons to stop using drugs and maintain a sober lifestyle)
2.5.3.3. Insight MT with reconstructive goals: music techniques used to elicit unconscious material and worked through to reorganize the personality (music improv to elicit unconscious reactions to the experience and develop insight)
2.5.4. Table 4.2, pg 73; Four levels of engagement
2.5.4.1. Music as psychotherapy: issues worked through by listening to or creating music (improvisation w/out verbal processing)
2.5.4.2. Music-centered psychotherapy: issues worked through by listening to or creating music (improvisation followed by verbal processing)
2.5.4.3. Music in psychotherapy: music and verbal discourse (lyric replacement songwriting)
2.5.4.4. Verbal psychotherapy with music: mostly verbal, music in tandem to facilitate or enrich, but music not necessary (lyric analysis without pts actively making music)
2.5.5. Client and therapist may have differing ideas of where to fall on continuum, both are valid and right
2.6. Long-term and acute care setting
2.6.1. Long-term: use non-threatening interventions for self-esteem, maturation, illness management and recovery knowledge, appropriate behavior, reality orientation, and to open a line of communication
2.6.2. Acute care: illness management, recovery, rehabilitation, prevent relapse, link medication compliance, personal goals, healthy activity and leisure skills, enhance problem solving skills, and motivate to use community supports
2.6.2.1. Box 3.1, pg 59; Modules for Single Sessions
2.6.2.1.1. 1. Recovery
2.6.2.1.2. 2. Practical facts about mental illness
2.6.2.1.3. 3. The stress-vulnerability model
2.6.2.1.4. 4. Building social support
2.6.2.1.5. 5. Using medication effectively
2.6.2.1.6. 6. Drugs and alcohol
2.6.2.1.7. 7. Reducing relapses
2.6.2.1.8. 8. Coping with stress
2.6.2.1.9. 9. Coping with persistent symptoms
2.6.2.1.10. 10. Meeting needs within the mental health system
2.6.2.1.11. 11. Living a healthy lifestyle
2.6.2.2. Box 1.2, pg 8; Attitudes for single-session therapy
2.6.2.2.1. This is it
2.6.2.2.2. View each and every session as a whole, complete in itself
2.6.2.2.3. All you have is now
2.6.2.2.4. It's all here
2.6.2.2.5. Therapy starts before the first session and will continue long after it
2.6.2.2.6. Take it one step at a time
2.6.2.2.7. You don't have to rush or reinvent the wheel
2.6.2.2.8. The power is in the patient
2.6.2.2.9. Never underestimate your patient's strengths
2.6.2.2.10. You don't have to know everything to be helpful
2.6.2.2.11. Life is full of surprises
2.6.2.2.12. Life, more than therapy, is a great teacher
2.6.2.2.13. Time, nature, and life are great healers
2.6.2.2.14. Expect change. It's already well underway
2.6.3. Holistic treatment--treating all aspects of health, not just psychiatric or physiological
2.6.3.1. Important to develop skills and knowledge for transition back into the real world--medication only can't teach that
3. Additional Resources
3.1. Box 8.1, pg. 137 (Silverman), In-Service Suggestions
3.2. Box 3.2, pg 63; AMTA reimbursement methods
3.3. The dodo bird verdict
3.3.1. The idea that talk-based therapies have relatively equivalent effects--MT can be effective, but specific type of intervention is necessarily more effective than another