Teaching pages are therapeutic concepts which are generally introduced in group therapy settings
(lasting 30-45 minutes) and address specific goals/objectives of individual treatment plans. Though each patient is unique,
patients share many developmental and behavioral deficits which can be identified in a group setting and processed for solutions.
At a later time these teaching page concepts can be used in one to one dialogue to either reinforce learning or apply the
reward/consequence results of individual decision making.
A brief sample of the more
than 100 existing teaching pages/DVD's will be provided. Before a specific teaching page is described, let’s discuss
the philosophy, technique and general content of a teaching page. How should or can seriously mentally ill people learn and
retain critical information for life success? This important question arises out of the reality that a huge percentage of
these patients do not believe they have a problem (Anosognosia). They also are often consumed by powerful residual symptoms
even when properly treated which interfere with attention, concentration, learning, retention of information, and abstract
reasoning. Gradually, after years in and out of public health care treatment settings, they embrace a core set of beliefs
(to be described at a later time) which are untrue, counterproductive, and counter therapeutic. And finally, each patient
is at a different level of ability and motivation which makes teaching to a group a more challenging and frustrating (for
both teacher and listener) experience.
As a side bar topic, to assume that every seriously mentally
ill patient receives the proper and best medication for effective symptom control is an error in thinking. The truth is that
most of the seriously mentally ill are not provided the needed aggressive medication management for best symptom control.
One need only look at the CATIE study to see that Clozapine is the drug of choice for treatment resistant psychosis, yet Public
Heath Care Psychiatry (where most of the seriously mentally ill reside) is reluctant or refuses to use Clozapine. This fact
is addressed in The John Henry Model by making aggressive medication management including Clozapine a key component of care.
Returning to the challenge of teaching, metaphor is often and repeatedly used to construct easily
retainable concepts through images and story. In fact, the entire teaching process is called “Learning How to Succeed
in the Game of Life”. The game of life has certain rules which must be understood, demonstrated, practiced, applied,
and then retained for continuous use when needed. It is only through a complete mastery (errorless learning) of each critical
rule, can an individual hope for and seek greater independence and responsibility. One huge mistake made by treatment environments
is to prematurely discharge an individual to greater independence (financial decision or poor treatment plan) only to see
regression and likely re-hospitalization because the patient skill sets are deficient.
is repeatedly used but not as an esoteric concept. Each metaphor and therefore each teaching page are always linked to real
life situations, real life deficiencies and real life success. An early prerequisite teaching page is the Green-Yellow-Red
stoplight metaphor. Each word (green, yellow or red) is defined, described, given meaning, illustrated through example, and
lastly applied to specific behavior being demonstrated by patients. Are you green (good to go) out of the house in the morning
if you have not showered and smell? At the door when you are about to depart you are red (stop, not good to go). Earlier in
the morning when you were reminded by a caregiver that you needed to shower, you were yellow (caution, potential problem).
Much earlier when the patient chose to shower they were green and had demonstrated (at least regarding this one specific responsibility)
that they were good to go.
As we can see, a teaching page has elements or characteristics:
1) It has a theme
2) It utilizes metaphor as a technique
3) It links metaphor concept to a specific
and real life difficulty
4) It describes the specific Rules of the Game of Life relating to the real life difficulty
5) It clarifies the rewards and consequences of success and failure to properly learn and apply the needed task.
6) It repeats itself as often as is needed until mastery occurs. This mastery is deemed complete only when success
is independently motivated, does not require any prompting, and endures a requisite length of time.
7) It attempts
to address the needs of “the many” by addressing the “need of the one.”
examples of teaching page topics include:
1) The Plane Has Taken Off (attention to time and responsibility
to be punctual)
2) Prepared To Launch? (will your skill sets let you fly or will you crash and burn)
Out of the Quicksand (learning how to accept, use, and trust guidance)
4) What You Want Isn’t Always What
You Need (best interest vs expressed interest)
5) Are You Better Than or Better Off?
6) Why We Behave
the Way We Do (we are seeking something)
7) What are ADL’s (not just morning hygiene but all of each days
8) ADL Complexity (simple, moderately complex and complex)
9) Is Budgeting
an ADL? YES.
10) Is Kindness an ADL? YES. What else should we call an Activity of Daily Living (ADL), and why have
we limited the term to just basic hygiene?
11) Sow (plant) and Reap (grow) (how to build habits and character)
12) The Meaning of Life? SMOKING!
13) Climbing Mount Everest (learning to prepare for and deal with change)
14) Your Problem is Not My Emergency (learning to accept personal accountability)
15) The Faces of Entitlement
"The Entitlement Syndrome": my money, my cigarettes, my right, my wants)
16) I Feel, I Act, but Did I
Think? (learning how to introduce thought into action)
17) Premack Principle: First/Then (first
responsible attention to your illness needs/then you receive your entitlement check
18) What is Normal? Ability
to adjust and deal with your life challenges/problems with proper insight and skill which allows for effective functioning
and peace of mind
19) Excessive Anything: Addictions of all kinds- Drugs legal or illegal, food,
smokes, spending, caffeine etc.
20) Anger is like Barf: You need to get it out but you are not supposed
to get it on anyone
21) Smooth Sailing: Even, Uneventful, and Peaceful equals BORING-Dealing
with the boredom of stability and symptom control which is called "Maintenance"
a DUD: To misfire, to be unsuccessful, to fail
23) Faith: Is not an excuse for unclear thinking
24) F.A.C.T.S.: Families Achieving Clear Thinking Solutions-
the critical importance of caregiver influence and guidance
25) Russian Roulette: When you stop taking your medications
you are playing Russian Roulette with you life
26) Expunging the term "High Functioning": One is high functioning
when one effectively applies their specific skill sets, not when one is endowed with better skill sets which they refuse to
27) How do I get out?: Graduate, be dislodged, or be expunged
28) The relationship between Counterintuitive
and Maturity: Knowing when being counterintuitive will be in the best interest of yourself, your child or your family
29) The Stages of Rehabilitation: Stage 1- Diagnostic
2- Medical stabalization with best symptom control
3- Inventory (Assessment of strengths and deficits)
4- Growth Stage (obvious and rapid growth
dependent on individual skill sets)
5- Maintenance Stage (emphasis on retention of
gains and possible slower growth)
NOT REGRESS! ERRORLESS LEARNING!