Re: Applying Standard CT with Jarrad

Dear Dr. Pretzer, Here are some more thoughts and information on Jarrad. I hope it is helpful. I do appreciate your time and energy in corresponding with me.

Thank you so much for your feedback on Jarrad. I too think Jarrad did well in his group cognitive therapy program in identifying his automatic thoughts, beliefs and in developing rational responses. He also did well in developing and trying to use behavioral interventions such as pleasant imagery, time-out etc. As we re-write the group program, I think we need to incorporate more of the guided discovery to "challenge" dysfunctional cognitions as in the examples you suggested in "applying standard CT with Jarrad." We have been relying on a pragmatic challenge "Does this thinking lead you into trouble?" I think we should add more challenges. So thank you.

As you mention in your "Proposed guidelines for CT with Personality Disorders" it is important not to get discouraged with personality disorders. I do get discouraged.

Jarrad did well in his group program and then went to minimum custody. He was living in a dorm with 16 other inmates. Jarrad reports his thoughts "Feel trapped, too many people, get away, get out of life." With other people, Jarrad reports the following thoughts- "Everyone's watching me, talking about me. Talking bad about me. Like they're gonna jump me when I leave. They're all out to get me."

Jarrad learned in his group program to take time-outs and use calming self-talk. He would go down to the basement to pace and try to calm himself.. He would think: "Calm down, it won't be long now, you're in minimum and you'll see the parole board in 2 days. It's all in your head [that others are out to get me]. (Here Jarrad was using the cognitive interventions he learned in CGIP. He had reason to believe that the parole board would give him a grant and he would be out of prison anyday). Then, when Jarrad had to go back upstairs, he would feel tense again and couldn't get the thought out of his head that the others were out to get him. Jarrad describes himself "Like a cat caught in a cage. Jumpy, ready to explode. That's how I feel."

Jarrad states that he thought about killing himself in minimum. But he says that many times when he thinks of killing himself, he then switches to thinking about killing someone else. Jarrad reports that in minimum, he was working on an outside work crew with chainsaws and axes. He says: "Once I had an ax. The guard was treating us like slaves. I thought about killing him in the head with an axe. I wanted to, I was going to but the moment passed. The feeling went away. Then I decided I gotta get the hell out of here I went back to the unit and was in bed when I finally made the decision to leave the minimum camp and escape."

Thus, Jarrad had tools to intervene but they didn't work. I figure there are two possible reasons for the failure: 1) Jarrad needs much more practice in identifying counters and in practicing interventions and/or 2) there are underlying belief systems or Maladaptive schemas that have not been identified or countered.

I doubt that many of the automatic thoughts and beliefs that Jarrad identified in group programming like "crime is fun or crime is easy money" is related directly to his desire to hurt others. The thought "They need to suffer for what they've done to me" appears directly related to the violent fantasies and suggests a rage that runs very deep and is possibly related to some abuse or lack of bonding in his childhood.

You also emphasize improving "means-ends thinking, problem-solving and coping skills." I experienced difficulty with problem-solving since at times, Jarrad did not care if he was in prison for life.

• T: What is the worst thing that could happen to you? How about being in prison for the rest of your life?
• J: I would just kill myself.
• T: What if prison wouldn't end? What if you were in hell for eternity and there were no escape?
• J: I've thought of that a lot. But sometimes I think it's worth the chance.

The pleasure Jarrad obtains from violent fantasies is worth the chance of hell to Jarrad. Also, Jarrad likes taking chances. That's why he thinks "crime is fun." In working with offenders, I believe that crime becomes an addiction and it is the intermittent reinforcement that provides the motivation for the behavior. Many criminal feels a "rush" or thrill when they are committing a crime. They feel powerful and "in control." Looking at the consequences of their actions does not seem to be effective in extinguishing the behavior unless the addictive qualities of "taking the chance" is taken into account.

I have just a few other thoughts but I'll leave them for later. Thank you again.

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