Current Directions in the
Treatment of the Seriously Mentally Ill
Open Lecture for Clinical Staff
San Bernardino County
Department of Behavioral Health
Victorville, CA
22 and 23 March 2001

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Introductions

Part One

What is "evolutionary psychology" and what does it offer for the treatment of the seriously mentally ill?

  1. The human past and the EEA

  2. The common human, the possible human, and design problems

  3. The centrality of scientific and rational methodologies

Nature and Nurture

  1. Why this been such an issue over the last century

  2. What current research tells us

  3. The role of genetics in SMI

Primate developmental sequences

  1. Comparison of early developmental sequence, simian and homo

  2. Commonalities in the life cycles of primate species

  3. Current and future contributions of genetic mapping

  4. Innate cognitive, emotional, and behavioral mechanisms

  5. The once and future EEA

  6. Life in the trenches, postcards from the front

Ultimate and Proximate Goals

  1. What really matters

  2. The early philosophers and what we’ve learned since then

  3. Religion, myth, and middle earth

  4. Current trends toward the neurology of reality

  5. The central role of the unconscious in everyday life

  6. The uses and risks of heuristics

  7. The Titanic and the Hindenberg

Psychopathology and common neurosis

  1. Traditional psychologies

  2. Freud, Jung, Adler, Erikson, and the history of modern psychology

  3. The lessons of history

  4. Is there any difference between social and clinical psychology?

  5. The centrality of the essential “other”

  6. Object relations

  7. I, me, myself

  8. The legend of the mountain man

Part Two 

How psychotherapy works

  1. The role of the psychotherapist

  2. Self-awareness and the meaning of life

  3. The essential therapist

  4. What the client doesn’t know

Assessment of the prospective patient

  1. Taking the early life history

  2. The unreliability of client self report

  3. The unreliability of prior treatment records

  4. How to effectively and objectively observe

  5. The written assessment

  6. The role of psychological testing

  7. The value and limitations of psychodiagnostics

Treatment planning

  1. The role of temperament, character, early learning, and personality

  2. Identifying the fundamental issues

  3. Selecting initial therapeutic strategies

  4. Informed consent

  5. Targeting and leverage

  6. The usefulness of treatment planning systems

The therapeutic endeavor

  1. Purposes of therapy

  2. Engagement

  3. Process

  4. Techniques

  5. Goals

  6. Working Through

  7. Termination at the beginning of treatment

  8. Other issues – how many sessions, how frequent, when to bring in family and friends, use of email and telephone contact, referral for medications, etc.·        the essential purposes of clinical records

The therapeutic future

  1. The presumed miracles of mood medications

  2. Does talk therapy have a future?

  3. Funding—Who pays for a lot of talk?

  4. Is psychotherapy a medical procedure?

  5. Culture, politics, society, and the future of the species

  6. Memes

  7. The many worlds hypothesis