Spiritual self-schema therapy

Domain VII · Transpersonal, psychedelic & altered states · S. Kelly Avants, Arthur Margolin · 2003 · Yale University, USA

What it is

Spiritual Self-Schema (3-S) therapy is a manualised, skills-training individual therapy for people in treatment for drug addiction (originally heroin and cocaine users, many on methadone). It targets drug use, HIV risk behaviour and, in 3-S+, HIV medication adherence. It combines cognitive…

Format

• Format. 12 weekly 60-minute individual sessions. An optional 12-session manual-guided group is available as adjunctive practice, not stand-alone treatment. The programme is designed to sit inside methadone maintenance or other addiction treatment, alongside case management and pharmacotherapy.…
• Phases (3-S+ individual).

Who practises it, and how they are trained or regulated

• Entry criteria. The client is in addiction treatment (in 3-S+, also HIV-positive), has completed detoxification where appropriate, and is medically stable. The client is not in precontemplation, is willing to examine the addict self, and is interested in developing a spiritual self-schema. Psychiatric screening comes first. The manual says the programme is not suitable for people with psychotic or dissociative…
• Therapist requirements. Experience delivering CBT to drug users (in 3-S+, to HIV-positive drug users) and an interest in spirituality. A personal daily practice of mindfulness, prayer or contemplation, plus a few minutes of metta (loving-kindness) directed toward the client before each session. Working knowledge of HIV regimens and of local disclosure and partner-notification law. Training: over 17 hours of free DVD…
• Spiritual Self-Schema (3-S) therapy is a manualised, skills-training individual therapy for people in treatment for drug addiction (originally heroin and cocaine users, many on methadone). It targets drug use, HIV risk behaviour and, in 3-S+, HIV medication adherence. It combines cognitive self-schema theory with Theravada Buddhist psychology, which it uses in a non-sectarian way as a framework. It does not aim to…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the cue losing its surprise. Rotate it.
• literacy limits. Modify verbal presentation and pacing.
• do not give individual medical advice. Refer questions to the prescriber.
• comprehension. Ask the client to restate the key points in their own words.
• an overly ambitious plan. Start with three or four anchor points and add more.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.