CASE CONFERENCE — During a Case Discussion Meeting at the Sacred Heart Auditorium, Program Director Lea Tumbado takes the opportunity to highlight the scripts and guidelines of the REBT approach to the clinical team. Others in the photo are: (from left) Facility Nurse Abby Leynes, Counselor Carol Amingnan, Deputy Clinical Director Lyn Simbulan, Residents Development Head Sol Laureta, Clinical Head Mai Bucong, and Counselor Nel Bayaban.

CASE CONFERENCE — During a Case Discussion Meeting at the Sacred Heart Auditorium, Program Director Lea Tumbado takes the opportunity to highlight the scripts and guidelines of the REBT approach to the clinical team. Others in the photo are: (from left) Facility Nurse Abby Leynes, Counselor Carol Amingnan, Deputy Clinical Director Lyn Simbulan, Residents Development Head Sol Laureta, Clinical Head Mai Bucong, and Counselor Nel Bayaban.

In 2005 Jay was an active member of the Family Association (FAM)as the guardian of his eldest brother, a dual diagnosed resident at SELF. Three years later, on January 18, 2008, Jay was admitted for drug abuse and excessive gambling, joining his brother in the facility.

Background

Jay is the second child of his mother’s first marriage. When he was seven years old his father passed away while working as a seaman. This loss created numerous changes in his life.

His father’s siblings snatched the insurance money and his family was left only with their house to live in. His mother struggled financially and had to work hard to support the family.

As a student, Jay experienced hardships since his mom had difficulty providing for his necessities. Eventually, he started stealing money from his mother and uncle. When he was inevitably caught stealing by his mother, she physically beat him. Consumed with shame, he vowed that he would cease to care.

His mother’s rejection and neglect affected his schooling. At age 13 he started drinking and gambling. On his graduating year in high school he was expelled and transferred to another school due to his misconduct. He started smoking marijuana around this time. He ran away from home, but was picked up by the police.

A time came when Jay’s mom sought and obtained employment overseas. With this he got more time and space to drown himself in vices. Prior to entering college his girlfriend introduced him to shabu, and he sank deeper into the world of alcohol, drugs, and gambling.

Eventually Jay wound up marrying his girlfriend. Without a job to support his habit and his family, he resorted to selling everything he could possibly steal inside their house. As a result he was evicted and landed in a squatter’s colony, where he engaged in drug dealing.

After some time he attempted to mend his relationship with his mother. She gave him another chance and he tried to straighten out. But unknown to him his wife continued selling drugs and eventually developed an intimate relationship with their drug supplier. His futile efforts to fix their marriage failed.

Enraged with life’s pains, he attempted suicide but was able to stop himself. He continued to pursue his addictions, which now included women. Then his wife’s best friend came into his life and became his live-in partner.

At this point Jay’s mother accepted him back home to manage the household and attend to his eldest brother. He enrolled in a vocational school and was selected to go to Japan for further training, but he blew the opportunity because his vices once more took over his life. He became so physically abusive to his son and partner that his mother decided to bring him to SELF out of sheer desperation.

Initial Intervention

Upon admission, Jay was in denial and claimed he did not need treatment. His anger towards his family intensified because he once again felt alone, rejected, and now humiliated. He was ashamed that he was once a FAM member and now wound up being a resident.

At the Evaluation & Motivation Unit, he underwent the standard medical and clinical assessments. Along with substance dependency, Jay was also diagnosed as having an anti-social personality disorder. He was not prescribed any medications and was deemed psychologically fit to undergo the therapeutic community (TC) behavior modification program.

Jay was exposed to the TC confrontation process which unearthed his maladaptive behaviors. He would lie when confronted and displayed a non-caring attitude. He always found ways to avoid responsibility and refused to confront inappropriate behavior in others. When confronted, he claimed that his lack of interest to change was coming from feelings of anger and rejection from his own mother.

Jay obviously needed to deal with such issues as rejection, anger, hatred, and sibling rivalry. Little did he know that these unpleasant emotions were already manifesting in his excessive joking around in the program. He would always get into trouble and find himself getting sanctioned constantly.

Taking note of these intense feelings the clinical team proceeded with the cognitive behavior therapy (CBT) approach. Jay’s feelings towards his family were first affirmed but through counseling he was encouraged to consider changing his faulty thoughts that were only exacerbating his feelings.

Breakthrough

After a battery of behavior shaping tools and counseling, he soon responded to group therapy sessions and confrontations. This gave light to the possibility that he would respond further to encounter sessions with his family, which transpired successfully. Jay realized that his thoughts about them were rooted in some deeper source and expressed willingness to be further helped.

With this development, towards his senior phase the staff felt that it was time to shift and utilize rational emotive behavior therapy (REBT), which focuses on uncovering irrational beliefs which may lead to unhealthy negative emotions and replacing them with more productive rational alternatives. This clinical approach eventually aided him in discovering the faulty core beliefs that kept leading him to think irrationally, thus making him feel very negative and propelling him towards his addictive behavior.

Through the REBT counseling process, Jay identified the following faulty core beliefs: 1) I must not sacrifice for I am not the eldest; 2) I must be given freedom because the world owes me; 3) I should not care because my mom never cared anyway when she would beat me up.

Slowly, he learned how to use the TC Unwritten Philosophies and a few other enlightening affirmations to help him dispute his faulty core beliefs. Thus, he learned to accept his problem, found forgiveness, and began to focus on sustaining a positive disposition. In this way he learned to be a good follower, which paved the way to his becoming a good leader. Towards the latter stages of his stay in SELF, he fulfilled the dream of establishing renew ties with his family.

Currently in Aftercare, Jay now serves as one of the staff of the program. Through his continued trust in the process, he surpassed several impediments and found comfort in his faith in God.

Conclusion

REBT is a powerful tool that can be successfully administered to clients in treatment. It can be taught to clients with the end goal of having them develop a self-monitoring and facilitation habit. Clients in therapy who address core beliefs can emerge fully resolved about their past. They can take root in a newfound existence or life in recovery and continue to grow emotionally and spiritually.
By Lea Tumbado
Program Director