Finding Your Success: CR therapist thoughts
by Elisabeth Thibaudeau, Neuropsychologist and Postdoctoral Fellow at McGill University
A little bit about me and cognitive difficulties…
I am a neuropsychologist and a postdoctoral fellow in mental health and cognition. I grew up around people with mental health issues. While they were facing some challenges, most of them successfully recovered from their mental illness in different areas of their life which gave me hope for a positive outcome despite a diagnosis.
I, however, became truly aware of the impact of cognitive difficulties to recover from mental illness while being trained as a neuropsychologist. Despite efficient pharmacological and psychosocial treatments addressing clinical symptoms such as hallucinations, depression or anxiety, a piece of the puzzle was missing supporting people in their recovery and helping them achieve their goals of working, studying, living independently, and having successful relationships. This missing piece was the cognitive difficulties that were still observed despite the successful treatment of clinical symptoms.
How I got familiar with CIRCuiTS.
I got familiar with cognitive remediation therapy at the end of my undergraduate studies, working in Dr Caroline Cellard's lab who was using the program CIRCuiTS to help people with cognitive difficulties from different backgrounds. I had the opportunity to act as a CIRCuiTS therapist with young adults presenting with a schizophrenia spectrum disorder with the goal of returning or maintaining their education. I also worked as a therapist with adolescents with a history of maltreatment.
The positive aspects and the challenges with CIRCuiTS.
From my experience with the program, I have been able to witness several successes with different people getting back to school, succeeding a class or being able to organize their everyday living. However, the most important success I had the chance to witness with several people is the feeling of pride, self-competence and empowerment after completing the program. Developing a new set of skills and strategies with CIRCuiTS allows people to feel more confident in the challenges they face in their everyday life.
The main challenge to achieve these successes is, however, engaging in an intensive treatment. CIRCuiTS, and more largely cognitive remediation therapy, is an intensive treatment that requires commitment and motivation, which can sometimes be difficult to integrate in a busy schedule, or when dealing with residual clinical symptoms.
However, the personalized approach of CIRCuiTS and the therapist can help engaging in therapy in different ways. I believe the most important aspect to deliver CIRCuiTS successfully is to be able to tap into the person daily life, which is an important role of the therapist; making concrete links between the strategies developed in CIRCuiTS and the person’s everyday life. I particularly like the ecological tasks in CIRCuiTS such as planning a day or a journey because they give us the opportunity, as a therapist, to observe how a person solve complex problems close to the skills used in daily life. This allows the development of alternative strategies, considering the strengths and the preferences of the person.
I also believe that a key therapist skill to successfully deliver CIRCuiTS is flexibility; every person engaging in CIRCuiTS is different, including different goals, background, resources, and challenges. I believe a CIRCuiTS therapist should be able to deliver a reliable treatment while being able to adapt to these different aspects.
If I was granted a wish to improve people’s mental health…
As for any psychosocial treatment, CIRCuiTS (and more largely cognitive remediation therapy) requires vulnerability to accept and work on one’s difficulties. If I could be granted one wish to improve people’s mental health in the context of cognitive remediation, it would be for people to have self-compassion and to feel proud of themselves because it takes a lot of courage to accept one’s difficulties and to work toward improving them.
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