The Shores of Recovery RRTP at Perry Point VAMC

A clean, quiet, safe place with plenty of grass fields and nature, rabbits, deer, geese, and wildlife. A calm, beautiful view of water. Shores of Recovery, a calm place to remodel your mind. Philip J.

The Shores of Recovery Residential Rehabilitation Treatment Program (RRTP) at the Perry Point VAMC has been transitioning from a general psychosocial residential program to one that provides more specialized services to our Serious Mentally Ill veterans. The RRTP team choose to implement Recovery-Oriented Cognitive Therapy (CT-R) as the theoretical guide for all our treatment, milieu and individual and group interventions. The MIRECC small grant we applied for and were awarded allowed us to engage in a 6-month virtual consultation with the Beck Lab to learn and implement CT-R. We have finished the consultation and are excited to share the outcome of that experience.

Recovery-Oriented Cognitive Therapy (CT-R) is an evidence-based practice developed by the Beck Lab. It is centered on helping people access their adaptive modes (the space where the person is at their best, have energy, focus, connection, and where symptoms do not interfere). This allows them to develop and move toward their aspirations. A large focus of the treatment is helping clients identify and engage in personally meaningful activities that move them toward living their desired life. For our program to foster this process, our milieu needed to change. These changes included moving away from traditional groups and toward seminars and clubs, plus creating meaningful roles on the unit where veteran’s expertise and talents are highlighted and opportunities are offered for connection and community.

Having a role on the unit presents an opportunity for a Veteran to engage in meaningful activities in service of their aspirations. This experience is then externalized in therapy to help challenge negative beliefs by identifying successes and accomplishments. One Veteran on the unit, Mr. Smith (pseudonym), identified his aspiration as "wanting to work on producing music or to become an art buyer or seller." At that time, our social work intern had initiated an art club that would culminate in a unit art show. Mr. Smith was given the role of curator, which included recruiting veterans to create art, setting up the space for the show, curating the display, and selecting the music. In this role and work, he was able to directly target his defeatist beliefs. He benefitted from the positive accolades from others, and the adaptive role was personified as Mr. Smith personally escorted staff through the exhibit. During individual therapy themes of resilience, connection, creativity, and ability were reinforced. Despite nagging beliefs that he is not taken seriously and is a failure, Mr. Smith was able to reflect that others appreciated his expertise and input, and that he created an environment of peace that inspired others.

For other Veterans, roles vary as they target different aspirations and barriers. For example, a Veteran who is very knowledgeable about technology was recruited by the Program Coordinator to identify computers to be requested for the unit. In this role, he selected the computers, set them up, and posted tips and tricks for peers. In his individual therapy his capability beliefs were targeted by his being able to identify others seeking out his technology expertise and his increased confidence in social interactions as a result.

The Shores of Recovery had a positive consultative experience with the Beck Lab. In addition to learning individual therapy interventions for veterans with an SMI, the consultation allowed for a broader milieu change. This change allowed for the creation of roles that foster capability, connection, and control.