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from the issue of March 8, 2007
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Schizophrenia focus forges new treatment programs
BY SARA PIPHER, UNIVERSITY COMMUNICATIONS
UNL psychology professor Will Spaulding has dedicated his career to improving the quality of life for Nebraskans living with chronic severe mental illness. In a career spanning nearly three decades, he has developed a cutting edge treatment program that is now utilized globally.
Spaulding was hired at UNL in 1979 to expand the research capabilities of the clinical training program. He was a schizophrenia researcher, which was uncommon in psychology departments; generally, schizophrenia and other mental illnesses were studied by medical and psychiatric students.
Shortly after his arrival in Lincoln, the clinical director of the Lincoln Regional Center asked Spaulding and his wife Mary Sullivan, a social worker, to help him develop a new psychiatric treatment program.
The team began working in a back ward occupied by the LRC's most chronic patients, and developed the Community Transition Program, a state of the art research and rehabilitation facility. By the end of the 1980s, they had finished the first phase of that development, and the CTP had become recognized nationally and internationally.
"One of my main interests was developing a type of psychotherapy that addressed the cognitive impairments that are characteristic of schizophrenia," Spaulding said. "By coincidence, we discovered that there was a group of clinical researchers in Switzerland doing similar work. We began collaborating and developed a joint research project. In 1990, we received a federal research grant to test out this type of therapy. With the resources from that grant project we ran the first large-scale test of what is now a common approach to therapy for schizophrenics."
The treatment that Spaulding created works very much like physical therapy for the brain.
When you sustain a physical injury, even when you're well along in the healing process, you've lost a lot of the effectiveness of the injured area, Spaulding explained. Physical therapy helps return function to the area.
"A comparable thing happens with psychotic disorders," he said. "Patients' brains go through biochemical chaos, which can be stabilized with medications. But when you've stabilized someone's brain after they've been psychotic, you still have a situation in which their brain looks like an office a tornado has gone through; it's totally disorganized. They have to do brain exercises to return to a normal level of function."
Spaulding developed a collection of exercises to work on those aspects of the mind that are most disorganized by psychosis. Treatment occurs mainly in groups. Superficially, the sessions-which run several times a week for three to six months-appear much like conventional group therapy, but patients are not just talking about their lives, they are engaged in highly structured activities. For example, sessions include activities that resemble "20 questions," a mental exercise in how to strategically analyze a mystery, which is an ability the brain loses in psychosis.
All of the patients at LRC are civilly committed, meaning they have been ordered into institutional care by a mental health board because they are a danger to self or others. "We wanted this program to serve people who weren't being served anywhere else in the mental health system," Spaulding said. "When we first started at LRC, many patients had been there for years. But the nature of the population that state hospitals now serve is different. People are caught in a revolving door between the emergency room and the community; these people can't stay out of institutions."
One challenge in Spaulding's career has been working with the state mental health system. Like bureaucracies everywhere, the system ensures that change happens slowly and the endorsement of new ideas occurs at a snail's pace. Nebraska also stands out in its absence of mental health professionals in the upper levels of mental health administration.
"It's no secret that I've been a persistent critic of the state mental health system," said Spaulding, who served for a time as director of state government affairs for the state psychological association. "I'm happy to say the state has improved over time. I have seen a major reform over the years, and despite the fact that things have been bungled, changes are happening."
Despite these hurdles, Spaulding has seen his research and work at the LRC take off. By now, students come to UNL specifically to study with him.
"There aren't many people who want to be psychologists working with severe mental illnesses," he said. "UNL is one of a handful of places where students can get that kind of training."
In recent years, the success of the LRC's program has attracted attention and visitors from around the world.
Spaulding and Sullivan travel frequently and consult with hospitals, to help them make the conversion from conventional treatment to the CTP's unique approach.
Spaulding gives his colleagues at UNL a great deal of credit for his success.
"The fact that I'm still here is a testimonial to this department," he said. "This is an unusual department in its sense of civic and community responsibility. A tradition of service existed in this department long before I arrived. You'll find very few psychology departments in the country that have so much going on in terms of community service. My work is just one example of many."
Spaulding knows he is working on a monumental task within an imperfect system, but his commitment to service continues.
"There was a point in my own personal development in which I came to the realization that what was going to change the lives of people with severe mental illness was not dramatic scientific discoveries and advances," he said. "It suddenly occurred to me that what would really change their lives was changes in public policy and public attitudes, and the way in which our government responds to the needs of this population.
"That has become a major theme in my work for the past 10 or 15 years."
GO TO: ISSUE OF MARCH 8
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Schizophrenia focus forges new treatment programs
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732743S36812X
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