Collaboration leads to conference submission, potential new treatment model

A team from the Fort Steilacoom Competency Restoration Program partnered with a professor from the University of Alabama to create a new treatment model tailored to competency restoration patients.

Soon, they will present what is known as Stephen’s Game to the American Psychology-Law Society’s annual conference, and they hope to begin a pilot program introducing the treatment at FSCRP this year.

Dr. Elizabeth Bolinger, the FSCRP clinical services manager, led a team of psychology associates at the restoration treatment facility in collaboration with University of Alabama researcher Dr. Lauren Kois and some of her graduate students. The group worked together despite being 2,500 miles apart to tailor Michael’s Game — the treatment used by BHA as part of the Breaking Barriers Competency Restoration Program that was created for people suffering from delusions — directly to the needs of competency restoration patients.

“The research for cognitive behavioral therapy on psychosis in general is vast in terms of reducing delusional conviction and increasing reality testing,” said Kois, the director of UA’s Collaborative Law and Social Sciences laboratory. “That makes it an effective treatment for people with delusions. In the context of restoration, we want to address the symptoms that are upholding competency. If an accused person is incompetent all or partly due to delusional conviction, CBTp can help get more at the root of the issue, and that will help with competency restoration.“

The goal of the team when it presents at the conference in Denver in March is to share the research about Stephen’s Game with peers in psychology and possibly inspire a new way of treating competency restoration patients nationwide.

“Stephen’s Game was created to improve cognitive flexibility and increase rational thought processes,” Bolinger said. “It’s closely tied to the theoretical underpinnings of Michael’s Game and heightens it to relate to competency restoration-related delusions and thought patterns.”

Michael’s Game was created in 2006 by a group of European researchers and uses 80 scenarios that begin with non-emotional and non-psychotic content and progresses to emotional and psychotic situations. The goal of Michael’s Game is to decrease a patient’s conviction in a delusion. Bolinger used a glass of ice water as an example of helping a patient deal with delusions: Ice is in the glass when the person goes to sleep, but it’s gone when they wake up. A person suffering from delusions might believe the ice was stolen rather than melted.

In Stephen’s Game the scenarios are tailored toward understanding courtroom interactions and how to communicate with the judge and attorneys. No modifications to the structure of Michael’s Game have been made, so Stephen’s Game could have profound implications in the treatment of competency restoration patients.

“We want to bring attention to the various treatment modalities that are out there for competency restoration and to put this new spin on having it more focused on competency restoration treatment,” Bolinger said. “Tailoring it to a competency restoration setting could be more beneficial for treatment.”

In addition to getting exposure for the research team and their findings, the conference will provide others in the psychology field the opportunity to see the innovative work being done by the Office of Forensic Mental Health Services. Teaming with Kois and her team was a bonus for Bolinger.

“Dr. Kois is building a name for herself, and the University of Alabama has a world-renowned psychology and law research program,” Bolinger said. “I think we were lucky she reached out.”

Kois said she was excited to team with OFMHS because of its groundbreaking competency restoration work that other states are closely monitoring.

“Compared to many areas of the country, Washington is being very progressive in terms of competency restoration issues,” she said. “For years I was eager to integrated cognitive behavior therapy for psychosis into restoration protocols, and OFMHS has been doing it for years, so it was kind of a match made in heaven in that way.”

Kois will also get a measure of personal pleasure if Stephen’s Game becomes a national model for competency restoration treatment. It’s named after her husband.

“He’s never been in a forensic hospital and I’m in them all the time, so I told him I’m going to get him in every forensic hospital in the country,” she said with a laugh.




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