[The video begins by showing four women seated at a table in an office conference room. One of the women, Dawn, is providing CAT supervision to the other three.]
Dawn Okay, so Natalie how many people do you have on your case load right now?
Natalie I have thirteen people that I’m seeing right now.
Dawn Okay, why don’t we start with somebody who you’re having the most difficulty with and then we’ll see how much time we have.
Natalie Okay, then let’s start with Jim. I’ve been seeing him for about three months now and his goal from the beginning has always been to lose weight. He’s got diabetes, he’s insulin-dependent. He wants to lose about 25 pounds, he says.
Dawn Okay, and what’s his CAT classification?
Natalie He is disinhibited, fair functioning.
Dawn Alright, and what have you tried?
Natalie We started with a food journal just to see what he was eating every day, and he was really good about writing things down, and he’s very aware now of what he’s eating.
Dawn It’s a good beginning because one of the things you want to do is make people aware of what they’re doing and a lot of eating is kind of unconscious, so at least now he knows how much he’s eating. What else have you tried besides the food diary? Anything?
Natalie We’ve also done a checklist to try to start exercising, some type of exercise behavior. He says he’s going to do it every week. We’ve been trying this for probably a month now, a checklist, and he has not followed through on actually exercising yet.
Dawn Okay, for the exercise, does he have the equipment that he needs? Does he have a good pair of shoes? Is there somewhere close he can exercise or does he walk? What is his kind of exercise that he wants to do?
Natalie Yeah, we bought him shoes and one workout outfit.
Dawn Okay, one of the things you may want to do is you may want to start by going to his house wearing exercise clothes and starting with him because he has to have a plan of some kind. Does he have a specific exercise in mind that he wants to do?
Natalie He says that he wants to go walking in his neighborhood.
Dawn Okay, so maybe what you can do is you can map out a course with him and walk it together. Another thing that you might want to do is prompt that behavior when you’re not there using an alarm. With his stated goal in mind, if I move more, you know, I’m going to do better, in terms of insulin or diabetes or weight.
Natalie So, like, a talking alarm?
Dawn Yeah, and you might want to get him a pedometer just so he can start monitoring his steps, and once he’s doing that, you can try for small increases every week, every day, that kind of thing.
Natalie Okay. What about the eating thing? He says he wants to cut down but he’s obviously overeating.
Dawn What’s the last thing you’ve seen when you’ve been over to his house? I mean, how has that gone as far as what food he’s got?
Natalie The food is not very nutritious. He had a half-eaten chocolate cake in there this last week when I went. You know, there’s doughnuts and stuff like that everywhere.
Dawn Okay, so is he in charge of buying the food?
Natalie Yes, he’s doing it.
Dawn So maybe helping him learn how to shop from a list, going with him to the store, helping him pick out foods that will be more appropriate. The other thing is if he’s disinhibited and the first thing he sees when he opens the refrigerator is the chocolate cake, he’s going to go for it. So maybe reorganizing the refrigerator so that the items that, you know, he wants to eat more, the items that are more nutritious are right in front. So help him cut up some celery sticks or something that he likes that’s right there that he can grab. The other thing you might want to do is nobody’s going to give up chocolate cake so, you know, forget that as a plan. So one of the things that you can ask him if it’s okay to help him in his stated goal is to portion out the cake. So cut it in small enough portions that are a certain number of calories. This is why 100-calorie packs are so popular. People take a whole and they eat too much so if you portion-size the cake, put it in individual Ziplocs, freeze most of those Ziplocs, and have him take one out every day and label it with the day of the week and his goal that you know, you don’t want to eat more than one pack because… and have him write the answer to that and label it right on the pack so that each pack reminds him. I can eat this chocolate cake. It’s okay, you know, I’m not giving up chocolate cake but I can only eat one of these a day. So it’s a little bit more trying to get him the control over the portions.
Natalie On every label?
[The screen cuts in and out indicating a time lapse.]
Dawn Okay, Elisa, let’s move on to you. How many people are in your case load?
Dawn Okay, so you’re planning to take on a few more this week?
[Elisa nods her head “yes.”]
Dawn Okay. Who would you like to start with?
Elisa I’d like to start with Sam. He’s 24 years old and I’ve been working with him for about three weeks.
Dawn Okay, so really new.
Elisa Really new.
Dawn What’s his CAT classification?
Elisa He’s apathetic, fair functioning.
Dawn Okay, and what is the problem that you’re working on?
Elisa His goal is to become more social so he’d like to make a few more friends. Currently, he’s going to The Clubhouse on Saturdays, but nobody is really talking to him.
Dawn What’s the problem?
Elisa We’ve identified that his hygiene is a problem. He doesn’t take a shower. He does work a labor-intensive job five days a week, but he only takes a shower about two days.
Dawn So what have you tried?
Elisa So far, the only things that we’ve been doing is creating a checklist so he can check off when he actually takes a shower in the morning, but it hasn’t been working.
Dawn What do you mean it hasn’t been working?
Elisa Well, he works five days a week in a very labor-intensive job so he sweats a lot but he’s only taking a shower about two days a week.
Dawn Does he think that’s enough?
Elisa No, he recognizes that this isn’t working for him.
Dawn Okay, so he sees that it’s not enough. What does he say is his reason for not checking off the other days?
Elisa That he forgets.
Dawn Okay, have you done any kind of alarm to remind him?
Elisa Just this last week we started doing the alarm.
Dawn Okay, and do you know if that’s had any effect yet?
Elisa It seems to have helped increase his showering a little bit more. It increased by one day extra.
Dawn One extra day. Okay, so there may be a couple of things that you may want to try or see if he’s willing to do. One of the things might be if he hasn’t showered when you come for your visit, to tell him you’ll come back. Ask him to shower and that you’ll come back. So that’s another day that he’ll be able to check off. You can also call him and ask him if it’s okay to call him and remind him in the mornings or have him call you after he’s done it, and if you don’t hear from him by a certain time, you can call him. You could try something like a gift card. That after a certain number of times that he showers a week that he could get a $5 gift card to something that he would like.
Elisa Those sound like good ideas.
Dawn Another thing that you might want to do is really be clear about what the social behavior is. Being social is very vague, so what is it that he really wants to do? Where does he want to go?
Elisa He’d like to make more friends so he’s currently going to The Clubhouse on Saturdays.
Dawn Okay, so making sure he showers before he goes to The Clubhouse. Is that happening?
Dawn Okay, so what you might want to do is have him shower one time before he goes to The Clubhouse and one time not shower and see if there’s any difference in the reaction that he gets from people and have him write that down for you. Give him a little notebook that he can carry in his pocket.
Dawn So those are all things you can try. Talk to him and see what he thinks is going to work, what you think is going to work, and then you can go from there.
Elisa Okay, and you mentioned the gift card. How long do I continue giving him this?
Dawn Well, because this is a new behavior, you want to establish it so what you would do is if he showers say, five times every week for two weeks, then he would get a gift card and then you would phase it out. You would say, now it has to be three weeks, and then eventually you would just phase out the gift card once he develops a habit about showering when he wakes up in the morning.
Elisa Okay. I’ll talk these over with him.