I like the idea of "going for the gold" - but can you recommend where to "dig?" I.E. can you suggest particulars for the "motivational assessment and intervention." The usual existential approaches (considering living in the face of dying and disease) has not met with much success with these individuals, at least through MY delivery, which is of course limited. That is, when I ask about motivation, what they like, etc. they too often answer with a dysthymic "I don't really care about anything except food and TV." I wonder whether a "tough love" appraoch, focusing on strict behavioral expectations in order to continue in therapy might not be of value. When I was at Duke, our day-treatment program was very successful with such folks. But I have far less success with once/week out-patient structures. Thanks for the help. Jim
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