Treatment stages and goals

Pre-treatment and engagement phase

Before initiating formal therapy, there is a critical pre-treatment stage aimed at orientation and engagement. In this phase, therapy per se is not conducted, but rather the rules of the game are established.

Present problems are assessed, the consultant's goals are determined and, crucially, a collaborative agreement is negotiated.

The therapist explains the demanding nature of the treatment and the hierarchy of goals.

This is a time to obtain robust informed consent; for example, if an individual is unwilling to work to reduce lethal behaviors, he or she would not be a candidate for this model.

It seeks to ensure that the individual understands that the goal is not just to avoid pain, but to build a life worth living, thus establishing a solid alliance before navigating emotional turbulence.

From crisis to emotional stability

Once treatment is initiated, Stage 1 focuses obsessively on behavioral stability and safety.

The focus is on getting the individual to stop engaging in life-threatening or life-destroying behaviors (such as uncontrolled substance use or homelessness).

The premise is that it is not possible to work on deep emotional problems if behavioral chaos reigns in daily life.

Once behavioral stability is achieved, one moves on to Stage 2, where "silent" emotional distress is addressed.

Here conditions such as post-traumatic stress or residual emotional despair are addressed.

The goal is to move the individual from "quiet despair" to full emotional experience, processing past traumas that could not be touched in the stabilization stage.

Building a fulfilling life and transcendence

The final stages, 3 and 4, focus on the consolidation of an ordinary life and the search for meaning.

In Stage 3, the individual works on "living" problems, such as job dissatisfactions, minor marital conflicts or boredom; the goal is to reach a common level of happiness and functionality.

Finally, Stage 4 addresses the sense of incompleteness or existential emptiness that may persist even after resolving mental disorders.

This stage is oriented toward transcendence, sustained joy, and spiritual or philosophical connection.

It seeks for the individual to not only be "cured" of a pathology, but to have the capacity to experience joy and self-realization, thus completing the arc from extreme suffering to vital wholeness.

Summary

The pre-treatment stage establishes the commitment and the rules of the game. It negotiates collaborative goals and ensures that the patient agrees to actively work to reduce his or her lethal behaviors.

The first phase obsessively prioritizes behavioral stability and physical safety. Once control is achieved, the second stage addresses silent emotional distress and trauma processing.

The final stages seek to consolidate a functional ordinary life and resolve dissatisfaction. The ultimate goal is to achieve transcendence and spiritual connection, completing the arc to life fulfillment.