Orientation Manual

The Attention Deficit Spectrum Disorders Basic Orientation Manual

COPYRIGHT ©2007 EFRÉN RAMÍREZ, MD

Did you know that according to the American Psychiatric Association, about 3 to 7 percent of school age children have Attention Deficit Spectrum Disorders (ADSD)?   Did you know that approximately two thirds of those children will continue to have this condition even as adults, and for the rest of their lives? Did you know that there is scientific evidence that undiagnosed or inadequately treated ADSD puts you in high risk of eventually developing emotional complications?

 During the last several years, professionals who treat children and adults with ADSD have been receiving increasing demands from patients for a treatment approach other than the traditional drug based modality.  These persons frequently mention the intolerable secondary effects caused by the drugs, such as toxicity and degenerative long term effects; they are also worried about the use of stimulants and addictive substances.

This booklet describes a totally drug free alternative approach to the diagnosis, prevention, treatment and rehabilitation of persons with ADSD, which is practiced in the Ocean Park Ambulatory Therapeutic Community, promoted by the ADDAPR Foundation (Fundación de Adultos con Desorden de Déficit de Atención de Puerto Rico).  This alternative approach is geared towards correcting the epigenetic roots of mental dysfunctions by supplementing the diet with essential nutrients, which are neither toxic nor addictive.

 What is a Therapeutic Community (TC)?

A TC is a system for the diagnosis, prevention, treatment and rehabilitation of mental dysfunctions, based on the alternative drug-free philosophy and the cultural concept of the extended family.  It started in 1961, in Puerto Rico’s Centro de Investigaciones sobre la Adicción (CISLA) and spread rapidly to the Caribbean, Latin America and the world.  At the present time, there are more than 9,000 programs using this system, most of them organized under the World Federation of Therapeutic Communities.  The Ocean Park Ambulatory Therapeutic Community is a cutting edge development of this concept.  Among other things, it is precisely an ambulatory community, which is different from the original residential community concept.

What are the Attention Deficit Spectrum Disorders (ADSD)?

The ADSD are genetic (hereditary) dominant and polyfactorial variants of the personality which express themselves in multiple ways.  Because they are primarily genetic conditions, social and psychological factors are secondary to the primary cause.  And because they are dominant genetic variants, they are inherited even if only one parent has the condition.  This explains their high incidence.  The ADSD are frequently manifested in absent minded, risky and impulsive behavior.  Symptoms are essentially the same in children and in adults.

How can we identify the Attention Deficit Spectrum Disorders (ADSD)?

The ADSD can be identified by the presence of a group of twenty habitual attitudes and behavioral patterns, which correspond to twenty obstacles to success, whose intensity varies form person to person, and which can range from no impediment, to incapacitating or catastrophic impediments.  These twenty behavioral patterns, which will be listed below, if not treated in time, or if treated inadequately, can produce complications such as panic attacks, depression, manic-depressive psychosis, addiction, criminal behavior, academic failure, domestic violence, divorce, corruption, homelessness, suicide, occupational incompetence, and several other psychiatric conditions.

What is the origin of Attention Deficit Spectrum Disorders?

According to the triadic Theory of the Personality developed by Dr. Efrén Ramírez, the personality is constituted by temperaments, talents and character.  The expressions of the ADSD related disorders have their root in the temperamental component of the human personality.  This aspect of the personality is hereditary.  An out of control temperament is evidence of the individual’s immaturity.  There are eight temperaments: aggressive, callous, impulsive, irritable, melancholic, sexual, sensitive and timid. Temperament is the earliest factor in the evolution of the human personality, and rules everyone’s automatic and irrational reactions.  To manage the temperaments, and to achieve a balance in our personality, it is necessary to develop our talents and nurture our character.

Our talents provide us with the natural channels for the temperamental energies. Talent, which is narcissistic and amoral, is easily seduced by temperament.  Character, which is the learned aspect of the personality, consists of attitudinal skills and patterns which allow us to more efficiently handle day to day situations.  Character generates the individual’s executive function (or moral conscience), which civilizes the temperaments and keeps the talents untainted, and steers each person towards his dharma (his/her life’s purpose), and humanity towards a culture of peace.  An individual who can maintain control of his temperaments demonstrates that he is developing or has already developed maturity in his emotional intelligence, which is independent of his intellectual intelligence.  Emotional intelligence is about the wisdom with which individuals moderate their impulses.  It is severely affected in cases of ADSD.

Do you know anyone with ADSD? Have you ever thought that you might have it?

The person who does not know if he/she has ADSD cannot take the first step to take care of the condition.  Do you want to find out if you have it?  In this booklet we offer you an easy method to determine, by means of a simple self-assessment, if you have or don’t have Attention Deficit.  It is important that you be honest with yourself when you answer the self-assessment page.

Instructions for Self-assessment

At the end of this booklet you will find a page with a list of 20 indicators for Attention Deficit Spectrum Disorders (ADSD), which includes the types or patterns of behavior which one way or another show up in persons with an underlying genetic deficit.  You should evaluate yourself item by item, in an honest self assessment exercise, and fill the page according to your own behavior.  Every behavioral pattern in the page is quantified in five levels: you should put a mark under column “N” if you sincerely determine that you do not have a given pattern at all.  If you have observed in yourself something of the conduct described in any pattern, put a mark under the corresponding quantification, be it “L” (light), “M” (moderate), “S” (severe), or “C”(catastrophic or incapacitating).   To estimate the final score, add up the marks under the last four columns, L+M+S+C, as indicative of the presence of ADSD.

This arithmetical operation will offer you a quantitative diagnosis, in other words, how many of the twenty behavioral patterns are recognizable as factors negatively affecting your conduct.  Persons with less than five indicators are considered free of ADSD.  For those who score between five and ten indicators, the condition is bothersome, but not incapacitating.  For persons who score between ten and fifteen, the condition causes noticeable impediments, and for those with more than fifteen, the condition tends to be incapacitating.  If you score more than fifteen, you should seek help immediately.

A word of caution: if you recognize in your conduct “S” (severe) and/or “C”(catastrophic) levels in any pattern of behavior, but your over-all score is less than five, you should go over your self-assessment from the beginning, taking time to be more careful.  You should be particularly careful in pattern 19, which measures poor insight.  It is very improbable that a person show severe or catastrophic levels in any pattern while scoring “well” in others.

From a qualitative point of view, you should consider the patterns that reflect severe or catastrophic levels (columns S and C) in order to have an idea of what your therapeutic priorities should be.  This diagnostic page shows a profile of your condition so that you can take the appropriate action and consequently achieve a better quality of life.

Once you have begun the process which is recommended later in this booklet, you may use the self-assessment page to measure your progress by observing the evolution of your personality and discovering the forward course of your treatment.

Now fill the page at the end, keeping in mind that you must be totally honest with yourself.

After you have filled in the self-assessment page, take a look at the totals under each column.  Discard the total under the “N” column and add up the totals of the four other columns.  If the sum of these totals more than 13, it is very probable that you have ADSD.

Is there a sure way of confirming an ADSD diagnosis?

Yes, there is: by observing your reaction after taking a minimal dose of a completely natural and safe vegetable nutrient which does not require a medical prescription.  This nutrient is chelated lithium, which is not toxic, and must not be confused with lithium carbonate, which is prescribed by psychiatrists, and is toxic.  Chelated lithium, which is not toxic, is also known as organic lithium, because it is produced naturally by certain plants, which combine the mineral lithium with the plants’ essential amino acids.  Chelated lithium is usually sold in 50 microgram capsules.  The brand of chelated lithium most readily available In Puerto Rico is Lithinase, produced by Progressive Laboratories, Inc.  It is usually sold in health food stores.

How much chelated lithium should I take to make the test?

Buy a bottle of chelated lithium and take four 50 microgram capsules (a total of 200 micrograms).  If after 10 or 15 minutes you feel more alert, your attention is more focused; you are less distracted, less anxious, more optimistic, less bored, with a reduced oppositional attitude, and with a general increase in well-being, then you have ADSD.  You are feeling better because ADSD is caused by a chelated lithium deficiency in your system and when you take the capsules you correct this deficiency.  You will notice that the chelated lithium does not have a “drug” effect; it does not dull you.  On the contrary, it produces an equanimous state in which you will feel tranquil, yet focused and alert.

How frequently must I take chelated lithium?  In what amount?

As you read further, you will find a way to determine your individual maintenance dose of chelated lithium; which can be different for different persons.  In this way the effect of lithium may be sustained during the day, day after day.  You should know that the body eliminates chelated lithium in a few hours’ time, so that lithium does not accumulate, nor does it produce toxic effects.  For this same reason, it is necessary to repeat the daily dose at breakfast, lunch, dinner and bed time in order to maintain the necessary lithium level in the body during the whole day.

Aside from taking chelated lithium, should I do anything else?

Once you establish a daily pattern of ingesting chelated lithium four times a day, in the individual dosage which is appropriate to you (that dose could be higher or lower than the 200 micrograms of the original dose, which is also your starter dose), you will be ready to pay attention to other aspects of your ADSD condition, by adding some simple strategies which will be explained shortly.  The combined use of chelated lithium with these other strategies in an integrated manner will allow you to correct your ADSD, as well as the other secondary manifestations which generally accompany this condition.  You will not only solve your ADSD, you will also be on your way to realize your personal potential.

How to establish your individual dose of chelated lithium

By repeating periodically the self-assessment exercise mentioned above, you will be able to measure the effect that taking chelated lithium is having on you.  This exercise measures in each person what may be called the twenty barriers which hinder, or even prevent, the success of persons with ADSD.  Filling the page with total honesty will allow you to focus your attention on certain patterns of negative behavior, so that you will gradually achieve the objectivity of an external observer.

How often must I do the self-assessment exercise?

At the beginning you should do the evaluation formally, in paper, frequently, even daily.  As you get used to observing your own conduct, you can reduce the written evaluations to once a week, because you will have made a habit of being aware of your conduct and of your negative behavioral patterns.  In addition, the state of attention and equanimity provided by the chelated lithium will facilitate the observation, and the correction of those negative patterns.

How do I know if I should increase or reduce the original 200 microgram dose?

If you notice that even after taking 200 micrograms of chelated lithium four times a day, it is difficult for you to correct your patterns of negative conduct, you should gradually increase the dosage.  In the same manner, if you notice a significant improvement in your behavior, you can try a gradual reduction of the dose, till you arrive at the lowest amount which produces an equanimous, alert and focused state.  This is your maintenance dose.

Is another type of adjustment in the pattern of lithium ingestion necessary?

As you sharpen your self awareness skills you will notice that the amount of lithium you need to maintain an optimum state of equanimity will not always be the same in each of the four times a day (breakfast, lunch, dinner and bedtime) when you take your lithium.  Some people, for example, find that they need a slightly larger dose at breakfast, others at bedtime.  But this varies with each person.  What is important is to find the optimal dose for your individual situation.

What risks do I take by ingesting chelated lithium?

It is important that you realize from the very beginning that you must not be afraid of increasing your lithium intake.  In the first place, and as mentioned above, chelated lithium is not toxic.  It is a natural nutrient.  In the second place, the human body eliminates chelated lithium in a few hours’ time; therefore it does not accumulate in your body.  In the third place, the dosage we recommend is in micrograms, that is, in millionths’ of a gram. (A millionth of a gram is 0.000001 gram).  If you would like to compare doses: lithium carbonate, which is prescribed by psychiatrists, is generally consumed in doses of 300 to 450 milligrams, which is from 1,500 to 2,250 times more than 200 micrograms.  And lithium carbonate is toxic in itself, wheras chelated lithium is not.

Other necessary skills

When you take chelated lithium consistently, four times a day in adequate doses, you will find that the negative impact of the twenty barriers, which make life difficult for those with ADSD, has diminished.  Yet, in order to address these difficulties further, and work towards achieving your personal potential, it is necessary to develop other skills. The most efficient and easiest way to do this is to participate in the peer group “tertulias” of the Ocean Park Ambulatory Community.   There you will learn the following:

1.   Nutritional Correction of your nutritional deficiencies which underlie ADSD, by means of the use of chelated lithium (four times a day), plus free form amino acids, vitamins, minerals and phytochemical supplements.  In adequate doses, chelated lithium modifies temperamental intensity without changing its essential nature.

2.   Neurolinguistic Reprogramming in individual and group sessions to clear up common confusions about ADSD, biogenetics, chelated lithium and the amino acids, and to reprogram negative beliefs and relations.  It is a treatment modality developed in a therapeutic community context, where, in an honest encounter with reality, the person learns to discard false beliefs and make space for correct convictions.

3.   Joining the Metanoia groups where group dynamics are not focused on the individual’s problems, or on commiseration, but on the celebration of change and of the progress achieved by each participant, and in the shared exploration of successful strategies.

4.   Vocational Reorientation: Individual and group training focusing on the identification and nurturing of talents directed towards maximizing treatment results and promoting vocational and economic self-sufficiency.

5.   Meditation Techniques to expand the intuitive component of the personality, in order that the person with ADSD will not consider him/her self as a victim of destiny, but will see the condition as a gift and a way towards the development of a humanistic conscience.  Meditation as practiced in the Ocean Park Ambulatory Therapeutic Community is a therapeutic technique which aims to reach an intermediate level of consciousness, a state between wakefulness and dreaming, which will allow the conscious ego access to subconscious and unconscious levels of the psyche, including the transpersonal (spiritual) level.

The Development and Management of the Five Strategies

The Ocean Park Therapeutic Community has two separate groups.  It is important to know that these groups are directed by a psychiatrist (the Director of the Therapeutic Community), and constitute a therapeutic group modality, which is covered by most medical insurance plans.

How does the development and management process of the five strategies begin?

The participants in the “tertulias” of the Therapeutic Community (who have been previously evaluated by the Director), begin attending a group called Induction, which meets every Monday at 6:00 pm.  In these meetings micronutritional correction is explained, and the participants learn to observe in themselves the changes it generates.  Participants become more skilled in completing the self-assessment document, which is handed out at each meeting.  Detailed information on ADSD, on biogenetics, chelated lithium and the amino acids is given.  With this information, each participant can gradually achieve his/her own neurolinguistic reprogramming, that is, the modification of the way the individual conceives and understands his/her own particular situation.  This is turn will help each one to find means to modify his temperamental reactions, and in this way overcome the barriers created by the ADSD.  In this stage the participant begins the process of recognizing his/her own resources which will enable success in life, in spite of the ADSD condition.

What is the next step?

Once the induction group participant has normalized the curve of the twenty barriers he is promoted to the next level: the Metanoia groups.  Metanoia is a Greek word which means transformation in the way of thinking.  The Metanoia group usually meets Thursdays, at 6:00 pm.  In these groups, which are also led by the Therapeutic Community Director, there is further development of the topics related to transformation which were initiated in the Induction process.  In particular, the Individuation Process, initially developed by Carl G. Jung, and adapted to group therapy by Dr. Efrén Ramírez, the Director of the Community, is considered at a more profound level.  Through the Metanoia process, which changes the way in which we observe our surrounding reality, we not only change the way in which we react to that reality, but we also create the conditions which will allow us to change our existential situation, and in this way, to improve that reality.

What else happens in a Metanoia group?

The Metanoia group offers an opportunity to share energy and information.  All the participants contribute, but not by recounting problems or sorrows, but by sharing strategies which they have developed to effectively face the twenty barriers to successlisted in the self-assessment document.  Another important aspect of these talks is that the participant learns to pay attention to others, and really understand what is being said by them.  This is reinforced at the end of each meeting, when participants share with the group a short comment (“the pearl”) about what he/she learned, contributing in this way to everyone enrichment.

Are there activities other than the groups?

The Metanoia participants have the option to participate, one Sunday a month, in group meditations.  In these sessions, and through a technique of self hypnosis, the participant lives a personal experience which allows for a better understanding of the mind-body relation, which in turn paves the way to holistic healing, by harmonizing the diverse components of his/her personality and by diminishing the temperamental manifestations.  It also expands the intuitive component of the personality, the development of a humanistic conscience, furthers the attainment of each one’s potential, and the development of psychic faculties (the “indigo” component of the personality).

ADSD and some problems of daily living

The Attention Deficit Spectrum Disorders (ADSD) are not mere theory.  They create many personal and social problems around us.  You might not have ADSD, or only have it to a slight degree, but you can be sure that there are many people around you who do have it, including some at severe or catastrophic levels.  Eventually, other person’s ADSD (family, co-workers, clients, people you meet on the street, etc.) can bring you problems, whether you yourself have ADSD or not.  It is important that you be able to recognize the situation so that you can handle it better.

There are multiple types of conduct, which are extremely negative, which are caused by ADSD, even if we don’t know it.  Some examples of these types of conduct, or of its consequences, and the corresponding ADSD diagnosis (see self assessment page twenty barriers) which are indicators of risk for every condition.

 

Addictions: There are many forms of addiction, not only addiction to illegal drugs.  Some persons are addicted to work, or sex, or eating; to alcohol, gambling, etc.  The principal ADSD indicators pointing to addictive behavior are:

·         Risky behavior

·         Boredom

·         Rebelliousness

·         Irritability

·         Impulsivity

·         Poor insight

·         Family history


Panic attacks, anxiety, phobias
.  The principal ADSD indicators which correspond to these problems are:

·         Melancholic Pessimism

·         Dispersion

·         Distraction

·         Irritability

·         Preoccupation

·         Family History

 

Depression: Clinical depression is almost always the severe or catastrophic complication of the following ADSD indicators:

·         Melancholic Pessimism

·         Procrastination

·         Boredom

·         Distraction

·         Irritability

·         Preoccupation

·         Insecurity

·         Affective Bipolarity

·         Low Self-esteem

·         Family History

 

Academic failure can be anticipated if the student has high levels of the following FDSD indicators:

·         Melancholic Pessimism

·         Disorganization

·         Procrastination

·         Careless verbalization

·         Risky behavior

·         Boredom

·         Distractions

·         Inventiveness

·         Rebelliousness

·         Insecurity

·         Restlessness

·         Low Self esteem

·         Poor Insight

·         Family history

 

Delinquency: Habitual delinquent conduct is preceded by high ADSD indicators in the following patters:

·         Disorganization

·         Dispersion

·         Careless verbalization

·         Risky behavior

·         Boredom

·         Inventiveness

·         Rebelliousness

·         Irritability

·         Impulsivity

·         Affective bipolarity

·         Restlessness

Corruption:  The tendency towards corrupt conduct (white collar crime) may be for seen in ADSD cases with severe levels in the following patterns:

·         Dispersion

·         Risky Conduct

·         Inventiveness

·         Rebelliousness

·         Impulsivity

·         Affective bipolarity

·         Restlessness

·         Poor insight

·         Family history

 

Substandard work performance: failure in the workplace is a complication of the following patterns:

·         Disorganization-difficulty in planning and management

·         Procrastination with difficulty in initiative

·         Dispersion

·         Careless verbalization

·         Distraction

·         Rebelliousness

·         Irritability

·         Addictions

·         Poor insight

·         Family history

Obesity: Chronic obesity is a ADSD complication, specially when the following patterns are present:

·         Disorganization

·         Procrastination

·         Risky Conduct

·         Boredom

·         Distraction

·         Inventiveness

·         Rebelliousness

·         Impulsivity

·         Insecurity

·         Affective bipolarity

·         Addiction (compulsive habits)

·         Low self esteems

·         Poor insight

·         Family history

 Manic depressive psychosis.  An intensification, at a catastrophic level of affective bipolarity (pattern #15). It frequently accompanies severe or catastrophic levels in any of the other behavioral patterns which are ADSD indicators, especially:

·         Family history

Schizophrenia: A catastrophic intensification of any of the behavioral pattern indicators of ADSD, especially the following ones:

·         Disorganization (mental)

·         Distraction

·         Irritability

·         Preoccupation (excessive and unnecessary)

·         Insecurity

·         Poor insight

·         Family history

 

 Autism: Catastrophic level of stunted maturity, with elevated levels in all the ADSD patterns, and catastrophic levels in the following:

·         Distraction

·         Impulsivity

·         Restlessness

·         Addictions (repetitive and compulsive behavioral patterns)

·         Low self esteem

·        Family history at catastrophic levels

Suicide: Catastrophic complications of a constellation of ADSD complications which include:

·         Melancholic Pessimism

·         Boredom

·         Rebelliousness

·         Irritability

·         Impulsivity

·         Excessive and unnecessary preoccupation

·         Insecurity

·         Affective bipolarity

·         Low self esteem

·         Family History

Domestic Violence: Catastrophic deterioration of the relationship caused by the presence of severe  ADSD indicators in one or both partners, in the following patterns.

·         Careless verbalization, the verbal component of domestic violence.

·         Risky behavior

·         Boredom

·         Rebelliousness

·         Irritability

·         Impulsivity

·         Affective bipolarity

·         Addictions

·         Low self esteem

·         Poor insight

·         Family history

Insomnia: Frequently related to severe ADSD indicators, especially the following:

·         Irritability

·         Preoccupation (excessive and unnecessary)

·         Restlessness

·         Family History

 Sexual Dysfunction: All the sexual dysfunctions not derived from an organic cause have catastrophic ADSD levels in:

·         Dispersion (polyvalent sexual activity)

·         Risky Behavior (seeking sexual excitement and stimulation without considering the consequences).

·         Impulsivity

·         Addictions (compulsive and repetitive patterns of sexual behavior)

·         Family history (severe or catastrophic levels)

Homelessness: This complication can be anticipated if severe and catastrophic ADSD levels exist in the following patterns:

·         Melancholic Pessimism

·         Disorganization

·         Procrastination

·         Careless Verbalization

·         Risky behavior

·         Distraction

·         Rebelliousness

·         Impulsiveness

·         Insecurity

·         Affective bipolarity

·         Restlessness

·         Addictions

·         Low self esteem

·         Poor insight

·         Family history

 

Alzheimer’s disease: In cerebral degeneration cases, including Alzheimer’s with a pre-morbid ADSD history, we can expect a substantial improvement in the patient’s quality of life if the following ADSD patterns are adequately treated.  In addiction to family history (#20), we find high ADSD levels in:

·         Disorganization

·         Dispersion

·         Distraction

·         Inventiveness

·         Insecurity

 

Eating disorders (anorexia/bulimia):

·         Melancholic Pessimism

·         Disorganization

·         Procrastination

·         Dispersion

·         Risky behavior

·         Distraction

·         Inventiveness

·         Rebelliousness

·         Impulsivity

·         Preoccupation

·         Insecurity

·         Affective bipolarity

·         Restlessness

·         Addictions

·         Low self-esteem

·         Family history

Hypochondria: The presence of multiple ills without clear medical causes, (included in the Medical History Inventory, which is filled out upon entering the program).  The connection with ADSD is through the epigenome.

 Conclusion

All the manifestations of psychiatric disorders which can be traced back to infancy, childhood or adolescence should be evaluated with the Attention Deficit Spectrum Disorders (ADSD) in mind.  If these are present, treatment for the specific condition should accompany adequate ADSD treatment.  For example: the specific learning disabilities in school children frequently reveal an ADSD background which goes unnoticed by the professionals, who focus their attention on a specific difficulty (learning) while ignoring the root or cause of this difficulty (ADSD).

In these cases it is easier to solve the learning problem if the ADSD is treated. ADSD treatment should be based on nutrients, including chelated lithium, should be free of toxic drugs, and should be centered in a therapeutic community environment, where the skills which are necessary  to treat this condition are learned and practiced.

 

[1]     Diagnostic and Statistical Manual of Mental Disorders, 4th. ed., Text Revision, Washinton D. C.:  American Psychiatric Association; 2000.  It is generally referred to as DSM-IV TR.  [This manual contains definitions of the several mental disorders, taking into account only the symptoms of these disorders, without considering their causes or their treatment.  The fifth edition, which is now in the making, will probably include not only the  biogenetic basis of the disorders, but also guides for their treatment, both conventional and alternative.]

[2]     Hallowel E and Ratey J, Driven to Distraction, New York:  Touchstone Press; 1995, p. 6.

[3]     Aggressive: Tendency to correct and control others. Callous: Lack of sensitivity and indifference to the consequences of one’s actions. Impulsive: Tendency to act without considering the consequences. Irritable: Intolerance to frustration, not accepting reality. Melancholic: A tendency to re-live the past in the present. Sensitive: A tendency to histrionic, dramatic reactions; emotional outbursts with manipulative intentions. Sexual: A tendency towards erotic reactions, polyvalent sexual behavior. Timid: Reluctant to take action; difficulty in turning intention into action.

[4] The author does not receive benefits from the sale of Lithinase in these stores.

[5]     As you will see in more detail further on, these “tertulias” are in no way mere social gatherings, but meetings of a group, previously sifted by the Director of the Community, under whose leadership the participants learn various attitudinal skills, and share successful strategies, that help them attain balance between their temperaments, talents and character.  Those who follow the process gradually attain a positive transformation in their personality, overcome the limitations caused by their ADSD, and move towards achieving their potential as individuals.  These therapeutic “tertulias” are geared towards helping each participant to an existential understanding of, and a personal commitment to, what Carl G. Jung called the process of individuation.

[6]     Sharing strategies does not in any way mean revealing details of personal problems.  What is shared are the methods by which the participants have overcome obstacles and achieved goals.