Basic to moderate level of familiarity with the material

This institute will teach participants how to conduct time-limited group and individual therapy using an evidence-based Guided Self-Change cognitive-behavioral (CB) motivational intervention. A brief overview of the results of the randomized controlled trial comparing the GSC treatment delivered in a group and individual format will be presented. This workshop will first provide practitioners with a solid overview of key motivational interviewing (MI) skills to work more effectively with their clients. MI, consisting of different nonjudgmental and non-confrontational strategies and techniques derived from existing models of psychotherapy and behavior change, is a therapeutic style that has been shown to work well across a variety of health and mental health behaviors (e.g., dual disorders, smoking, diet, HIV screening, sexual behavior, diabetes control, medical adherence, depression). A key goal of MI is to help individuals who are ambivalent or low in readiness to change to become more committed to changing. MI techniques and strategies will be demonstrated using short role- and real-play exercises and videotape clinical vignettes.

Conducting group therapy is considerably more complex and challenging than conducting individual therapy as it involves simultaneously handling multiple clients. Research shows that to achieve successful group outcomes it is necessary to build group cohesion. When applied to group therapy, group cohesion is built by identifying commonalities among group members, and by having the group members do most of the talking and interacting to facilitate change. In this regard, the group leaders’ task is to use the group itself (i.e., group process) as an agent of change by using round robin discussions, and to avoid doing individual therapy in a group setting.

The workshop will include (a) written and videotaped clinical examples demonstrating how to integrate CBT and MI in groups, (b) a protocol for integrating CBT and MI in groups, (c) selected MI feedback handouts, including CB homework exercises used in the group format, and (d) sample dialogues of how to deal with difficult and challenging group situations and clients.

You will learn:

• How to implement the Guided Self-Change treatment model into both individual and group therapy
• How to integrate the basic CB and MI strategies and techniques into group therapy using round robin discussions
• Fundamental skills needed to effectively conduct and manage groups, including building cohesion by looking for commonalities among members, ensuring all group members participate regularly, managing multiple clients at one time, managing resistance and dealing with conflict, and importantly, having the Music Come From the Group.
• How to effectively conduct and manage the dynamics of interpersonal interactions in groups (e.g., structure of groups, developing cohesion), as well as discussing how to manage challenging clinical situations and issues that arise when conducting groups.

Recommended Readings:

Sobell, L. C. & Sobell, M. B. (2010, in press; due out August 2010). Clinician’s Guide to Conducting Group Therapy Using a Cognitive Behavioral Motivational Intervention: The Music Comes From the Group (tentative title). New York: Guilford Press.

Sobell, L.C., Sobell, M. B., & Agrawal, S. (2009). Randomized controlled trial of a cognitive-behavioral motivational intervention in a group versus individual format for substance use disorders. Psychology of Addictive Behaviors, 23, 4, 672-683. doi: 10.1037/a00116636.

Beiling, P. J., McCabe, R. E., & Antony, M. M. (2006). Cognitive-behavioral therapy in groups. New York, NY: Guilford Press.

Basic level of familiarity with the material

Cognitive Processing Therapy (CPT) has been successfully tested as a 12-session treatment for posttraumatic stress disorder (PTSD) across a number of trauma populations including interpersonal assault survivors, combat veterans, and motor vehicle accident victims. This evidence-based intervention is increasingly utilized in clinical settings through statewide and federal implementation efforts. Beyond decreases in PTSD and depression, CPT also targets concurrent symptoms such as guilt and anger. The treatment is widely used in both individual and group therapy. Findings suggest that clinical gains are maintained at 5 years following treatment. Despite ample evidence regarding CPT’s efficacy, based on randomized clinical trials and effectiveness trials, clinicians may sometimes struggle with implementing a therapy into their standard clinical practice. Specifically, questions often emerge regarding the level of training necessary to implement CPT, when to deviate from the therapy protocol, when to end the therapy early or extend the therapy past the 12 weeks, and how to successfully respond to crises during the course of treatment. In this workshop, participants will be taught the basics of CPT for PTSD along with tips and strategies for implementing CPT in clinical practice. The workshop will utilize didactic presentation, video-tape demonstrations, and live roleplays when appropriate. It will also provide attendees with practical and useful materials including treatment manuals and client handouts, along with information regarding further online training. You will learn:

• to implement CPT, including identifying areas of disruptive thinking and use of a writing trauma account.
• Socratic dialogue that can be applied in the practice of CPT and more generally in clinical practice.
• how to adapt the CPT therapy protocol when necessary to meet individual client treatment needs.

Recommended readings (optional):

Resick, P. A., Galovski, T. E., Uhlmansiek, M. O., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243-258.

Resick, P. A., Monson, C. M., & Chard, K. M. (2007). Cognitive processing therapy: Veteran/military version. Washington, DC: Department of Veterans' Affairs. [Email Patricia.Resick@va.gov for a copy.]

Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive processing therapy, prolonged exposure and a waiting condition for the treatment of posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867-879.

Basic level of familiarity with the material

An empirical approach to psychotherapy calls for the therapist to develop a hypothesis (formulation) about the factors that cause and maintain the patient’s symptoms, problems, and disorders; use the formulation to guide intervention; and collect data to evaluate the effectiveness of the interventions that flow out of the formulation. In this Institute Dr. Persons briefly describes the conceptual model underpinning this hypothesis-testing approach to cognitive-behavior therapy, and spends most of the Institute providing hands-on training in the key skills of developing and using a case formulation and monitoring progress. Dr. Persons presents tools and strategies for developing formulations at the level of the case, the disorder, and the symptom. She describes and illustrates using these formulations to guide intervention. She provides tools to aid the task of monitoring the patient’s progress in therapy. Teaching methods include lecture, video and audio demonstration, and practice exercises. Dr. Persons provides numerous handouts and forms and an Excel scoring tool to aid progress monitoring using the Depression Anxiety Stress Scales (DASS).

You will learn:

• A conceptual model for using a case formulation to guide individualized evidence-based CBT.
• Strategies for developing CB formulations at the level of the symptom, disorder, and case.
• Strategies for collecting progress monitoring data in every therapy session.

Recommended Readings:

Kazdin, A. E. (1993). Evaluation in clinical practice: Clinically sensitive and systematic methods of treatment delivery. Behavior Therapy, 24, 11-45.

Persons, J. B. (2005). Empiricism, mechanism, and the practice of cognitive-behavior therapy. Behavior Therapy, 36, 107-118.

Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. New York: Guilford.

Basic to moderate level of familiarity with the material

A new approach to CBT case conceptualization offers a step-by-step model to guide therapists’ treatment planning with complex cases, especially when no single treatment model applies. This approach incorporates three guiding principles: (1) collaborative empiricism, (2) three levels of conceptualization that evolve over the course of therapy, and (3) incorporation of client strengths into each level of conceptualization so therapy is designed to both relieve distress and build resilience.

While this Institute demonstrates all three principles, there is an emphasis on incorporation of client strengths at each stage of conceptualization. Padesky and Mooney model how to incorporate client culture, personal interests, imagery, and metaphors into constructive, strengths-based conceptual models. In addition to the opportunity to participate in structured exercises designed to develop relevant skills, participants explore the implications of explicitly adding a resilience focus to CBT conceptualization and treatment.

Learning objectives:

• Improve your awareness of how to search for hidden client strengths
• Practice methods to bring strengths into client awareness; and
• Collaborate with your clients to construct conceptualizations that incorporate strengths as well as vulnerabilities

Recommended Readings:

Kuyken, W., Padesky, C. A., & Dudley, R. (2009). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. New York: Guilford.

Mooney, K.A., & Padesky, C.A. (2000). Applying client creativity to recurrent problems: Constructing possibilities and tolerating doubt. Journal of Cognitive Psychotherapy: An International Quarterly, 14 (2), 149-161 [available online].

Basic level of familiarity with the material

The workshop will begin with a brief discussion of the characteristics that differentiate OCD from other disorders that share some similar features. Next, the empirical evidence for the efficacy of exposure and ritual prevention (EX/RP) in ameliorating OCD symptoms will be reviewed, along with the theoretical principles that underlie the treatment. A description of the four components of EX/RP will then follow: in vivo exposure, imaginal exposure, processing of the exposure experiences, and ritual prevention. The implementation of these four components in a comprehensive treatment program will be discussed in detail, and examples will be provided to demonstrate how to implement them effectively. After reviewing the general treatment principles of EX/RP, the workshop will address the common obstacles encountered in treating patients with OCD. Barriers to success include: 1) overvalued ideation; 2) poor or misplaced motivation; and 3) diminished tolerance for discomfort. Clinical case presentations and videos of patients will be used to demonstrate both the essential components of EXRP, as well as the kinds of patient barriers that are typically encountered in treating OCD. The overall goals of the workshop are to introduce the essential elements of EX/RP, discuss the common problems of implementing EX/RP effectively, and provide case examples of how to implement EX/RP and overcome common treatment barriers.

You will learn:

• How to distinguish OCD from other disorders with overlapping characteristics.
• How to implement EX/RP effectively by using the manual in a flexible manner.
• How to address barriers that clinicians face when treating OCD patients.

Recommended Readings:

Foa, E. B., & Kozak, M. J. (2004). Mastery of obsessive-compulsive disorder: A cognitive-behavioral approach. Therapist Guide. New York: Oxford University Press.

Franklin M. E., & Foa, E. B. (2008). Obsessive-compulsivedisorder. In D. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (pp. 164-215). New York: Guilford.

Basic to moderate level of familiarity with the material

Increase the emotional intensity, interpersonal focus, and impact of your CBT treatment. Functional Analytic Psychotherapy (FAP) employs functional analysis to create deep, meaningful, and healing therapeutic relationships by focusing on the subtle ways clients' daily life problems occur in the therapy session. FAP uses awareness, courage, and love (behaviorally defined) in the therapist-client relationship to produce significant change. Innovations in therapeutic rationales and treatment planning lead clients to go beyond presenting symptoms into their purpose and passion for living. FAP can be applied to a wide range of clinical problems, including depression, anxiety, intimacy issues, personality disorders, problems of the self, and OCD. This institute will include videotaped therapy segments, experiential exercises, demonstrations and client handouts. Considered one of the new generation Cognitive Behavior Therapies identified as "third wave," FAP can be integrated into your practice, and provides a conceptual and practical framework that will help super charge your next therapy session.

You will learn:

• How to make clients’ learning experiences more powerful by addressing the subtle ways their daily life problems are brought into the session.
• Five therapeutic rules to guide treatment, plus concrete exercises to increase connection, intensity, and effectiveness in your interventions.
• When commonly used interventions can be inadvertently counter-therapeutic.

Recommended Readings:

Tsai, M., Kohlenberg, R. J., Kanter, J. W., Kohlenberg, B. S., Follette, W. C., & Callaghan, G. M. (2008). A guide to functional analytic psychotherapy: Awareness, courage, love and behaviorism. New York: Springer.

Kohlenberg, R. J., & Vandenberghe, L. (2007). Treatment-resistant OCD, inflated responsibility, and the therapeutic relationship: Two case examples.Psychology and Psychotherapy-Theory Research and Practice, 80, 455-465.

Kohlenberg, R. J., Kanter, J. W., Bolling, M. Y., Parker, C., & Tsai, M. (2002). Enhancing cognitive therapy for depression with functional analytic psychotherapy: Treatment guidelines and empirical findings. Cognitive and Behavioral Practice, 9, 213-229.

Kohlenberg, R. J., & Tsai, M. (1994). Functional analytic psychotherapy: A radical behavioral approach to treatment and integration. Journal of Psychotherapy Integration, 4(3), 175-201.

Basic level of familiarity with the material

Substance Use Disorders are inherently complex, often involving symptoms of other mental health problems, such as depression and anxiety. ACT, an overarching treatment model, can assist clinicians in understanding and intervening with substance abuse and related distress by tapping core processes thought to be associated with psychological flexibility. This workshop, intended for clinicians new to ACT or new to the use of ACT in the context of substance abuse, will provide a description of the ACT model of psychological health and a rationale for the use of ACT with this population. The workshop will include discussion of the therapeutic processes ACT seeks to engage and provide demonstrations of specific experiential exercises designed to engage these processes with substance abusing clients. Those attending the workshop will have the opportunity to participate in experiential exercises, watch others demonstrate exercises live and via videotaped vignettes, and practice leading exercises themselves during role play.

You will learn:

• To articulate a rationale for using ACT with substance abusers
• To conceptualize treatment in terms of the six core processes ACT seeks to engage
• To apply specific exercises and techniques typical of an ACT intervention with substance users

Recommended Readings:

Hayes, S. C., Strosahl, K. D., & Wilson, K.G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford.

Luoma, J. B., Hayes, S. D., & Walser, R. D. (2007). Learning ACT: An acceptance & commitment therapy skills-training manual for therapists. Oakland, CA: New Harbinger.

Hayes, S. C. [with Spencer Smith) (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland, CA: New Harbinger.

Wilson, K. G., & Byrd, M. R. (2004). ACT for substance abuse and dependence. In S. C. Hayes & K. D. Strosahl (Eds.) (2004). A practical guide to acceptance and commitment therapy (pp. 153-184). New York: Springer.

Moderate level of familiarity with the material

Cognitive-behavioral therapy (CBT) is widely recognized as an effective treatment for posttraumatic stress disorder (PTSD). Yet clinicians often encounter challenges when implementing CBT for PTSD patients with multiple problems, which may result in reluctance to use it. The goal of this institute is to enhance therapists’ comfort and confidence in flexibly applying evidenced-based methods for treatment of PTSD with complicated patients. Participants will learn how to use a case formulation approach to conceptualize the array of difficulties faced by patients with complicated posttraumatic presentations and to develop a tailored treatment plan for each patient’s problems that draws from a range of evidence-based strategies. The challenges of designing treatment to address multiple problems will be addressed, including whether to deliver treatments simultaneously or sequentially, using assessment data to guide treatment decisions at various stages, and revising the case formulation when treatment does not proceed according to plan. This approach enables the clinician to weave together therapy methods and adapt them for patients with varying trauma histories, comorbidity, and complicating life circumstances. Troubleshooting suggestions and clinical tools to address roadblocks with complex cases will be discussed. Case examples and sample dialogues will illustrate ways to overcome frequently encountered obstacles to treatment completion.

You will learn:

• To use a case formulation approach to conceptualize multiple problems and challenges and develop individualized treatment plans
• To address barriers and troubleshoot problems that may arise when implementing prolonged exposure and cognitive therapy for PTSD
• To integrate cognitive behavioral strategies for comorbid problems systematically using ongoing assessment to guide treatment decisions.

Recommended Readings:

Cook, J. M., Schnurr, P. P., & Foa, E. B. (2004). Bridging the gap between posttraumatic stress research and clinical practice: The example of exposure therapy. Psychotherapy: Theory, Research, Practice, Training, 41, 374–387.

Zayfert, C., & DeViva, J. C. (2010) Avoiding treatment failures in PTSD. In M. Otto & S. Hofmann (Eds.) Avoiding treatment failures in the anxiety disorders. (pp. 147-168). New York: Springer.

Zayfert, C., & Becker, C. B. (2007). Cognitive behavioral therapy for PTSD: A case formulation approach. New York: Guilford.