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Ticketed Sessions
Master Clinician Seminars
Throughout the Convention attend these useful sessions where the most skilled clinicians explain their methods and show recordings of clients' sessions.
Master Clinician Seminar 1 Implementing Prolonged Exposure for PTSD: Optimizing Outcomes Edna B. Foa, University of Pennsylvania School of Medicine Moderate level of familiarity with the material Posttraumatic stress disorder (PTSD) is a debilitating and chronic mental illness with lifetime rates ranging from 8% to 14% of the U.S. population. Importantly, PTSD is the most common health problem experienced by veterans, including those returning from the current wars in Iraq and Afghanistan. Several psychotherapies have been proved effective in reducing PTSD symptom severity. Of these, the efficacy of Prolonged Exposure therapy (PE), a cognitive behavioral therapy using both in-vivo and imaginal exposure, has been the most studied program, shown to be effective for various types of traumas (e.g., combat, rape, natural disasters) for men and women. Further, in comparison to other active treatment modalities, PE has consistently shown equivalent, if not greater, efficacy. PE is one of two psychotherapies for PTSD that has been disseminated throughout the VHA. The first part of this presentation will be devoted to a description of the main components of PE. These components will then be demonstrated with a volunteer who will role-play a patient who has developed chronic PTSD after a rape. At the end of this demonstration, participants will be invited to discuss PE and how to maximize its efficacy. You will learn:
Master Clinician Seminar 2 Behavioral Activation Principles in Practice in the Treatment of Depression Christopher R. Martell, Associates in Behavioral Health and University of Washington Basic level of familiarity with the material Behavioral Activation (BA) treatment for depression has been studied since the late 1960s and has recently been found to be efficacious in several randomized clinical trials. While several versions of BA exist, the behavioral principles underlying the various applications of BA are consistent and based on decades of research and theory. Because the treatment relies on a functional analysis and individualized case conceptualization, therapists are expected to follow certain behavioral principles rather than a session-by-session protocol. Thus, while each BA case may be slightly different in terms of choice of techniques, and will focus on specific targets for the individual client, several principles guide the therapist throughout the treatment. This Master Clinician Seminar will present the basics of BA in a brief didactic format, utilize video of actual BA clients to illustrate the principles, and include role-play demonstrations. Time will be allowed for discussion of audience members’ cases from a BA perspective. While BA does not offer guaranteed solutions to tough problems, this seminar will also allow for trouble-shooting difficulties audience members may have with severely depressed clients. You will learn:
Recommended Readings: Addis, M. E., & Martell, C. R. (2004). Overcoming depression one step at a time: The new behavioral activation approach to getting your life back. Oakland, CA: New Harbinger Publications. Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. New York: W. W. Norton and Company. Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2010). Behavioral activation for depression: A clinician’s guide. New York: Guilford.
Master Clinician Seminar 3 Problem-Solving Therapy (PST) to Enhance Resilience and Improve Psychological and Emotional Immunity Christine Maguth Nezu, Ph.D., ABPP, and Arthur M. Nezu, Ph.D., ABPP, Drexel University Moderate level of familiarity with the material PST has strong empirical support as a multidimensional system of psychotherapy for the treatment of depression, anxiety, worry, personality disorder, and mood disorders associated with the stress of chronic illnesses. Specifically, the treatment is aimed at helping people learn to view problems and negative emotions as important information to clarify values and identify goals, manage negative emotional arousal, and employ a rational problem-solving style to remain committed to achieving their goals. As such, PST treatment techniques focus on how patients can actualize these principles of change in their day-to-day lives. More recently, PST has been adapted to focus on a preventative framework in order to improve resilience, increase positive life experiences, and decrease the likelihood of developing full diagnostic syndromes when exposed to life stressors. Such stressors might include resilience training for persons in the military adjusting to pre- or post-deployment, chronic or complicated medical illnesses, such as heart failure, diabetes, or cancer, high-stress professions such as first responders, coping with the death of a loved one, or counseling for college students. This clinical masters experience will focus on applying PST to help prevent people from becoming future patients by role-playing examples of how best to increase resilience. Participants will be engaged in clinical demonstrations and role plays that will help identify specific areas of therapeutic challenge. These include learning how to work with individuals’ negative emotional arousal, interruption techniques for cognitive behavioral chains that interfere with rational problem-solving ability, and encouraging hope even when people are confronting very difficult circumstances. You will learn:
Recommended Readings: D'Zurilla, T. J., & Nezu, A. M. (2007). Problem-solving therapy: A positive approach to clinical intervention (3rd edition). New York: Springer Publishing. Nezu, A. M., Nezu, C. M., & D'Zurilla, T. J. (2007). Solving life's problems: A 5 step guide to enhanced well-being. New York: Springer Publishing. Master Clinician Seminar 4 Artistic Adherence: Maximizing “Flex” While Minimizing “Drift” in Conducting Competent Cognitive-Behavioral Therapies Cory F. Newman, University of Pennsylvani, School of Medicine Moderate level of familiarity with the material Empirically supported therapies require competent delivery in order to increase the probability of the clients’ experiencing positive outcome and long-term maintenance of gains. By “competent” we mean that the therapy is conducted in adherence to the corresponding treatment manual for the clinical problem and client population in question. Additionally, competent CBT therapists utilize individualized case conceptualizations, taking into account the idiosyncratic needs of a given client and the specific contextual factors in which his or her problems are manifest. Nonetheless, there are some cases in which outlier clients and/or their unexpected life problems sometimes require clinical management strategies not directly addressed or anticipated by the manual. Here, the competent CBT therapist must find a way to use the case conceptualization and good organizational skills to stay largely on task as per the general protocol, while providing the client with accurate empathy, attention to moment-by-moment interactions, and creative adaptations of the general CBT methods that will have the most therapeutic relevance and impact for the individual. This seminar will explicate ways for therapists to be maximally flexible in faithfully delivering empirically-supported CBT, while preventing undue drift from those procedures that are central and vital to the success of the treatment. This seminar is applicable to those who are learning and practicing manualized cognitive-behavioral treatments, as well as those who are teaching and supervising them, whether in everyday practice or in randomized clinical trials. You will learn:
Recommended readings: Kuyken, W., Padesky, C. A., & Dudley, R. (2009). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. New York: Guilford. Newman, C.F., & Beck, J.S. (2008). Selecting, training, and supervising therapists in randomized controlled trials. In A.M. Nezu & C.M. Nezu (Eds.), Evidence-based outcome research: A practical guide to conducting randomized controlled trials for psychosocial interventions (pp. 245-262). Oxford, UK: Oxford University Press. Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47, 119-127.
Master Clinician Seminar 5 Conducting Therapeutic Exposures with Anxious Adolescents: Practicalities, Pitfalls, and Ultimately, Progress Anne Marie Albano and Sandra Pimentel, Columbia University and New York State Psychiatric Institute Moderate level of familiarity with the material Therapeutic exposure is the cornerstone of cognitive behavioral treatments for anxiety disorders. In clinical practice, the conduct of exposure may be hampered by any number of limitations, including access to relevant stimuli, inability to create a realistic exposure scenario in session, or, in youth, lack of “buy in” by an adolescent client. In this seminar, the role of therapeutic exposure in the treatment of adolescents with anxiety disorders will be presented. Contemporary theory, principles, and the process of exposure will be reviewed. Clinical case examples will illustrate the role of case conceptualization, maturation, and development, and the necessity for creativity and flexibility in developing and processing exposures with adolescents. Parent involvement in maintaining anxiety will be addressed. Engaging parents in their own “letting go” exposures is conceptualized as a key component of successful treatment. Applications and examples of exposures across the range of anxiety disorders in adolescents will be discussed, and audience discussion of case material is encouraged. You will learn:
Recommended Readings: Hambrick, J.P., Comer, J.S., & Albano, A.M. (in press). Cognitive behavioral model of anxiety disorders: Theory, practice and current issues. In H. B. Simpson, F. Schneier, Y. Neria, & R. Louis-Fernandez (Eds.), Understanding anxiety: Clinical and research perspectives from the Columbia University Department of Psychiatry. New York: Cambridge University Press. Pimentel, S. S., Robin, J., Comer, J. C., Regan, J., & Albano, A. M. (2007). From everyday worries to anxiety disorders in youth: A cognitive-behavioral approach for helping children cope with a scary world. Child and Family Journal, 10, 30-44.
Master Clinician Seminar 6 What to Do When You Don’t Know What to Do: Practical Guidelines for Keeping CBT with Youth Fresh Robert D. Friedberg, Pennsylvania Psychiatric Institute and Penn State Milton Hershey Medical Center Advanced level of familiarity with the material Clinicians dread moments when they do not know what to do. Patients presenting with dizzying symptom patterns that are embedded in complex developmental, cultural, and systemic contexts partially account for difficulties. Further, therapist factors such as skill level, conceptual proficiency, and attitudinal/emotional biases influence the way treatment is delivered. Frequently, these paralyzing instances involving raw world realities are accompanied by a stunning lack of resources. Fortunately, Bennett-Levy (2006) cogently outlined declarative, procedural, and self-reflective domains of clinical skills and knowledge. Declarative knowledge represents the foundational theoretical and empirical material that informs clinical practice. Procedural knowledge applies this declarative information, establishing rules for how and when. Self-reflective knowledge involves self-monitoring and modification of clinicians’ knowledge, skills, emotions, thoughts, and behaviors when conducting cognitive behavioral therapy. These domains are precisely the foundations upon which to rely when challenged by difficult clinical situations. Accordingly, the workshop begins with the necessary pretext of declarative knowledge. The empirical and theoretical rudiments for CBT with children are reviewed and explained. Training in aspects of procedural knowledge follows. The how and when rules of session structure, collaborative empiricism, and guided discovery are laid out. Specific emphasis will be placed on therapeutic impasses and difficult moments in CBT with youth. Traditional and innovative ways to implement and modify self-monitoring, cognitive restructuring, rational analysis, and behavioral experiments/exposure techniques are demonstrated. Finally, self-reflective clinical practice is addressed where clinicians identify and manage their distressing thoughts and feelings when working with difficult young patients. You will learn:
Recommended Readings: Bennett-Levy, J. (2006). Therapist skills: A cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 31, 143-158. Friedberg, R. D., McClure, J. M., & Garcia, J. H. (2009). Cognitive therapy techniques for children and adolescents: Tools for enhancing practice. New York: Guilford. Friedberg, R. D., & McClure, J. M. (2002).Clinical practice of cognitive therapy with children and adolescents: The nuts and bolts. New York: Guilford.
Master Clinician Seminar 7 Beginning and Ending Psychotherapy: Mindful, Ethical Practice in an Era of Manuals and Managed Care Denise D. Davis, Vanderbilt University and Independent Practice Moderate level of familiarity with the material Much is written about beginning psychotherapy, but relatively little about its conclusion, especially in the contemporary context of manuals and managed care. This seminar will explore how clinicians can structure these important boundaries of cognitive behavioral therapy mindfully and responsibly, even when conditions are challenging, by using fundamental ethical principles. First, ethical issues most salient to the opening and closing of therapy will be reviewed, linking informed consent and termination as points on a continuum of care. Next, concepts of premature termination and abandonment will be defined and discussed in the context of different types of terminations. Finally, an ethically based model for termination that provides for flexible decisions and self-assessment of practical competence will be presented. Participants will learn specific steps for handling routine as well as complex or crisis terminations with confidence. The information presented in this seminar is relevant to any type of cognitive behavioral psychotherapy. You will learn:
Recommended Readings: Davis, D. (2008). Terminating therapy: A professional guide to ending on a positive note. Hoboken, NJ: John Wiley & Sons. Davis, D., & Younggren, J. (2009). Ethical competence in psychotherapy termination. Professional Psychology: Research and Practice, 40, 572-578. Younggren, J. N., & Gottlieb, M. C. (2008). Termination and abandonment: History, risk and risk management. Professional Psychology: Research and Practice, 39, 498-504.
Master Clinician Seminar 8 Exposure Therapy for Anxiety Disorders Michelle G. Craske, UCLA Moderate level of familiarity with the material Exposure therapy is an effective tool for treating anxiety disorders, but some clients drop out, and others do not achieve adequate levels of improvement. Several ways of maximizing learning during exposure therapy (and eventual outcomes from exposure therapy) for anxiety disorders will be discussed. Traditional “habituation-based” models of exposure will be compared to “violation of anxiety-based expectancy” models of exposure. The latter models draw from principles of fear learning and extinction and memory, and depend upon repeated functional analyses of behaviors and cognitions so that each exposure practice maximally addresses what the client needs to learn. For some clients, it may be essential to learn that fear/anxiety can be tolerated, or that they can function even while anxious. For others, it may be essential to learn that fear/anxiety subside over time. Discussion will also center upon the importance of, and ways of, weaning from safety signals and safety behaviors. A second topic will be the role of coping skills (cognitive and somatic) during exposure therapy. The research to date suggests coping skills do not add significantly to the effectiveness of exposure therapy, but this may be due in part to inadequate attention to the degree to which the skills are acquired and then actually applied within exposure therapy. Discussion will center upon ways of maximizing the use of coping skills during exposure, as well as their disadvantages. You will learn:
Recommended Readings: Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46, 5-27. Arch, J. J., & Craske, M. G. (2009). First line treatment: A critical appraisal of cognitive behavioral therapy developments and alternatives. Psychiatric Clinics of North America, 32, 525-547.
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