Master Clinician Seminars

Throughout the Convention attend these useful sessions where the most skilled clinicians explain their methods and show recordings of clients' sessions.

Friday, 8:15 a.m. – 10:15 a.m.

Master Clinician Seminar 1

DBT Skills Training With Adolescents and Families: Teaching Points and Dos and Don’ts

Alec L. Miller, Montefiore Medical Center/Albert Einstein College of Medicine

Jill H. Rathus, Long Island University–C.W. Post

Moderate level of familiarity with the material

Drs. Miller and Rathus literally wrote the book on adapting DBT to teens and families. DBT with adolescents is increasingly being applied with youth in a variety of clinical, school, and forensic settings, with promising results. Miller and Rathus will share their clinical wisdom related to effective methods of teaching DBT skills to adolescents and their families. Specifically, this workshop will highlight the following skills: mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness, and walking the middle path. Teaching methods will include didactics, vignettes, role-plays, and videos.

You will learn:

 How to teach the biosocial theory to teens and their family members;  Effective ways of introducing and practicing mindfulness with teens;  How to avoid certain common pitfalls in teaching skills in a multi-family skills group setting;  Key teaching points for walking the middle path skills.

Recommended Readings: Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press. • Miller, A. L., Wyman, S. E., Glassman, S. L., Huppert, J. D., & Rathus, J. H. (2000). Analysis of behavioral skills utilized by adolescents receiving Dialectical Behavior Therapy. Cognitive and Behavioral Practice, 7, 183-187. • Wagner, E. E., Rathus, J. H., & Miller, A. L. (2006). Mindfulness in DBT for adolescents. In R. Baer (Ed.), Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. New York: Academic Press.

Friday, 10:30 a.m. – 12:30 p.m.

Treating Generalized Anxiety Disorder: Evidence-Based Strategies William C. Sanderson, Hofstra University

Basic level of familiarity with the material

GAD may be the most common of all anxiety disorders, and the core feature of GAD—worry—is common in other disorders as well. Knowing how to diagnose and treat GAD is an invaluable skill. This highly practical seminar will provide an overview of evidence-based strategies for treating clients with GAD, as well as treating worry in general. The focus of the lecture will be on the step-by-step implementation of proven cognitive behavioral strategies (e.g., cognitive restructuring, worry exposure, stimulus control procedures, problem-solving training, response prevention).

You will learn:

• How to diagnose GAD and distinguish this condition from other anxiety disorders;

• How to implement specific cognitive behavioral strategies to treat GAD and worry;

• How the cognitive behavioral model of GAD relates to the treatment strategies employed.

Recommended Readings: Huppert, J., & Sanderson, W. C. (2009). Psychotherapy for generalized anxiety disorder. In M. Stein, E. Hollander, & B. Rothbaum (Eds.), Textbook of anxiety disorders (2nd ed.). Washington, DC: American Psychiatric Press. • Rygh, J., & Sanderson, W. C. (2004). Treating generalized anxiety disorder: Evidence-based strategies, tools, and techniques. New York: Guilford Press.

Friday, 12:45 p.m. – 2:45 p.m.

Cognitive Therapy for Paranoia Neil A. Rector, Sunnybrook Health Sciences Centre and University of Toronto

This seminar will begin with an overview of case descriptions illustrating the continuum of paranoia from heightened suspiciousness to persistent persecutory delusions, and the steps to conceptualize these problems within a cognitive approach. Emphasis in the cognitive formulation will be on the role of distal and proximal aversive interpersonal experiences, dysfunctional beliefs focusing on interpersonal threat, negative interpersonal “other” schemas, information-processing biases, negative appraisals, behavioral avoidance, and safety behaviors. Specific empirically supported intervention strategies will be outlined to address different forms of paranoia, in terms of cognitive and behavioral change strategies and in terms of what therapists can do to manage the threats to engagement that often arise with the highly suspicious patient. Case material with illustration of assessment, case formulation, engagement, and intervention strategies for treated patients from the seminar leader’s naturalistic and clinical trial caseload will be presented. Teaching methods will include didactic case presentations, clinical vignettes, handouts, and a participant question and discussion period.

You will learn:  How to develop a cognitive conceptualization of different forms of paranoia based on recent clinical and experimental advances in the field;  Step-by-step empirically supported cognitive-behavioral strategies to reduce paranoia and the underlying self-processes that confer risk for relapse;  Effective and ineffective therapeutic strategies for dealing with threats to engagement and the therapeutic alliance, including when the therapist becomes a suspected agent in the patient’s paranoid outlook.

Beck, A.T., & Rector, N.A. (2005). Cognitive approaches to schizophrenia: Theory and therapy. Annual Review of Clinical Psychology, 1, 577-606. • Beck, A. T., Rector, N. A., Stolar, N., & Grant, P. (2009). Schizophrenia: Theory, research, and therapy. New York: Guilford Press. • Rector, N. A. (2007). Homework use in cognitive therapy for psychosis: A case formulation approach. Cognitive and Behavioral Practice, 14, 303-316.

Friday, 3:00 p.m. – 5:00 p.m.

Ending on a Positive Note: Mastery of the Ethics and Practice of Termination

Denise D. Davis, Vanderbilt University and Independent Practice, Nashville

All levels of familiarity with the material—especially recommended for trainees and early-career professionals

A clinician ending therapy is like a pilot landing an aircraft—achieving a smooth transition requires heightened attention and skill. Therapy endings that are forced, unexpected, turbulent, or poorly handled are emotionally stressful and potentially risky to both client and therapist. Termination is encountered with every client, yet little attention is given to this significant point of redirection.

This seminar will explore how therapists can end therapy responsibly, even when conditions are challenging. We’ll begin with a cognitive behavioral model and identify five types of terminations and the ethical risks associated with each. We’ll discuss evidence-based recommendations and outline six essential steps for negotiating a clinically and ethically sound termination experience. We’ll explore the emotional challenges commonly encountered by client and therapist and ways to handle these from an empathic and practical stance. Finally, we will conclude with an overview of special issues pertinent to the ethics and practice of supervisory termination.

You will learn:

 To identify five types of termination and practical strategies for each type;  To formulate a protocol with six essential steps to ensure a clinically and ethically appropriate termination;  To apply specific coping strategies for emotional stresses encountered in termination;  To integrate ethically sound practices with supervisory terminations.

Recommended Readings: Davis, D. D. (2008). Terminating therapy: A professional guide to ending on a positive note. Hoboken, NJ: Wiley. • Goldfried, M. R. (2002). A cognitive-behavioral perspective on termination. Journal of Psychotherapy Integration, 12, 364-372. • Jakobsons, L. J., Brown, J. S., Gordon, K. H., & Joiner, T. E. (2007). When are clients ready to terminate? Cognitive and Behavioral Practice, 14, 218-230.

Saturday, 8:15 a.m. – 10:15 a.m.

Master Clinician Seminar 5 Mindfulness for Two: An ACT Approach to Mindfulness in Psychotherapy

Kelly G. Wilson, University of Mississippi

All levels of familiarity with the material

What would therapy look like if we brought the same attention to the therapeutic interaction that we bring to our breath in a breathing meditation? In this workshop, we will examine, using video materials and an experiential exercise, the translation of meditation practice to therapeutic interaction. This workshop will teach methods aimed at cultivating a present-moment-focused, accepting, defused interaction with clients. This interaction aims to facilitate valued living and committed action.

Both ACT and mindfulness meditation seek to bring us more richly into contact with the present and with the potential for wondrousness in each moment of life. In this workshop, we will explore in depth the connection between mindfulness practice and ACT. Our examination of mindfulness practices will not be mere speculation; rather, it will be an examination that is informed by direct interaction with mindfulness and with ACT principles and procedures.

You will learn:

 The nature of mindfulness from an ACT perspective;  To bring a mindful perspective to bear in a therapeutic interaction;  To identify obstacles to mindful therapeutic interactions.

Recommended Readings: Wilson, K. G., & DuFrene, T. (2009). Mindfulness for two: An acceptance and commitment therapy approach to mindfulness in psychotherapy. Oakland, CA: New Harbinger. • Wilson, K. G., & Sandoz, E. K. (2008). Mindfulness, values, and the therapeutic relationship in Acceptance and Commitment Therapy. In S. Hick & T. Bein (Eds.), Mindfulness and the therapeutic relationship (pp. 89-106). New York: Guilford Press. [The 2008 chapter and a sample of Mindfulness for Two can be downloaded at www.mindfulnessfortwo.com]

Saturday, 10:30 a.m. – 12:30 p.m. Master Clinician Seminar 6 Introduction to Parent-Child Interaction Therapy Cheryl B. McNeil, West Virginia University

Basic level of familiarity with the material

This Master Clinician Seminar describes Parent-Child Interaction Therapy (PCIT), an evidence- based behavioral treatment for families of young children with disruptive behavior disorders. PCIT is based on Baumrind’s developmental theory, which holds that authoritative parenting—a combination of nurturance, good communication, and firm limits—produces optimal child mental health outcomes. In PCIT, parents learn authoritative parenting skills through direct therapist coaching of parent-child interactions, guided by observational data collected in each session. Parents receive immediate guidance and feedback on their use of techniques such as differential social attention and consistency as they practice new relationship enhancement and behavioral management skills. Videotape review, slides, handouts, and experiential exercises will be used to teach participants the basic interaction skills and therapist coding and coaching skills used during treatment sessions. Applications of PCIT within physically abusive families and other special populations will be discussed. You will learn:

 Theoretical framework and assessment procedures used in PCIT;  Child-directed and parent-directed interaction components of PCIT;  Skills for coaching parents as they interact with their child in treatment sessions;  Evidence-based uses of standard PCIT and innovative adaptations of PCIT in new populations.

Recommended Readings: Go to www.pcit.org for a list of the PCIT literature, as well as the treatment integrity manual for conducting PCIT. • Brinkmeyer, M., & Eyberg, S. M. (2003). Parent-child interaction therapy for oppositional children. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 204-223). New York: Guilford Press. • Eyberg, S. M. (2005). Tailoring and adapting parent-child interaction therapy for new populations. Education and Treatment of Children, 28, 197-201. • Hembree-Kigin, T., & McNeil, C. (1995). Parent-Child Interaction Therapy. New York: Plenum. • Hood, K. K., & Eyberg, S. M. (2003). Outcomes of parent-child interaction therapy: Mothers’ reports on maintenance three to six years after treatment. Journal of Clinical Child and Adolescent Psychology, 32, 419-429.

Saturday, 12:45 p.m. – 2:45 p.m.

The Reality of Conducting Virtual Reality Exposure Therapy: Expectations, Techniques, and Limitations Mitchell L. Schare and Allen B. Grove, Hofstra University

Moderate level of familiarity with exposure therapy, basic level of familiarity with virtual reality. Advancements in computer technologies have yielded the ability to readily produce virtual reality environments in the therapists’ office. Psychology researchers have developed specialized application software for the treatment of phobias and posttraumatic stress disorder. Via personal computers patients are able to experience places with the sounds, slights, physical feelings and even the odors of their real-life counterparts. Four years ago the Hofstra University Phobia & Trauma Clinic was established to provide quality treatment to community patients while serving as a venue for therapeutic skills development and a research center for doctoral students. Using protocols developed for the treatment of aviophobia, the fear of flying, this seminar will discuss, demonstrate, and offer data regarding the rationale and practicality of using virtual reality for treatment by augmenting the established procedures of exposure. Positives, limitations, and difficulties of using this technology will be discussed as well as demonstration of other virtual environments.

You will learn:  To understand the advantages and limitations of using virtual environments when compared to imaginal ones;  To be able to articulate the major components of a virtual reality system for therapeutic application;  To appreciate the active, rather than passive nature of using virtual reality exposure therapy with patients. In other words, how to actually operate a virtual reality system during a therapy session. Suggested Readings: Krijn, M., Emmelkamp, P. M. G., Ólaffson, R. P., Bouwman, Van Gerwen, L. J., Spinhoven, P., Schuemie, M. J., & Van Der Mast, C. A. P. G. (2007). Fear of flying treatment methods: Virtual reality exposure vs. cognitive behavioral therapy. Aviation, Space, and Environmental Medicine, 78, 121-128. • Maltby, N., Kirsch, I., Mayers, M., & Allen, G. J. (2002). Virtual reality exposure therapy for the treatment of fear of flying: A controlled investigation. Journal of Consulting and Clinical Psychology, 70, 1112-1118. • Rothbaum, B. O., Hodges, L., & Smith, S. (1999). Virtual reality exposure therapy abbreviated treatment manual: Fear of flying application. Cognitive and Behavioral Practice, 6, 234-244. • Wiederhold, B. K., & Wiederhold, M. D. (2005). Virtual reality therapy for anxiety disorders: Advances in evaluation and treatment. Washington, DC: American Psychological Association.

Saturday, 3:00 p.m. – 5:00 p.m.

“Why Would I Ever Want to Feel That?”: Overcoming Emotional Avoidance in Cognitive Therapy

Stephen J. Holland, Capital Institute for Cognitive Therapy, Washington, DC

Moderate level of familiarity with the material

This seminar will focus on practical strategies for working with emotional avoidance in cognitive therapy. Avoidance of negative emotion is a key feature of almost all of the clinical problems we treat and can often be a challenge in the process of therapy. We will review standard cognitive therapy approaches to emotion and subtle changes in technique that can help facilitate emotional engagement. We will then discuss advanced cognitive techniques, including challenging core beliefs about emotion, as well as behavioral, experiential, and mindfulness techniques that can be integrated within a cognitive therapy framework. How to include patients’ habitual patterns of emotional processing in case conceptualizations will be described, along with guidelines for selecting which techniques to use when. We will also discuss working with our own habits of emotional avoidance in order to improve our effectiveness as therapists. The presentation will include handouts, clinical examples, and demonstration of technique.

You will learn:

 How to adapt standard cognitive techniques to increase access to emotion;  How to include emotional factors in case conceptualizations;  Advanced and integrative techniques for accessing emotion and helping patients cope more effectively with negative emotions

Recommended Readings: Holland, S. J. (2003). Avoidance of emotion as an obstacle to progress. In R. L. Leahy (Ed.), Roadblocks in cognitive-behavioral therapy: Transforming challenges into opportunities for change (pp. 116-131). New York: Guilford Press. • Leahy, R. L., & Holland, S. J. (2000). Treatment plans and interventions for anxiety disorders and depression. New York: Guilford Press. • Safran, J. (1998). Widening the scope of cognitive therapy: The therapeutic relationship, emotion, and the process of change. New York: Rowman and Littlefield.