Master Clinician Seminars

Presented by:

Esme A L Shaller, Ph.D., Clinical Professor, University of California San Francisco

Participants earn 2 continuing education credits

Categories: Treatment – Mindfulness & Acceptance, Treatment – CBT

Keywords: DBT (Dialectical Behavior Therapy), Change Process / Mechanisms, Therapeutic Alliance

Basic level of familiarity with the material.

Dialectical Behavior Therapy (DBT) has helped to bring many tools into the mainstream of behavior therapy, including mindfulness, strategic self-disclosure, and dialectical thinking. One of the most useful concepts can be applied regardless of whether one is implementing comprehensive DBT: the direct labeling and addressing of “therapy interfering behavior,” or TIB.

Because TIB is so common, our definition is also broad. TIB is any behavior on the part of either the clinician or the client that gets in the way of DBT’s central goal—that the therapist and client continue to work together (Linehan, 1993). TIB can also reduce the overall effectiveness of the work of a client and therapist, even when both remain committed to the treatment. TIB can be purposeful—vindictive, even! — and also entirely unintentional. Regardless of intent, TIB can wreak havoc on an otherwise solid treatment plan!

As evidenced by the title, this talk is grounded in dialectical behavior therapy (DBT). Yet every client and every therapist will engage in TIB from time to time. Over many years I have taught trainees from a variety of professional backgrounds and therapeutic orientations how to systematically and non-judgmentally address and target TIB in all of their clients, regardless of the treatment plan. Some were working with clients in DBT, but many others were doing short-term stabilization on an inpatient unit, monthly medication management, cognitive behavioral therapy, or even other forms of psychotherapy. The tools and principles in this talk should enhance any clinician’s ability to have frank conversations with their clients about what might be getting in the way of their most effective work together.

In this two hour workshop, you will learn:

• How to orient a client to the concepts of TIB and how to elicit their help in managing them
• How to assess TIB with a new client and throughout the course of treatment
• How to effectively address TIB in the client
• How to effectively address TIB in yourself

Didactic portions will be broken up by live role plays and experiential practice in assessing and addressing TIB. Clinicians should come away confident in their abilities to address common TIBs such as lateness, not doing homework, avoidance in session, “yes-butting,” “I don’t knows,” and many more!

At the end of this session, the learner will be able to:

1. Define “therapy interfering behavior” and identify three reasons to address it effectively with clients.
2. Be able to effectively orient a client to the idea of addressing both client and therapist therapy interfering behavior.
3. Describe three therapist skills needed to effectively address therapy interfering behavior.
4. Describe three steps to effectively address therapy interfering behavior in session.
5. Differentiate between times when it would be effective to directly address therapy interfering behavior versus when it would be best to use extinction procedures.

Recommended Readings:

Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. Guilford press.

Miller, A. L., Rathus, J. H., & Linehan, M. M. (2006). Dialectical behavior therapy with suicidal adolescents. Guilford Press.

Koerner, K. (2011) Doing Dialectical Behavior Therapy: A Practical Guide. Guildford Press.

Shaller, E.A.L. (Anticipated Publication October 2024). Therapy Interfering Behavior in Dialectical Behavior Therapy. Guilford.

Allen, D. M. (1997). Techniques for reducing therapy-interfering behavior in patients with borderline personality disorder: Similarities in four diverse treatment paradigms. Journal of Psychotherapy Practice & Research, 6(1), 25-35.

Presented by:

Greg J. Siegle, Ph.D., Professor, University of Pittsburgh School of Medicine

Participants earn 2 continuing education credits

Categories: Treatment – CBT, Neuroscience

Keywords: Neuroscience, CBT, Neurocognitive Therapies

All levels of familiarity with the material.

It is clear that brains are involved in psychopathology and recovery, but it’s often hard to understand how to use that information practically with clients in the room. In this seminar we will discuss ways neuroscience can be employed with actual patients, including incorporating neuroscience into psychoeducation and case formulation, integration of contemporary neuroscience-informed treatments as adjuncts to CBT, and incorporating insights from neuroscience into understanding and accommodating neurodivergence.

Outline:

1. Using neuroscience principles and vocabulary in psychoeducation and case formulation. This will involve discussion of ways we are understanding emotional reactions, based on brain imaging, which could inform how we do CBT, including lessons from brain scans of individual subjects.
2. Integration of CBT with contemporary neuroscience-informed treatments that patients often ask about, which are readily available, and which may affect how patients respond to CBT (e.g., ketamine, TMS, TDCS, oxytocin, bio- and neuro-feedback, and vibration).
3. Lessons from neuroscience on neurodivergence that could inform CBT – sensory sensitivity, executive difficulties, internal meltdowns, and more.

At the end of this session, the learner will be able to:

1. List ways to incorporate neuroscience into psychoeducation, particularly regarding interactions of cognition and emotion, and the nature of changing cognitions.
2. Describe how a variety of contemporary neuroscience-based treatments may affect the brain and interact with CBT.
3. Describe how neurodivergence manifests in the brain, particularly with regard to mechanisms addressed in and affected by CBT.

Long-term Goals:

1. Be familiar with and conversant in basic neural systems and neuroscience principles which affect recovery in treatment.
2. Be familiar with how neuroscience informs ways in which treatments are being developed and combined.

Recommended Readings:

Siegle, G.J., Ghinassi, F., Thase, M.E. (2007). Neurobehavioral therapies in the 21 century: Summary of an emergingfield and an extended example of Cognitive Control Training for depression. Cognitive Therapy and Research, 31, 235-262. Doi:10.1007/s10608-006-9118-6

Compere, L., Siegle, G.J., Riley, E., Lazzaro, S., Strege, M., Pacoe, B., Canovali, G., Barb, S., Huppert, T.,Young, K. (2023). Enhanced efficacy of CBT following augmentation with amygdala rtfMRI neurofeedback in depression. Journal of Affective Disorders, 339, 495-501. PMID: 37459978; PMCID: PMC10530481. doi:10.1016/j.jad.2023.07.063.

Young, K.S., Craske, M.G. The Cognitive Neuroscience of Psychological Treatment Action in Depression and Anxiety. Curr Behav Neurosci Rep 5, 13–25 (2018). https://doi.org/10.1007/s40473-018-0137-x

Field, T.A., Beeson, E. T., Jones, L.K. (2015). The new ABC’s: A practitioner’s guide to neuroscience informed Cognitive Behavior Therapy, Journal of Mental Health Counseling, 37(3), 206-220.

Presented by:

Martin E. Franklin, Ph.D., Clinical Director, Rogers Memorial Hospital

John Piacentini, ABPP, Ph.D., Professor, University of California, Los Angeles

Participants earn 2 continuing education credits

Categories: OC and Related Disorders, Treatment – CBT, Comorbidity

Keywords: OCD, Child/Adolescent, Treatment

Moderate to advanced level of familiarity with the material.

Pediatric OCD is associated with substantive symptoms, comorbidity, and functional impairment that can extend into adulthood, but fortunately the efficacy of treatments including cognitive-behavioral therapy (CBT) involving exposure plus response prevention (ERP) is now well established. Drs. Franklin and Piacentini will first set the stage by offering a targeted critical review of the pediatric OCD treatment literature, including discussion of the key randomized trials that have established the efficacy of ERP, both alone and in combination with concomitant serotonin reuptake inhibitors (SRIs). They will then focus on explicating common clinical barriers to optimal outcomes, including presentation of empirically supported strategies that should be brought to bear to mitigate the potentially pernicious effects of these variables.

These potential pitfalls specifically include low motivational readiness, unusual obsessional presentations (e.g, fears of being buried alive or trapped in someone else’s dream), clinical management of suicidal ideation in the context of obsessions pertaining to suicide, and presentations related to disgust and incompleteness. They will also address the effects of psychiatric comorbidity and treatment decision-making in the context of comorbidity, as well as family accommodation and other family factors associated with poorer OCD outcomes along with clinical recommendations to address these concerns. Case examples will be emphasized to punctuate the core clinical procedures recommended to navigate these challenges. Moreover, ample time will be provided for questions and discussion, after which the floor will be opened to audience members to discuss theoretical and clinical issues including case presentations and examples of their own. Throughout each of the presentations, particular emphasis will be placed on provision of clinical services for pediatric OCD patients and their families who have demonstrated prior partial or non-response to cognitive-behavioral, pharmacological, or combined treatment approaches.

Outline:

1. Focused review of efficacy data for treatments including ERP, serotonergic medications, and their combination
2. Identification of empirical and clinical moderators and predictors of attenuated treatment outcome
3. Presentation of these variables and clinically recommended strategies to address them, including:
   1. Low motivation for treatment
   2. Unusual obsessional content
   3. Suicidal ideation in context of patients presenting with obsessions pertaining to suicide
   4. Not Just Right/Incompleteness concerns
   5. Psychiatric comorbidity
   6. Family factors including accommodation

At the end of this session, the learner will be able to:

1. Recognize the three most common psychiatric comorbidities in pediatric OCD and the accompanying clinical strategies to mitigate their effects.
2. Name the recommended strategies used to address predictors of negative response including low motivation and suicidal ideation in the context of obsessions pertaining to suicide.
3. Identify the clinical strategies used to address family accommodation at various stages of treatment and promote empirically supported techniques to encourage families to work together towards productive solutions in treatment.

Long-term Goals:

1. OCD is associated with significant impairment and comorbidity, but efficacious treatments can be brought to bear to reduce symptoms in the majority of youth who complete them.
2. Many of the negative predictors of treatment outcome can be mitigated by the use of empirically informed strategies designed specifically to address them.

Recommended Readings:

Farrell, L. J., Waters, A. M., Storch, E. A., Simcock, G., Perkes, I., Grisham, J. R., Dyason, K. M., & Ollendick, T. H. (2023). Closing the gap for children with OCD: A staged-care model of cognitive behavioural therapy with exposure and response prevention. Clinical Child and Family Psychology Review, 26, 642-664. https:/doi.org/10.1007//s10567-023-00439-2

Franklin, M. E., Engelmann, J. M., Bulkes, N. Z., Horvath, G., Piacsek, K., Osterlund, E., Freeman, J. B., Schwartz, R., Himle, M., & Riemann, B. C. (2024). Intensive CBT telehealth for pediatric OCD during the COVID-19 pandemic: Comparison with a matched sample treated in person. Journal of the American Academy of Child & Adolescent Psychiatry Open, 2(1), 26-35.

Kemp, J., Barker, D., Benito, K., Herren, J., & Freeman, J. (2021). Moderators of psychosocial treatment for pediatric obsessive-compulsive disorder: Summary and recommendations for future directions. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 50(4), 478–485. https://doi.org/10.1080/15374416.2020.1790378

Presented by:

Anne Marie Albano, ABPP, Ph.D., Professor, Columbia University Medical Center

Aleta Angelosante, Ph.D., Clinical Assistant Professor, Hassenfeld Children’s Hospital at NYU Langone Medical Center

Participants earn 2 continuing education credits

Categories: Parenting/Families; Child/Adolescent – Anxiety; Treatment – CBT

Keywords: Parenting, Anxiety, Adolescents

All levels of familiarity with the material.

While substantial evidence supports the use of cognitive behavioral therapy (CBT) to address anxiety in youth, addressing parental responses to youth anxiety is important to achieving an optimal response in treatment (Wei & Kendall, 2014). Parents can struggle with knowing how best to support their child as well as how to differentiate between normative and pathological anxiety. The primary instinct of all parents is to soothe and comfort their children when they experience distress; this instinct, however, can lead parents to unknowingly accommodate their child’s anxiety in a way that maintains rather than dispels anxiety (Thompson-Hollands et al, 2014).

Parents’ own anxiety, history and beliefs can also impact their ability to skillfully address their child’s anxiety (Settipani & Kendall, 2017). Though the general principles needed by parents to address childhood anxiety are universal, there can be variability in the specific skills utilized across child development from early childhood through emerging adulthood. This master clinican seminar will address how to assist parents in developing the insight and skills needed to support their anxious children, teens, and young adults.

Outline:

1. Development and maintenance of anxiety
   1. Normative vs pathological anxiety
   2. Ontogenetic parade
   3. Habituation
2. Parenting
   1. Modeling of anxiety
   2. Accommodation
   3. Other parent-child communication spirals that maintain anxiety
3. Modifications for special cases
   1. Addressing parental history and psychopathology
   2. Addressing co-parenting
   3. Parenting across the ages, with a focus on failure to launch/emerging adults

At the end of this session, the learner will be able to:

1. Discuss motivational and values-driven interventions for engaging reluctant, resistant, anxious parents in the CBT of their anxious child or adolescent.
2. Use developmental milestones for normative anxiety and typical age-appropriate skills that are necessary for a child’s progression through to emerging adulthood. A model of parental overprotection or overcontrol, combined with child avoidance and escape, will be presented to participants, along with skills to educate parents about parenting strategies that may inadvertently create or maintain anxiety in youth.
3. Design individually-tailored psychoeducation about anxiety and development, as well as specific experiential therapeutic activities, for parents and their youth that are designed to promote healthy boundaries, foster greater child independence in managing anxiety and developmental tasks, and provide parents with their own cognitive and emotion regulation skills.
4. Plan to modify these strategies for parents given the different developmental needs of children, adolescents, and young adults.

Long-term Goals:

1. The tasks of development interact with parental overprotection, leading to greater levels of anxiety and stalled development in many youth.
2. Parents can strike a balance of providing support and encouragement for their child to face typical situations that may result in time-limited anxiety, and ultimately result in greater independence, confidence, and self-efficacy in the youth.
3. Effective CBT, while focusing on the here and now, also addresses the history and long held beliefs of parents that may inadvertently impact sustained response to treatment of youth with anxiety.

Recommended Readings:

Hoffman, L., Guerry, J., & Albano, A.M. (2018). Anxiety Disorders: Transitional Age Youth. Current Psychiatry Reports: Child and Adolescent Disorders, 20: 25. Philadelphia: Springer. https://doi.org/10.1007/s11920-018-0888-9, 10.1007/s11920-018-0888-9

Silk, J.S. Sheerber, L., Tan. P.Z., Ladouceur, C.D., Forbes, E.E., McMakin, D.L., Dahl, R.E., Siegle, G.J., Kendall, P.C., Mannarino, A., & Ryan, N.D. (2013). “You can do it!” The role of parental encouragement of bravery in child anxiety treatment. Journal of Anxiety Disorders 27:439-446.

Thompson-Hollands, J., Kerns, C.E., Pincus, D.B., & Comer, J.S. (2014) Parental accommodation of child anxiety and related symptoms: range, impact, and correlates. Journal of Anxiety Disorders 28: 765-773.

Vidair, H.B., Fichter, C.N., Kunkle, K.L., & Boccia, A.S. (2012). Targeting parental psychopathology in child anxiety. Child and Adolescent Psychiatric Clinics of North America 21: 669-689.

Presented by:

Cory F. Newman, Ph.D., ABPP, Center for Cognitive Therapy, University of Pennsylvania, Perelman School of Medicine

Danielle A. Kaplan, Ph.D., Clinical Assistant Professor, Department of Psychiatry, New York University School of Medicine

Participants earn 2 continuing education credits

Categories: Professional/Interprofessional Issues

Keywords: Supervision, CBT

Basic to Moderate level of familiarity with the material.

Drawing on findings from evidence-based programs of CBT supervision, this presentation will highlight the essential contents and processes of CBT supervision. The following major areas of interest will be described: (1) The supervisory relationship, (2) The chief responsibilities and teaching methods of a CBT supervisor, (3) Promoting ethical behavior and cultural humility in supervisees, (4) Facilitating supervisee competency across different levels of supervisee development, (5) Managing important administrative tasks, and (6) Providing feedback and formal evaluations in a timely, constructive manner.

Multi-modal aspects of the methods of supervision will be highlighted, including the use of readings, audio-visual recordings, role-modeling, and role-playing. This two-hour master clinician seminar is designed for early career professionals who anticipate or have recently commenced providing CBT supervision to trainees, as well as more experienced CBT supervisors looking for a refresher course. Vignettes of challenging supervision scenarios will be presented, along with brief demonstration role-plays by the presenters.

Outline:

• Overview of the multiple responsibilities of a CBT supervisor.
• Summary of the multi-modal methods of supervision.
• Setting goals and expectations in supervision.
• Establishing and maintaining a collaborative and constructive supervisory relationship.
• Promoting competency in case conceptualization and CBT interventions.
• Effectively performing the administrative tasks of clinical supervision, including providing evaluations.
• Managing challenging situations in supervision.
• Acquiring and instilling cultural humility as a life-long journey in clinical supervision.

At the end of this session, the learner will be able to:

1. Oversee and ensure the well-being of the clients the trainees are treating.
2. Establish and maintain a collaborative, constructive supervisory relationship.
3. Model professionalism, ethical behavior, and cultural humility to trainees.
4. Teach trainees to conceptualize cases and use the techniques of CBT competently.
5. Evaluate and give feedback to trainees.

Long-term Goals:

1. Prepare future generations of CBT trainees to become highly effective CBT practitioners.
2. Grow and develop as a clinical supervisor by continually learning from all relevant sources, including the trainees themselves.

Recommended Readings:

Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2014). Experiencing CBT from the inside out: A self-practice/self-reflection workbook for therapists. Guilford Publications.

Falendar, C. A., & Shafranske, E. P. (2014). Clinical supervision: The state of the art. Journal of Clinical Psychology, 70(11), 1030-1041.

Newman, C. F, & Kaplan, D. A. (2016). Supervision essentials for cognitive-behavioral therapy. American Psychological Association.

Reiser, R. P., & Milne, D. L. (2014). A systematic review and reformulation of outcome evaluation in clinical supervision: Applying the fidelity framework. Training and Education in Professional Psychology, 8(3), 149-157.

Sudak, D. M., Codd, R. T., Ludgate, J., Sokol, L., Fox, M. G., Reiser, R., & Milne, D. L. (2015). Teaching and supervising cognitive-behavioral therapy. Wiley.