Master Clinician Seminars

Presented by:

Colleen Carney, Ph.D., Professor, Toronto Metropolitan University

Participants earn 2 continuing education credits

Category: Sleep/Wake Disorders, Adult Depression

Keywords: Case Conceptualization/Formulation, CBT

Basic to moderate level of familiarity with the material.

There is nothing more impactful for sleep, fatigue, chronic pain and depression than getting out of bed with some regularity and staying out of bed throughout the day. Regulating rise time and decreasing morning lingering predicts improvements in depression, insomnia, pain and fatigue. Yet, getting out of bed is a struggle for many people, including our clients, and it is not a manner of “finding motivation.” The reasons for difficulties with rising are complex: there can be genetic, behavioral, cognitive and mood explanations for these difficulties. Case formulation and a transdiagnostic approach to this issue, allows you to engage with clients more effectively in the assessment of the problem and testing out strategies. This includes assessing and addressing issues related to sleep inertia (i.e., feeling groggy upon awakening), anhedonia, chronic pain, delaying sleep in those with trauma, and delayed chronotype (i.e., night owl tendencies).

Understanding delayed chronotype, a common developmental issue in teens and genetically linked to ADHD, some depressions including Seasonal Affective Disorder, as well as those on the autism spectrum, will help you develop strategies across the 24-hour day that will help with rising. For example, collaborative strategies to build sleep drive during the day, wind down effectively in the evening can help with a gradual advance of circadian rhythms that can improve sleep, daytime alertness and ease of rising. Spend two hours filling your toolbox with effective strategies for this important, common transdiagnostic issue in your clients.

Outline:

1. Understanding rising difficulties in those with trauma, depression, insomnia, pain, delayed sleep phase, ADHD and anxiety
2. Using case formulation to uncover the multifactorial reasons
3. Collaborative troubleshooting of reasons for difficulties rising

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

1. Deliver collaborative psychoeducation on the link between rise time regularity, mood, pain, fatigue, depression and sleep.
2. Utilize case formulation worksheets to guide assessment of the barriers to rising at their client’s desired time.
3. Teach clients to generate contingencies for common problems with rising.
4. Devise behavioral experiments to test beliefs about sleep inertia, fatigue, and how we make up for lost sleep.
5. Use circadian science to gradually shift circadian phase earlier and make rising earlier.

Long-Term Goals:

• The attendee will leave with skills to address one of the most common transdiagnostic problems (rising consistently) that directly ties to highly impactful results: improved mood, sleep, and alertness.

Recommended Readings:

Harvey, A. G., Dong, L., Hein, K., Yu, S. H., Martinez, A. J., Gumport, N. B., … & Buysse, D. J. (2021). A randomized controlled trial of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) to improve serious mental illness outcomes in a community setting. Journal of consulting and clinical psychology, 89(6), 537.

Castiglione‐Fontanellaz, C. E., Schaufler, S., Wild, S., Hamann, C., Kaess, M., & Tarokh, L. (2023). Sleep regularity in healthy adolescents: Associations with sleep duration, sleep quality, and mental health. Journal of sleep research, 32(4), e13865.

Sletten, Tracey L., Matthew D. Weaver, Russell G. Foster, David Gozal, Elizabeth B. Klerman, Shantha MW Rajaratnam, Till Roenneberg et al. “The importance of sleep regularity: a consensus statement of the National Sleep Foundation sleep timing and variability panel.” Sleep Health 9, no. 6 (2023): 801-820.

Sletten, T. L., Cappuccio, F. P., Davidson, A. J., Van Cauter, E., Rajaratnam, S. M., & Scheer, F. A. (2020). Health consequences of circadian disruption. Sleep, 43(1), zsz194.

Presented by:

Janie J. Hong, Ph.D., Clinical Associate Professor, Stanford University School of Medicine

Participants earn 2 continuing education credits

Category:  Autism Spectrum and Developmental Disorders, Treatment — CBT

Keywords: Autism Spectrum Disorders, CBT, Case Conceptualization/Formulation

Basic to moderate level of familiarity with the material.

With the advent of the neurodiversity movement, there has been a call for clinicians to shift their understanding of autism spectrum disorder. Rather than viewing it as a disorder to be treated to normalcy, autistic individuals represent a minoritized group, deserving of adapted, neuroaffirming care. Like those with other marginalized identities, the distress experienced by autistic individuals often stems from difficulties in meeting behavioral norms and expectations. Underlying CBT formulations are similar majority-based normative expectations, which can indirectly reinforce the belief that well-being depends on the ability to conform and mask unwanted differences.

How, then, can clinicians help autistic individuals thrive in a world not designed for them? This master clinician seminar focuses on answering that question. Using CBT-based principles, Dr. Hong will present ways to adapt existing treatments and will use real-world case examples to illustrate how incorporating autism-related differences into the formulation can shift the approach and improve outcomes. The seminar will emphasize practical, concrete strategies and invite interactive discussion from the audience to inform concepts presented. Dr. Hong aims to empower clinicians already well-versed in CBT to adapt their case formulations to drive more effective treatments for autistic individuals.

Outline:

1. Introduction

   1. Incorporating diversity factors into treatment

   2. Where does diversity fit in

   3. What is neurodiversity

2. Training Overview

   1. Shifting the Goal of Therapy

      1. Disorder based CBT models

      2. Changing the goal of therapy

      3. Therapy as a learning context

3. Reframing the Autism Diagnosis

   1. Identifying autism

   2. Diagnostic criteria- social impairment

   3. Psychotherapy as a neurotypical context 

   4. Diagnostic criteria- repetitive, restrictive behaviors

4. Case example to address differences

5. Shifting the Interventions

   1. Functional behavior analysis          

   2. Creating a neurodiversity-centered formulation

6. Case example

7. Shifting the role of the therapist

   1. Autism related differences — relevance to therapy

   2. Advocacy in a therapy context

   3. Advocating for patient differences

8. Case example

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

1. Identify how existing CBT formulations may be limited for autistic individuals.
2. Name the ways the neurodiversity framework differs from a disorder based model of autism
3. Identify at least 2 ways including neurodiversity factors can change the case formulation and treatment plan
4. Name at least 2 ways CBT can be adapted to address difficulties experienced by autistic individuals
5. Explain how functional behavioral analysis can help improve treatment outcomes

Long-Term Goals:

• Participants will learn skills to develop neuroaffirming cognitive behavioral case formulations
• Participants will learn ways to adapt the psychotherapy process to enhance patient learning.

Recommended Readings:

Black, M. H., Helander, J., Segers, J., Ingard, C., Bervoets, J., De Puget, V. G., & Bölte, S. (2024). Resilience in the face of neurodivergence: A scoping review of resilience and factors promoting positive outcomes. Clinical Psychology Review, 113, 102487. https://doi.org/10.1016/j.cpr.2024.102487

Bury SM, Jellett R, Haschek A, Wenzel M, Hedley D, Spoor JR. Understanding language preference: Autism knowledge, experience of stigma and autism identity. Autism. 2023 Aug;27(6):1588-1600. doi: 10.1177/13623613221142383.

Leadbitter K, Buckle KL, Ellis C and Dekker M (2021) Autistic Self-Advocacy and the Neurodiversity Movement: Implications for Autism Early Intervention Research and Practice. Front. Psychol. 12:635690. doi: 10.3389/fpsyg.2021.635690

Kroll E, Lederman M, Kohlmeier J, Kumar K, Ballard J, Zant I and Fenkel C (2024) The positive impact of identity-affirming mental health treatment for neurodivergent individuals. Front. Psychol. 15:1403129. doi: 10.3389/fpsyg.2024.1403129

Presented by:

Brian Chu, Ph.D., Professor, Rutgers University

Sandra Pimentel, Ph.D., Chief, Child and Adolescent Psychology, Montefiore Medical Center

Participants earn 2 continuing education credits

Category: Treatment—CBT

Keywords:Case Conceptualization/Formulation, Clinical Decision Making, Therapy Process

Moderate to advanced level of familiarity with the material.

Infinite clinical presentations, not enough opportunities for consultation. We know the foundations – and they’re good. But what happens when real life interferes with our clean interventions? How do you address social anxiety in the context of ongoing bullying at school? How do you account for a history of family conflict, intergenerational trauma, and neglect? How does one help kids and families deal with societal injustices that seem ever-present and uncontrollable?

This workshop is built for the experienced cognitive behavioral therapist who believes they’ve taken the formula as far as it can go. We invite attendees to bring in the cases that produce genuine struggle – particularly those that center around depression, anxiety disorders, and family functioning. Using some of their own complex case examples, the presenters will demonstrate how CBT conceptualization and strategies (e.g., functional assessment, values-oriented goals development, problem-solving, exposure and behavioral experiments, mindfulness, cognitive restructuring, etc.) can be applied in a holistic way that acknowledges systems interventions, community context, and systemic/cultural barriers to change. Attendees will then be invited to nominate their own cases for live group discussion and demonstration. Attendees will work in small groups to brainstorm case conceptualizations to make treatment plans that target the youth’s primary goals while addressing the case’s complexities.

Outline:

1. Youth and family cases are ever and increasingly challenging
   1. Complex clinical profiles: how comorbidity and severity of psychological disorders requires.
   2. Challenging social and family contexts
   3. How these challenges require flexibility and adaptation in CBT
   4. Solicit case examples from audience
2. Multi-systems CBT Conceptualization
   1. Identify key social contexts and systems barriers that impact client functioning. Illustrate using APA’s Cultural Formulation Interview and Hays’ ADDRESSING system.
   2. Identify client strengths and interests that demonstrate resilience
   3. Illustrate conceptualization development using functional assessment and CFI.
   4. Solicit case examples from audience
3. Case Illustrations to guide how to respond to moment-to-moment decisions
   1. Solicit case examples from audience
   2. Using conceptualization and FA to guide effective exposures and behavioral experiments to optimize learning and minimize safety behavior
   3. Using FA/case conceptualizations to direct assessment of parent-child interactions and family-based exposures

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

1. Create a multi-systemic case conceptualization that incorporates youth, family, and community factors that maintain behaviors.
2. Apply key CBT strategies (e.g., functional assessment, values-oriented goals development, problem-solving, exposure and behavioral experiments, mindfulness, cognitive restructuring, etc) in the context of diverse clients, problems, and clinical contexts.
3. Throughout, learners will consult with presenters about challenging cases that have evaded understanding and intervention.
4. In the long-term, become a more flexible, principles based cognitive-behavioral therapist who incorporates systemic/local barriers and client strengths into their conceptualization and treatment planning.
5. In the long-term, be able to communicate about (e.g., treatment planning, case conceptualization) and teach (e.g., to trainees, colleagues) FA and case conceptualization principles and strategies to facilitate continuity of care in interdisciplinary settings and enhance intentional CBT for especially challenging cases.

Recommended Readings:

Hoffman, L. J., & Chu, B. C. (2019). When is seeking safety functional? Taking a pragmatic approach to distinguishing coping from safety. Cognitive & Behavioral Practice, 26(1), 176-185.

Hays, P. A. (2024). Four steps toward intersectionality in psychotherapy using the ADDRESSING framework. Professional Psychology: Research and Practice, 55(5), 454–462.

Jarvis, G. E., Kirmayer, L. J., Gómez-Carrillo, A., Aggarwal, N. K., & Lewis-Fernández, R. (2020). Update on the cultural formulation interview. Focus, 18(1), 40-46.

Rizvi, S. L., & Ritschel, L. A. (2014). Mastering the art of chain analysis in dialectical behavior therapy. Cognitive and Behavioral Practice, 21(3), 335-349.

Sanchez, A. L., Comer, J. S., & LaRoche, M. (2022). Enhancing the responsiveness of family-based CBT through culturally informed case conceptualization and treatment planning. Cognitive and Behavioral Practice, 29(4), 750-770.

Presented by:

T.J. Sullivan, Ph.D., Postdoctoral Associate, Yale School of Public Health

Audrey Harkess, Ph.D., Assistant Professor, School of Nursing and Health Studies, University of Miami

Participants earn 2 continuing education credits

Category: LGBTQ+, Treatment — CBT, Transdiagnostic

Keywords: LGBTQ+, Transdiagnostic, Treatment

Moderate level of familiarity with the material.

Individuals who identify as lesbian, gay, bisexual, transgender, queer, or any other minoritized sexual orientation or gender identity (LGBTQ) experience persistent mental health disparities and negative psychosocial outcomes relative to their heterosexual, cisgender counterparts. Such disparities are rooted in LGBTQ people’s disproportionate exposure to general life stressors (e.g., early childhood adversity) and identity-based stressors (e.g., exposure to discrimination). These stress exposures set off a cascade of internal stress reactions (e.g., internalized negative views of self, the burden of identity concealment, and hypervigilance to identity-based rejection), which in turn contribute to the development of negative psychosocial outcomes over the lifespan via their influence on general psychological processes (e.g., emotional reactivity, rumination, social support).

Adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, an evidence-based cognitive-behavior therapy (CBT) for the treatment of co-occurring emotional disorders, LGBTQ-affirmative CBT was specifically designed to address LGBTQ people’s general and identity-specific stress reactions (i.e., minority stress) underlying population-based mental health disparities. Through didactic presentations and experiential exercises, including live clinical demonstrations, this master clinician seminar will cover key principles and techniques for addressing the impact of minority stress in CBT with LGBTQ clients. All clinicians – regardless if whether they work in a setting that is LGBTQ focused or not – are likely to work with LGBTQ clients, as current data suggests that 9.3% of the US population identifies as LGBTQ. Thus, this master clinician seminar will be helpful to any clinician regardless of practice setting. Additionally, the seminar will cover the general principles of LGBTQ affirmative CBT, which can be used to facilitate LGBTQ-affirmative delivery of any evidence-based psychological treatment for clients. Clinicians who practice with another treatment approach (e.g., DBT, CPT, or other CBT-based interventions) can easily apply the content of this seminar to their practice approaches.

Outline:

1. Review of efficacy data and principles of LGBTQ-affirmative CBT
2. Overview of LGBTQ-affirmative CBT modules
3. Clinical demonstration of how to apply principles of LGBTQ-affirmative CBT to common clinical presentations
4. Role-play opportunity to practice implementation of key concepts in LGBTQ-affirmative CBT

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

1. Identify how minority stress is addressed in LGBTQ-affirmative CBT
2. Explain case conceptualization as it pertains to LGBTQ-affirmative CBT
3. Describe the principles of LGBTQ-affirmative CBT

Long-Term Goals

• Apply the concept of minority stress in therapy practice settings
• Implement LGBTQ-affirmative CBT with clients or with trainees via clinical supervision

Recommended Readings:

Pachankis, J. E., Harkness, A., Jackson, S., & Safren, S. A. (2022). Transdiagnostic LGBTQ-affirmative cognitive-behavioral therapy: Therapist guide. Oxford University Press.

Pachankis, J. E., Soulliard, Z. A., Morris, F., & Seager van Dyk, I. (2023). A model for adapting evidence-based interventions to be LGBQ-affirmative: Putting minority stress principles and case conceptualization into clinical research and practice. Cognitive and Behavioral Practice, 30(1), 1–17. https://doi.org/10.1016/j.cbpra.2021.11.005

Pachankis, J. E. (2015). A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions. Archives of Sexual Behavior, 44(7), 1843–1860. https://doi.org/10.1007/s10508-015-0480-x

Burger, J., & Pachankis, J. E. (2024). State of the science: LGBTQ-affirmative psychotherapy. Behavior Therapy, 55(6), 1318–1334. https://doi.org/10.1016/j.beth.2024.02.011