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Featured Therapist Interview
Cedar Koons received her B.A. degree from Duke University and her M.S.W. from the University of North Carolina. Ms. Koons founded the DBT program at the Women Veterans Comprehensive Health Center, the first DBT program to be established in a VA Medical Center. As a clinical associate in the department of psychiatry and behavioral sciences at Duke University Medical Center, she also taught a DBT elective for third-year psychiatry residents. She is the former President of Marie Institute, a nonprofit corporation dedicated to helping clinicians treating poor clients with severe mental illness receive training and consultation in providing empirically supported therapies.
Ms. Koons was principal investigator on a randomized controlled trial of DBT conducted at the VA Medical Center during 1996-1999 and published in the journal Behavior Therapy in 2001. Ms. Koons is in private practice in Santa Fe, New Mexico, where she provides DBT and other evidence-based cognitive and behavioral treatments, including Mindfulness Based Cognitive Therapy. She leads an outpatient DBT consultation team that provides DBT to adults using the standard model. She trains and consults with DBT programs all over the U.S. and abroad.
First, we would like to know a little about your practice.
When did you begin your practice?
I began my practice in 1993 as a clinical social worker at the Durham VA Medical Center in Durham, North Carolina.
Do you have a specialty?
Yes, my specialty is Dialectical Behavior Therapy.
What are your personal strengths as a practitioner?
I think my biggest strengths are determination and optimism. These are helpful to me in working with clients who are struggling with depressed mood, repeated therapeutic failures, and traumatic loss.
What is one method you use to promote your practice?
I have been using websites since 1997 and find them very helpful. Many clients locate me and my DBT team from our websites. I even have a blog at www.mindfulnessbasedtherapy.net
How important are board certifications and/or credentialing programs to your practice?
Not very important at present. But I hope in the future that meaningful certification and accreditation for DBT teams will be available. I consider that an important certification to establish for many reasons.
What tips can you offer to colleagues just opening a practice?
I recommend that anyone just opening a practice look at who is not being served in your community. Learn everything you can about what works with your target population and, if you can, team up with like-minded people to meet that need, for support and consultation. Then introduce yourself to all the people who will want to refer to you, including primary care doctors, social service agencies, and others in private practice who are unprepared to treat that population. Word will get around fast and you will be full and hard at work in no time.
Of course if you want to sustain yourself and your practice you have to be willing to convince third-party payers you are worth enhanced rates for what you do. But if you are really meeting their needs with excellent treatment, doors will open for you.
What sorts of literature that describes evidence- based therapy do you make available in your waiting room?
I make great use of the ABCT brochures, which people really appreciate. Since I share a waiting room with a physician, a testing psychologist, and my team members, they disappear fast.
What self-help books do you suggest to your clients?
I maintain a lending library in my office and am always offering books and videos to clients. My current favorites include The High Conflict Couple by Alan Fruzetti, Calming Your Anxious Mind by Jeff Brantley, and anything by Pema Chodron. I also like books by Reid Wilson, Edna Foa, and Thich Nat Hahn. My favorite video is Opposite to Emotion Action by Marsha Linehan.
What one book do you recommend as a “must read” to improve your practice?
I am not sure I would have just one such book. However, a very good book that has had lasting value for me is Functional Analytic Psychotherapy by Kohlenberg and Tsai.
Are you involved in other types of professional activities in addition to your private practice?
I am a trainer and consultant for Behavioral Technology out of Seattle and also teach and consult some on my own. I teach DBT, mindfulness, and an introduction to CBT for social workers, line staff, and other clinicians. I have also conducted effectiveness research on DBT, both at the VA and in my private practice, and have developed an adaptation of DBT for vocational rehabilitation.
Next, we are interested in your continuing education activities.
How do you stay current with new research or advances in the field as applied to your practice?
I try to attend the ABCT conference when I can, and seriously, I read several articles in each issue of the Behavior Therapist, Cognitive and Behavioral Practice, and Behavior Therapy. But I also read the New York Times Science Tuesday, subscribe to some websites, and have regular conversations with my friends and colleagues about what they are doing. I spend my book budget each month and try my best to read what I’ve bought. In addition, my DBT consultation team has science updates from time to time.
Where do you earn your continuing education credits?
Mostly by attending conferences and meetings that offer CEs, such as the trainer’s meeting for Behavioral Technology. I find it hard to get myself to go to a big, ballroom type of training, maybe because it would feel a bit like a busman’s holiday!
We would also like to know a little about you personally.
Who was your mentor?
I have been very fortunate to have had a lot of mentoring along the way. But three amazing psychologists definitely stand out. One is Clive Robins, who mentored me through my first time as a principal investigator and with whom I’ve written some articles and chapters. Clive was instrumental in my development early on and is a good friend. Next is Marsha Linehan, who has taught me more than I can credit about rigorous thinking and scientific inquiry but also about compassion and commitment. Finally, I would have to credit Cindy Sanderson, formerly Director of Training at Behavioral Technology, now deceased. Cindy was the very best teacher I ever trained with and the most generous in passing along her secrets and wanting me to succeed.
What is the last book you read?
Psychoanalytic Case Formulation by Nancy McWilliams was the last professional book I read largely because my daughter, a psychologist, recommended it. The last fiction I read was A Tree Grows in Brooklyn, by Betty Smith. The last nonfiction was Why Poetry Matters by Joel Parisi. I love to read and also to listen to books on my iPod. I would like to get more professional books in audible format.
How do you avoid burnout?
For more than 12 years I have been consulting once per month with Ruth Herman-Dunn of Seattle. We discuss our most difficult cases with each other and it has been a lifeline for me. Ruth is wise and insightful and she knows me very well, so her consultation is part of what keeps me sane. My DBT team is also very valuable in this regard, but as a team leader I have a training and supervision role to perform and not all my challenging clients are in DBT. Also, I only work four days a week and usually see seven or fewer clients per day. Finally, my daily mindfulness practice keeps me more balanced than I think I would otherwise be. It also helps me notice when I’m getting crispy so I can take time off and decompress.
When not practicing CBT, what do you do for fun?
I ride my horse, Pete, garden, read and write poetry, and get together with friends. I am a wife, mother, stepmother, and grandmother and that is all a lot of fun (mostly!)
Do you have any other talents?
I give a pretty good Tarot card reading.
We are also interested in some of your views of CBT.
What do you think is the single most important thing CBT can do for your clients?
Empower them to attain self-management and reach their goals.
Where do you see the field of cognitive and behavioral therapies going over the next 3 to 5 years?
It is my hope that our field will continue to challenge the common wisdom that pharamaceuticals alone are more effective than CBT alone. We need to continue to improve outcomes and reduce overall costs. We also need to educate people about the long-term benefits, lower side effects, and lower risks of these treatments.
How do you use the local media to educate your community on the benefits of CBT?
I’ve been on several radio shows and in the newspaper but I have not done much to promote more of this happening. This is a good idea for this upcoming year.
Finally, we would like to know your opinions about ABCT.
How long have you been a member of ABCT?
Almost 15 years.
How has ABCT helped you professionally?
It has been a professional home for me. I was fortunate to find ABCT because I was not going to get what it provides from NASW (of which I am also a member) or any other organization of which I am aware. It grounds me in the research and puts me in touch with a community of like-minded professionals. Sometimes I do feel a little like a duck among geese, though, because I am not in academia, and am a social worker and not a psychologist.
What services do you consider the most valuable from ABCT?
The publications, the conference, and the clinical directory-all are of real importance for me. Because of my web presence I get lots of calls from people desperate to find help in places where I know no one personally. The clinical directory is a real resource for me when handling these calls because I can be pretty confident that I will be referring to a competent, knowledgeable professional.
What service(s) are missing from ABCT in your role as a practitioner?
I wish ABCT demonstrated more interest in the needs of master’s- level practitioners, including social workers and licensed professional counselors. These clinicians are in the trenches providing the preponderance of care out there for people with severe problems and really need what ABCT provides. I would like to see more outreach to this group of clinicians and more workshops addressing their training and professional needs.
How do you see the future of ABCT?
As long as it continues to innovate and engage in outreach I see a vibrant future for ABCT.
Thank you very much for taking the time to answer our questions!