Treatment Resistant Depression...Treatment Resistant Depression Light University 6 Video-based...

transcript

TreatmentResistantDepressionCognitiveBehavioralAnalysisSystemofPsychotherapy

TrainingProgram

P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net

TreatmentResistantDepression

LightUniversity2

WelcometoLightUniversityandthe“TreatmentResistantDepression”TrainingProgram.Ourprayeristhatyouwillbeblessedbyyourstudiesandincreaseyoureffectivenessinreachingout to others. We believe you will find this program to be academically-sound, clinically-excellentandbiblically-based.Our faculty represents some of the best in their field—including professors, counselors, andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.Wehavealsoworkedhardtoprovideyouwithaprogramthatisconvenientandflexible,givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,

RonHawkinsDean,LightUniversity

LightUniversity3

TheAmericanAssociationofChristianCounselors

• Representsthe largestorganizedmembershipofChristiancounselorsandcaregivers intheworld,havingjustcelebratedits30thanniversaryin2016.

• Known for its top-tier publications (Christian Counseling Today and Christian CounselingConnection), professional credentialing opportunities offered through the InternationalBoard of Christian Care (IBCC), excellence in Christian counseling education, an array ofbroad-basedconferencesandlivetrainingevents,radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode,andcollaborativepartnershipssuchasCompassion International, theAACChasbecomethefaceofChristiancounselingtoday.

• TheAACCalsohelpedlaunchtheInternationalChristianCoachingAssociation(ICCA)in2011,

andhasdevelopedanumberofeffectivetoolsandtrainingresourcesforLifeCoaches.OurMission

The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,andlaychurchmemberswithlittleornoformaltraining.Itisourintention to equip clinical, pastoral, and lay caregivers with biblical truth and psychosocialinsights that minister to hurting persons and help them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.

LightUniversity4

OurVision

TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Second, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting theChurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselectedlaypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmust be supported by three strong cords: the pastor, the lay helper, and the clinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).

OurCoreValues

InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:

VALUE1:OURSOURCEWearecommittedtohonor JesusChristandglorifyGod,remaining flexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,training,andbenefits.VALUE3:OURSERVICEWe are committed to effectively and competently serve the community of careworldwide—both ourmembership and the Church at large—with excellence and timeliness, and by over-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueand invest inourpeopleaspartners inourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resources God gives to us in order to continueservingtheneedsofhurtingpeople.

LightUniversity5

LightUniversity• Established in1999underthe leadershipofDr.TimClinton—hasnowseennearly300,000

students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and Webinar presentations, video-basedcertificationtraining,andastate-of-the-art,onlinedistanceteachingplatform).

• Thesepresentations, courses, and certificateanddiplomaprogramsofferoneof themostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determinedby itsworld-class faculty—more than150of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core group of facultymembers represents a literal “Who’sWho” in Christiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.

• Educational and training materials cover more than 40 relevant core areas in Christian

counseling, life coaching,mediation, and crisis response—equipping competent caregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.

OurMissionStatement

TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.

AcademicallySound•ClinicallyExcellent•DistinctivelyChristian

LightUniversity6

Video-basedCurriculum

• Utilizes DVD presentations that incorporate more than 150 of the leading Christianeducators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.

• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorresponding text (inoutline format)anda10-questionexamination tomeasure learningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.

• Learning is self-directed and pacing is determined according to the individual time

parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official

Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.

! TheRegular Diploma is awarded by takingCaring for PeopleGod’sWay,BreakingFree,andoneadditionalElectiveamongtheavailableCoreCourses.

! TheAdvancedDiploma isawardedbytakingCaringforPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.

Credentialing

• LightUniversitycourses,programs,certificates,anddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).

• Credentialing is a separate process from certificate or diploma completion. However, theIBCCacceptsLightUniversityandLightUniversityOnlineprogramsasmeetingtheacademicrequirementsforcredentialingpurposes.Graduatesareeligibletoapplyforcredentialinginmostcases.

! Credentialinginvolvesanapplication,attestation,andpersonalreferences.

! Credential renewals includeContinuingEducation requirements, re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.

LightUniversity7

OnlineTesting

TheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.

• TOLOGINTOYOURACCOUNT

! You should have received an e-mail upon checkout that included your username,password,andalinktologintoyouraccountonline.

• MYDASHBOARDPAGE

! Once registered, you will see theMy DVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbaroftheWebsite.Thispagewill include student PROFILE information and the COURSES for which you areregistered.TheLOG-OUTandMYDASHBOARD tabswillbeatthetoprightofeachscreen. Clicking on the > next to the course will take you to the course pagecontainingthequizzes.

• QUIZZES

! Simplyclickonthefirstquiztobegin.• PRINTCERTIFICATE

Afterallquizzesare successfully completed,a “PrintYourCertificate”buttonwill appearnearthetopofthecoursepage.YouwillnowbeabletoprintaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard for Certified Counselors (NBCC) Approved Continuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.

LightUniversity8

Presentersfor

TreatmentResistantDepressionCognitiveBehavioralAnalysisSystemofPsychotherapy

TrainingProgram

LightUniversity9

PresenterBiographiesGarySibcy,Ph.D.,isProfessorofCounselingintheSchoolofBehavioralSciencesandCenterforCounselorEducationandSupervisionatLibertyUniversity,whereheteachesdoctoralcoursesinadvancedpsychopathologyanditstreatment,empirically-supportedtreatmentsforchildrenandadults,andattachmenttheory.He isaLicensedClinicalPsychologist (LCP),hasbeen inprivateclinicalpracticeformorethan20years,andcurrentlyworksatthePiedmontPsychiatricCenter.Dr. Sibcy specializes in anxiety disorders, including OCD and panic disorder, and chronicdepression in adults, as well as the diagnosis and treatment of children with severe mooddysregulation. He is currently developing an empirically-supported treatment within theframework of interpersonal neurobiology and attachment theory. Dr. Sibcy has co-authoredseveralbookswithDr.TimClinton,includingAttachmentsandWhyYouDotheThingsYouDo.Todd Vance, Ph.D., is the founder of Breakforth Counseling and Consulting. He a LicensedClinical Psychologist in Virginia. His goal is to help each of his clients live their fullest, mostproductivelives.Dr.Vancespecializesinthetreatmentofchronicdepression,anxiety,PTSD,andrelated disorders. He also offers career coaching, couples counseling, performance masterycoaching,andenjoyshelpingothertherapistsovercomeobstaclesintheirpractices.

LightUniversity10

TreatmentResistantDepressionTableofContents:

TRD101:AnOverviewofDepressionandtheStatusofCurrentTreatments...........................12GarySibcy,Ph.D.,andToddVance,Ph.D.TRD102:TheChronicallyDepressedPatient:ADeeperUnderstandingofDepression............19GarySibcy,Ph.D.,andToddVance,Ph.D.TRD103:ChronicDepressionandInterpersonalNeurobiology...............................................26GarySibcy,Ph.D.,andToddVance,Ph.D.TRD104:Attachment,InternalWorkingModels,andDepression...........................................31GarySibcy,Ph.D.,andToddVance,Ph.D.TRD105:Relationship,Healing,andTransformation:AnOverviewofCBASPandChristianIntegration.............................................................................................................................40GarySibcy,Ph.D.,andToddVance,Ph.D.TRD106:CBASPToolsandTechniques:SignificantOtherHistory...........................................46GarySibcy,Ph.D.,andToddVance,Ph.D.TRD107:CBASPToolsandTechniques:SituationalAnalysisPartI..........................................53GarySibcy,Ph.D.,andToddVance,Ph.D.TRD108:CBASPToolsandTechniques:SituationalAnalysisPartII.........................................61GarySibcy,Ph.D.,andToddVance,Ph.D.TRD109:CBASPToolsandTechniques:DisciplinedPersonalInvolvement..............................69GarySibcy,Ph.D.,andToddVance,Ph.D.TRD110:MeasuringProgressandChangeThroughoutTherapy.............................................76GarySibcy,Ph.D.,andToddVance,Ph.D.TRD111:ChristianIntegrationandAccommodation...............................................................84GarySibcy,Ph.D.,andToddVance,Ph.D.

LightUniversity11

TRD112:Role-play:ClinicalDiagnosisofPersistentDepression..............................................88GarySibcy,Ph.D.,andToddVance,Ph.D.TRD113:Role-play:SignificantOtherHistory.........................................................................93GarySibcy,Ph.D.,andToddVance,Ph.D.TRD114:Role-play:SituationalAnalysis.................................................................................97GarySibcy,Ph.D.,andToddVance,Ph.D.TRD115:Role-play:DisciplinedPersonalInvolvement..........................................................101GarySibcy,Ph.D.,andToddVance,Ph.D.

LightUniversity12

TRD101:

AnOverviewofDepressionandtheStatusofCurrentTreatments

GarySibcy,Ph.D.,andToddVance,Ph.D.

LightUniversity13

Summary

Intoday’sworldofcounselingandpsychiatry,howdowetreatdepression?Whatarethe

“effective”treatments?Medications?Therapy?Self-help?Despitetheadvancesintreatment

thathavetakenplaceoverthelastfewdecades,theSTAR*Dstudyandotherresearchsuggest

thatwehavealongwaytogo,especiallyforchronic,refractorydepression.Inthispresentation,

Drs.SibcyandVancedefineanddiscusstheissueofPersistentDepressiveDisorderandthe

statusoftreatmentoptionsthatareavailabletoday.

LearningObjectives

1. Participantswillidentifyanddefinethecoresymptomsofdepression.

2. Participants will evaluate the scope of the problem and evaluate current treatment

methods.

3. Participants will analyze the results of the STAR*D study and its impact on further

treatmentneeds.

LightUniversity14

I. CoreSymptomsofDepression

A. EmotionalSymptoms

1. Sadness

2. Lossofpleasure

B. SomaticSymptoms

1. Changeinappetite

2. Changeinsleep

3. Psychomotorchanges

4. Fatigue/lossofenergy

C. CognitiveSymptoms

1. Decreasedconcentration

2. Worthlessness/guilt

3. Thoughtsofdeath/suicidalideation

LightUniversity15

II. TreatingDepression

A. TheScopeoftheProblem

1. MajorDepressiveDisorder(MDD)isarelativelycommonpsychiatricdisorder,witha

lifetimeprevalencerateof7%to12%formenand20%to25%forwomen(Kessleret

al.,2003).

2. TheannualcostofMDDintheU.S.wasestimatedat$83.1billion(Greenbergetal.,

2003)andtheWorldHealthOrganizationpredictedittobethesecond-leadingcause

offunctionalimpairmentanddisabilityworldwideby2020(MurryandLopez,1996).

B. EmpiricallySupportedTreatments

1. Required

• Demonstrationofefficacythroughatleastonerandomizedcontrolledtrialwith

goodexperimentaldesign,or

• Demonstrationofefficacythroughalarge,well-designedclinicalreplication

series.

2. PreferredEfficacy

• Hasbeenshownbymorethanonestudy.

• Efficacyhasbeendemonstratedbyindependentresearchgroups.

• Clientcharacteristicsforwhichthetreatmentwaseffectivewerespecified.

• Acleardescriptionofthetreatmentwasavailable.

C. StatisticalSignificancevs.ClinicalSignificance

1. StatisticalSignificance

• Betterthanchancethattreatmentwasbetterthancontrolgroup

LightUniversity16

2. ClinicalSignificance

• Howmanypatients(ratherthantheentiregroupaverage)werereliablybetter?

• Howmanypatientsmadeatleast50%improvementfrombaseline?

• Howmanypatientsachievedremission(withinnormalrangeonoutcome

measure)?

D. EffectiveTreatment

1. Althoughseveraleffectivepsychiatricandpsychologicaltreatmentshavebeen

developed,asizeableportionofpatientshaveachronic,treatment-resistantcourse

ofillness,characterizedbyafailuretoreachfull-remissionandcontinuingtoexhibit

substantialsymptomology.

2. Inclinicaleffectivenessstudieswithrepresentativetreatmentsamples,70-89%of

patientsfailtoreachremissionafterrelativelyextendtreatmentcoursesofeightto

12months(Linetal.,1997;Rostetal.,2002;Rushetal.,2004)

E. TheSTAR*DStudy

1. Inthelargestreal-worldeffectivenessstudyofMDDeverconducted,theSequenced

TreatmentAlternativestoRelieveDepression(STAR*D).

2. Afour-steptreatmentprotocolwasdesignedtotreatpatientstoremission.

3. Eachleveloftreatmentlastedupto12weeks.AllpatientsenteredlevelIandifthey

achievedremission,theyremainedatthesamelevelandwerefolloweduptoone

LightUniversity17

4. Iftheyfailedtoreachremission,theywereupgradedtothenextlevel,offered

differentaugmentationstrategies.

5. 40%ofpatientsdroppedoutbeforecompletionofstudy.

6. Ofthe60%ofpatientswhocompletedthestudy,33%achievedremissionatLevelI,

57%atLevel2,and63%and67%achievedremissionatLevels3and4,respectively.

F. Upshot

1. Theupshotofthisstudywasthatwitheachsubsequentleveloftreatment,fewer

patientsachievedremission,withonlyabout10%oftreatmentresistantpatients

(i.e.,thosewhofailedtoreachremissionafterlevels1and2)achievingremission

afterlevel4.

2. Moreover,relapseratesincreasedwitheachtreatmentstep:40%instep1,53%in

step2,65%instep3,and71%instep4…andtheoveralldropoutratewas40%.

3. Thus,asubstantialproportionofpatientsfailtoachieveremission(33%ofthosewho

remainintreatmentoverthecourseofoneyear)andthemajorityoftreatment-resist

patientsrelapse(65%-71%)withinoneyear,evenwhencontinuingmaintenance

medication.

4. Consequently,theseresultsrepresentaneedtodevelopalternativetreatmentsthat

notonlyincreasetheproportionofpatientsachievingremission,butalsoreduce

bothrelapseanddropoutrates.

LightUniversity18

G. Treatments

1. CognitiveBehavioralAnalysisSystemofPsychotherapy

• SpecificallydesignedforChronic,RefractoryDepression—especiallyEarlyOnset

2. SingleEpisodevs.Recurrent

3. PersistentDepressiveDisorder

4. EarlyOnsetvs.LateOnset

LightUniversity19

TRD102:

TheChronicallyDepressedPatient:ADeeperUnderstandingofDepression

LightUniversity20

Summary

Depressionisamultifacetedproblem.Totrulyunderstandthisdisorder,itisbesttoexamineit

through an integrated model approach. In this presentation, Drs. Sibcy and Vance help

therapists identify the chronically depressed patient through extensive psychosocial profiles,

alongwithaddressingcommontreatmenthistory.

LearningObjectives

1. Participants will comprehend the social and neurocognitive patterns common to those

withdepression.

2. Participantswillidentifycharacteristicsofchronicdepression.

3. Participants will discover the typical psychological profile for a patient with chronic

depression.

LightUniversity21

I. AnIntegrativeModelofDepression

A. SocialandNeurocognitiveSkills

1. Cognitiverigidity

2. Lackofself-monitoringskills

3. Highemotionalreactivity

4. Poorsensorymodulation

B. EarlyMaladaptiveSchema

1. Alsoknownascorebeliefsandinternalworkingmodelsofattachment

2. Corefeature:Perfectionism

3. PerformancePerfectionism

• “ImustalwayssucceedateverythingIdoorIcan’tbehappy/content.”

4. RelationshipPerfectionism

• “ImusthavetheapprovalandloveofeveryoneallthetimeorIcan’tbehappy.”//

“Healthyrelationshipsneverstruggle.”

5. EmotionalPerfectionism

• “Ican’tbehappyandcontentandfeelnegativeemotions.”//“Negativefeelings

areasignofweaknessandlossofcontrol.”

LightUniversity22

C. StressfulLifeEvent

1. Roletransitions

2. RelationshipConflict

3. UnresolvedGrief

4. Loneliness

• TypeI

• TypeII

D. TheDepressiveTriad

1. NegativeBias

• Self

• Other

• Future

2. Chronicmooddysregulation

3. Confirmationbias

E. BehaviorDisturbance

1. BehavioralShutdown

2. Stop:MasteryBehavior—lossofmeaningandpurpose

3. Stop:PleasureBehavior—lossofenjoyment

LightUniversity23

4. RelationalWithdraw—Loneliness

5. Procrastination—Criticism

II. ChronicDepression

A. Characteristics

1. Long-standinghistoryofDysthymicDisorder,nowPersistentDepressiveDisorder

withmultiple,superimposedMajorDepressiveEpisodes

2. MultipleMajorDepressiveepisodes,eachlastingseveralyears

• Someneverfullyrecoverandremaininpartialremission

3. Manyhavecomorbiddisorders,includinganxietyandpersonalitydisorders

B. TypicalTreatmentHistory

1. Longperiodsofuntreateddepressionbeforeseekingfirsttreatment

2. Previouslymisdiagnosed

3. Antidepressantonlyatinadequatedosesand/orlengthoftreatment

4. Thosereceivingtherapyderivedlittletonobenefit

5. Fewwillhavereceivedcombinedmedicationandpsychotherapy

LightUniversity24

C. CharacteristicsofChronic,TreatmentResistantDepression

1. Highlytreatmentresistanttonearlyalltreatmentmodes

2. Medication

3. Psychotherapy

• CBT

• IPT

• STDP

D. PsychosocialProfile

1. Historyofearly—sometimescomplex—relationshiptrauma//attachmenttrauma

2. RelationshipTrauma"continuousseriesof“low-grade”trauma:

• Psychologicalinsults,putdowns,interpersonalrejection/punishment

• Combinedwithoneormore“high-grade”traumas:physical/sexualabuse,actual

parentalabandonment,emotional/physicalneglect

3. Neurocognitivedeficits"Pre-operationalthinking"apre-causalviewofworld

4. Learnedhelplessness(Lowinternallocusofcontrol)

5. Chronicmooddysregulation"doesnotrespondtoinformation/disputation/

insight/cognitiverestructuring

6. Behavioralshut-down

LightUniversity25

7. Ineffective,self-defeatingpatternsofsocialbehavior

8. SubmissiveIPStyle—pullstherapistintodominantrole-"recapitulatesprevious

relationships"helplessness

LightUniversity26

TRD103:

ChronicDepressionandInterpersonalNeurobiology

LightUniversity27

Summary

Neurobiology plays a significant role in the understanding and treatment of depression. The

brain is complicated—to fully comprehend chronic depression, counselors must also have a

foundational knowledge of interpersonal neurobiology. In this presentation, Drs. Sibcy and

Vance introduce the conceptof interpersonalneurobiologyandwalkparticipants through the

brainanditsfunctions.

LearningObjectives

1. Participants will evaluate Siegel’s Triangle of Well-being and how it relates to the

treatmentofchronicdepression.

2. Participantswillidentifytherolesoftheleftandrighthemispheresofthebrain.

3. Participantswilllistanddefinetheninefunctionsofthemiddleprefrontalcortex.

LightUniversity28

I. InterpersonalNeurobiology

A. Siegel’sTriangleofWell-being

1. Mind

2. Brain

3. Relationships

B. TheTwoHemispheresoftheBrain(HorizontalIntegration)

1. Righthemisphere

• Firsttodevelop

• Imagery,emotional,holisticthinking,nonverballanguage,autobiographical

memory

2. Lefthemisphere

• Developslater

• Logic,verbal,linear

3. Horizontalintegration

C. FromHeadtoGut(VerticalIntegration)

1. Nervoussystemascendsfrombottom(ourbodiesandgut)totop(brainstem,limbic

system,prefrontalcortex)

2. Verticalintegrationisaboutlinkingthesedifferentareastogether,bringingbodily

sensationupintoawareness

LightUniversity29

D. BrainStem

1. AutonomicNervousSystem–PolyvagalTheory

• TwoBranches

• Sympathetic—Gaspedal

o Fight

o Flight

• Parasympathetic—Brake

o Freeze

2. TheLadder

• Toprung:Ventralactivation(safety)

• Middlerung:Sympatheticactivation(defensesactivated)

• Lowerrung:Dorsalactivation(dissociation)

E. LimbicSystem

1. Emotionalcontrolcenterinbrain

2. Encodesemotionallychargedexperiences

3. Formingofkeymentalmodels/schemasabout

• Self

• Others

• World

4. ConditionedEmotionalResponses

5. Associativelearning

LightUniversity30

F. PrefrontalCortex

1. Themiddleprefrontalcortex

• Anteriorcingulate

• Orbitalprefrontalcortex

• Themedialprefrontal

• Ventrallateral

2. Allworktogetherasateam

G. NineFunctionsoftheMiddlePrefrontalCortex

1. Bodyregulation

2. Attunedcommunication

3. Emotionalbalance

4. ResponseFlexibility

5. Insight

6. Empathy

• Theoryofmind

• Mindsight–mentalization

7. Fearmodulation

8. Accessingintuition

9. Morality

LightUniversity31

TRD104:

Attachment,InternalWorkingModels,andDepression

LightUniversity32

Summary

Thispresentationcoversthebasicstructureofthesecurebasesystem,whichinvolveshowthe

brainandone’ssenseofselfdevelopwithinthecontextofattachmentrelationships.Thislecture

alsodiscussesmodelsofattachmentandinternalworkingmodelsastheyrelatetodepression.

LearningObjectives

1. Participantswillidentifythesecurebasecycleofattachment.

2. Participantswilldefineandexplorethefourtypesofattachmentstyles.

3. Participants will evaluate how attachment wounds impact chronic depression and its

treatment.

LightUniversity33

I. TheEssenceofAttachment

A. UniversalCoreEmotionalNeeds

1. Safety

2. Security

3. Nurturance

4. Acceptance

5. Autonomy

6. Livingwithinrealisticlimits"self-control

7. Competence

8. Senseofidentity

9. Freedomtoexpressfeelingsandneeds

B. SecureBase

1. Feltsecurity

2. Self-confidence/exploration

3. Perceivedthreat

4. Attachmentsystem

LightUniversity34

5. Signaling

• Caregiver’ssignaldetectionandinterpretation

6. Proximityseeking

7. Safehaven

C. ExpectationsaboutSelfandOthers

1. SenseofSelf

• Autonomy

• Competence

• Identity

• Creativity/spontaneity

• Realisticlimits/Self-control

2. SenseofOthers

• Safety

• Nurturance

• Acceptance

D. StylesofAttachment

1. Secure

2. Avoidant

3. Preoccupied

4. Disorganized

LightUniversity35

E. CoreBeliefs/RelationshipRules

1. Self

• AmIworthy?

• AmIcapable?

• AmIwilling?

2. Other

• Areyoutrustworthy?

• Areyouaccessible?

• Areyoucapable?

• Areyouwilling?

F. InternalWorkingModels:RelationshipRules

1. SecureAttachment

• Self-dimension

o I’mworthyoflove

o I’mcapableofgettingtheloveIneed

• OtherDimensions

o Othersarewillingandabletoloveme

o Icancountonyoutobethereforme

2. AvoidantAttachment

• Self-dimension

o I’mworthyoflove(falsepride)

o I’mcapableofgettingloveIwantandneed(falsesenseofmastery)

• OtherDimension

o Othersareincompetent

o Othersareuntrustworthy

LightUniversity36

3. AmbivalentAttachment

• Self-dimension

o I’mnotworthyoflove(Ifeelflawed)

o I’mnotabletogetloveIneedwithoutbeingangryorclingy

• OtherDimension

o Capablebutunwilling(becauseofmyflaws)

o Mayabandonme(becauseofmyflaws)

4. Fearful-AvoidantAttachment

• Self-dimension

o I’mnotworthyoflove

o I’munabletogettheloveIneed

• OtherDimension

o Othersareunwilling

o Othersareunable

o Othersareabusive,Ideserveit

G. LearningHistory

1. Self

• Needs

• Wants

• Feelings

• Opinions

2. Others

• Rejection

• Criticism

• Betrayal

• Abuse

LightUniversity37

3. Fearedoutcome

• Anxiety

• Shame

• Guilt

4. Avoidance/stufffeelings

• Worthlessness

• Helplessness

5. Helplessness

• Signalsbrainintoashutdownofenergy,motivation,andpleasure

• Signalsbrainintosurvivalmodewithfight/flight,on-edge,irritability/anger,and

hypervigilance

H. EmotionDysregulation

1. Avoidancebehavior

• Stopmasterybehavior

• Stoppleasure

• Signalsbraintostopproducingneurochemistry

• Reinforceshelplessness/worthlessness

• Lossofenergy,motivation,andpleasure

2. Dissociation/PerceptualDisengagement

3. TensionReductionBehaviors

• Self-mutilation

• Sexualactingout

• Addictivebehavior

• Suicidefantasy

LightUniversity38

I. PsychosocialProfile

1. MoodDisorderlearnedandmaintainedbychronicandpervasivepatternof

interpersonalavoidance.

2. Avoidanceisfueledbyattachment-basedfear(i.e.,fearbasedonhistoryof

interpersonallearningincontextofattachmentrelationships)whereexpressionof

self/attachment(wants,needs,emotions,andintentions)isrepeatedassociatedwith

attachmentinjuriesandpsychologicalinsultsdeliveredbyattachmentfiguresinthe

formofrejection,criticism,andblame.

3. Consequently,thepersoncomestoassociatetheexpressionofself(includingall

attachmentneeds)withanxiety,shame,andguilt.Anaturalresponsetothese

feelingsisavoidancebehavior(stuffingoffeelings).

4. Thisresultsinchronicfeelingsofworthlessness(“Myfeelingsdon’tmatter”)and

helplessness(“NothingIdoworks,sowhytry?”).Thebiologicalconsequenceofthese

perceptionsisthedeactivationofmotivation,energy,andpleasure(thebrainis

primarilyandconservatorofenergy,thuswhentheperceptionisthatnothingwill

workorchangeinturnsoffactivationrelatedneurotransmitters).Itmayalsoactivate

thebrainssurvivalmode,whichresultsinchronicover-activationofthesympathetic

nervoussystem,resultinginfeelingsofanxiety,tension,andirritability.

J. NeurocognitiveConsequences

1. Theneurobiologicalconsequenceofchronicemotiondysregulationisthe

disintegrationofdendriticconnectionsbetweenPFCandvarioussubcorticalsystems

inlimbicsystem,includinghippocampus.

LightUniversity39

2. Degenerationofmiddlefrontalareasofthebrainandhippocampus"impaired

abilitytoattendtoandcontextualizingrelationshipevents

• Consequently,personrelatesinmindlessfashion,repeatingsameoldpatternsof

relationshipexperiences—”InterpersonalSameness”

• Confirmsfeelingsofhopelessnessandhelplessness

3. Thisinterfereswiththebrainsabilitytoformautobiographicalmemoryandother

neurocognitivedeficits

K. NeurocognitiveDeficits

1. Theseneurocognitivedeficitsaresimilartodeficitsdescribedinotherresearch,

includingTheoryofMind,Mindsight,andMentalization

2. AlsosimilartoPiagetianconceptofpreoperationalfunctioning:childlikeegocentric

patternofthinkingwheretheindividualisnotinfluencedbyexternalenvironment….

3. FailureofPerceptualEngagement—visuallydisengagedfromsocialenvironment,

usingpastexperiencetointerpretpresentmoment,thuscreatingthepastinthe

present:continuous,interpersonalsameness.

LightUniversity40

TRD105:

Relationship,Healing,andTransformation:AnOverviewofCBASPandChristian

Integration

LightUniversity41

Summary

Treatingdepressionrequiresanin-depthunderstandingofhowrelationshipsimpacthealingand

transformation.ThispresentationtouchesonKiesler’sInterpersonalCircumplexModelandalso

provides viewers with a thorough overview of the Cognitive Behavioral Analysis System of

Psychotherapy and its components. Christian integration and accommodation are significant

parts of therapy for many clinicians—this lecture touches on ways Christian caregivers can

effectivelyintegrateCBASPprinciplesintotheirtreatmentmodels.

LearningObjectives

1. Participantswill analyze theKiesler InterpersonalCircumplexModel and its relevance to

treatingpatientswithchronicdepression.

2. ParticipantswillidentifythetheoreticalunderpinningsofCBASP.

3. ParticipantswilldefineandanalyzethetreatmentcomponentsofCBASP.

LightUniversity42

I. UnderstandingCBASP

A. TheKieslerInterpersonalCircumplexModel

1. Dominance

• Dominanthostility

• Dominantfriendly

2. Passivity

• Passivehostility

• Passivefriendly

3. Friendly

• Dominantfriendly

• Passivefriendly

4. Hostility

• Dominanthostility

• Passivehostility

B. TheTherapeuticAlliance

1. Empathy,understanding,andsafetyarepartofthetherapeuticalliance.

2. Agreed-upongoalsandmethodsarealsopartofthetherapeuticalliance.

C. WhatisCBASP?

1. CognitiveBehavioralAnalysisSystemofPsychotherapy

• NotBeck’sCognitiveTherapy

• Consideredathird-wavecognitivetherapy

LightUniversity43

2. Analytical

3. Exposure-based(avoidanceisactivelydiscouragedandconsequencesofbehaviorare

madeunavoidable)

4. Explicitlyfocusedonlearning–“teachingisarrangingcontingenciessopeoplelearn”

(Skinner,1968)

5. Practicalandactive,notabstract(thepre-operational,chronicpatientcannot

abstract)

6. Interpersonal

7. Focusedatthe“molecular”level(slowpaceandverybasic)

D. TheoreticalUnderpinnings

1. Developmentaltheory(Piaget)

2. Learnedhelplessness(Seligman)

3. Learningtheory(Skinner,Pavlov,Bandura)

4. Perceivedfunctionality(McCullough)

LightUniversity44

II. CBASPTreatmentComponents

A. TheSignificantOtherHistory

1. TransferenceHypothesis

2. Identificationof“HotSpot”

B. SituationAnalysis

1. Breakingdowninterpersonalproblematicsituationsinaspecific,structuredwayto

helpthepatientbegintoseewhathappened.

2. Identifyhowthepersonisreadingthesituation.

3. Trainclientstobecometheobserveroftheirownfeelingsandactions.

4. Evaluatetheactualoutcome.

5. Evaluatethedesiredoutcome.

6. Didtheactualoutcomematchthedesiredoutcome?

7. Why?

C. DisciplinedPersonalInvolvement

1. Designedtopenetratepatientsinterpersonalsamenessthroughperceptual

engagement

2. Confrontinginterpersonalbehavior

LightUniversity45

3. IncreasingMentalization,understandinghowbehavioraffectsothers

4. Notusingpasttointerpretthepresent

5. Usuallywillactivate“TransferenceHotSpot”

D. InterpersonalDiscriminationExercises

1. Hotspotactivated

2. Drawattentiontoit

3. Askhowotherswouldreacttoit

4. Askhow“you”reactedtoitwiththeminsession

5. Compareandcontrasttopast/others

6. Askaboutimplicationfortherapy

7. Askaboutgeneralizationtofuture

LightUniversity46

TRD106:

CBASPToolsandTechniques:SignificantOtherHistory

LightUniversity47

Summary

In this presentation, Drs. Sibcy and Vance continue the discussion of CBASP tools and

techniques,focusingspecificallyontheroleandpurposeoftheSignificantOtherHistory.They

discussthefunctionofSignificantOtherHistory inthetherapeuticsettingandunpackthefive

stepsofconductingaSignificantOtherHistory.Additionally, this lecturepresentsacasestudy

illustratingthe importanceofthistechnique inhelpingthetherapistunderstandandbesthelp

theclient.

LearningObjectives

1. Participantswillexploretheroleandpurposeofthesignificantotherhistory.

2. Participantswillwalkthroughthefivestepsofconductingasignificantotherhistory.

3. Participantswillanalyzeacasestudytodeterminethevalueofasignificantotherhistory.

LightUniversity48

I. SignificantOtherHistory

A. Introduction

1. TheSignificantOtherHistorypresupposesthatyouhavealreadydoneagood

diagnosticinterview

2. Beopenandhonestwiththeclientaboutthediagnosis

3. Focusonrelievingtheburdenofdepressionbeforeaddressingotherissuesintheir

4. CBASPisarelationaltherapy

5. CBASPmirrorstherelationalaspectsoftheChristianfaith

B. UnderstandingtheSignificantOtherHistory

1. Conductedinfirsttreatmentsessionwithpatient(afterproperdiagnosis)

2. Patientisinstructedtolistnomorethan6personswhohavehadasignificantimpact

onpatient’slife,forbetterorforworse

3. Incontrasttoatraditionalclinicalinterview,theSignificantOtherHistoryisa

structuredmeansofallowingthepatienttoeducatethetherapistaboutthepatient’s

worldastheyseeit

4. Patientbeginstomakeexplicitcausalinferences(movingfrompreoperational

functioningtoformaloperationsthinking)

5. ProvidesbasisforTransferenceHypotheses

LightUniversity49

6. LaysgroundworkforInterpersonalDiscriminationExerciseswiththegoalofhaving

thetherapistbecomeasafetysignalforthepatient

• Untilandunlessthishappens,learningcannotoccur

II. TheFiveSteps

A. Step1

1. Requestalistofupto6SignificantOtherswhohaveplayedamajorroleandhada

significantinfluenceonthedirectionthepatient’slifehastaken,orwhohasshaped

thepatienttobewhotheyaretoday.

2. TheinfluencesoftheSignificantOtherscanbepositiveornegative.

B. Step2

1. GothroughthelistofSignificantOthersintheorderthepatientlistedthem.

2. Makesureyouhavethekeyplayers.

C. Step3

1. Beginwiththisquestion:Whatwasitlikegrowinguporbeingaroundthisperson?

Letthepatientrecallseveralmemories,situations,orstories.

2. Then,gotooneofthefollowingpromptsandsay:

• Tellmehowthispersoninfluencedyoutobethekindofpersonyouaretoday

• Howhasgrowinguparoundthispersoninfluencedthedirectionyourlifehad

taken–whatisthatdirection?

• Whatkindofpersonareyouasaresultoflivingaroundthisperson?

LightUniversity50

D. Step4

1. GoalistohavethepatientformulateoneCausalTheoryConclusionforeach

SignificantOther.

2. Theconclusionshouldrepresentthe“stamp”orlegacythepatientbelievesthe

SignificantOtherhasleftonthepatient.

3. HowhastheSignificantOtherinfluencedthepatienttobewhohe/sheisrightnow

today?

E. Step5

1. Reviewthe“stamp/legacy”conclusionsofthe6SignificantOthers.Incooperation

withthepatient,trytoidentifyaconsistentthemethatcharacterizestherelationship

thepatienthadwithhis/herSignificantOthers.

2. Then,withthepatient,constructoneTransferenceHypothesisthatexpressesthe

prominenttheme.

• “Ifthissituationhappens,thenthatconsequencewilloccur”

3. Thetransferencehypothesisshouldbepositionedinoneofthefourdomainslisted

below:

• Intimacy/closeness(“IfIgettooclosetoDr.Vance,then…theexpectedoutcome

basedonthecausaltheoryconclusions”)

• Disclosedemotionalneedsorpersonalissues(“IfIneedanythingemotionallyor

disclosepersonalissuestoDr.Vance,then…”)

• Makingmistakes(“IfImakeamistakearoundDr.Vance,then…”)

• Expressednegativeemotionstowardthetherapist(“IfIexpressnegativefeelings

towardDr.Vance,then…”)

LightUniversity51

III. CaseStudies:Jane

A. Jane’sBackground

1. 25-year-oldfemale

2. Depressionsinceadolescence

3. Earlyenvironmentcharacterizedbyharshdiscipline,caretakerresponsibilitiesfora

drug-addictedparent,emotionalneglect

B. SignificantOthers

1. Father

2. Mother

3. Oldersister

4. Son

5. Currentboyfriend

C. Summaries

1. Father:Strictdiscipline,morals,butdidnotlivethemhimself(drugaddict),patient

actedasherfather’scaregiver.“DoasIsay,notasIdo.”

2. Mother:Angry,isolated.“Easiertoexpressangerthanotheremotions,‘anti-social.’”

3. Oldersister:Manipulative,dishonest.“Betheoppositeofher.”

LightUniversity52

4. Son:Helpedhergrowup.“Patience,letmyguarddown.”

5. Currentboyfriend:Considerateofherfeelings.“Betterabletoexpressloveandsofter

emotions.”

D. AdditionalInformation

1. DuringconstructionofTransferenceHypothesis,fatherofpatient’sson(nother

currentboyfriend)wasmentionedbythepatient

2. ThisS.O.wasaddedtolist,withemergingthemeof“Mencannotbetrusted”

3. ResultingTransferenceHypothesis:“IfItrustDr.Vance,hewillbetrayme.”(a

variationontheintimacydomain)

E. TheRoleoftheTherapist

1. Thetherapistthenrelatesthetransferencehypothesistothetherapist/patient

relationship

LightUniversity53

TRD107:

CBASPToolsandTechniques:SituationalAnalysisPartI

LightUniversity54

Summary

In this presentation, Drs. Sibcy and Vance continue the discussion of CBASP tools and

techniques,focusingspecificallyontheroleandpurposeofSituationalAnalysis.Drs.Sibcyand

VanceunpackthesevenstepsofSituationalAnalysis.Viewerswillalsoexploreandunderstand

techniquessuchastheElicitationPhaseandtheRemediationPhase.

LearningObjectives

1. Participantswillexplorethesevenstepsofsituationalanalysis.

2. Participantswillidentifythegoalsoftheelicitationphase.

3. Participantswillanalyzeacasestudyofworkingthroughsituationalanalysis.

LightUniversity55

I. CBASPToolsandTechniques

A. SituationalAnalysis

1. UsesCopingSurveyQuestionnaire

2. Twophases

• Elicitation–SAusedasaninterpersonal,cognitivebehavioraldiagnostictool

• Remediation–Problematicbehaviorsaretargetedforchangeandreviseduntil

newbehaviorsbringadesirableconclusion

3. Confrontsavoidanceanddirectsthepatient’sattentiontotheinterpersonal

environment

B. CopingSurveyQuestionnaire

1. DateofSituationalEventandDateofTherapySessionnoted

2. Instructions:Selectoneinterpersonalproblematiceventthathashappenedtoyou

duringthepastweekanddescribeitusingtheformatbelow.Pleasetrytofilloutall

partsofthequestionnaire.YourtherapistwillassistyouinSituationalAnalysisduring

yournexttherapysession.

3. SituationalArea:

___Spouse/Partner

___Children

___ExtendedFamily

___Work/School

___Social

LightUniversity56

C. TheSevenSteps

1. Step1:Describewhathappened.(Abrief“sliceoftime”withabeginning,anend,

andashortstoryin-between.)

2. Step2:Howdidyouinterpretwhathappened(howdidyou“read”thesituation?).(A

descriptionoftheprocessofthesituation.)

• 1.

• 2.

• 3.

3. Step3:Describewhatyoudidduringthesituation(whatyousaid/howyousaidit).

(Whatsomeoneelsewouldhaveobservediftheyhadbeenabletoseeyouduring

thissituation.)

4. Step4:Describehowtheeventcameoutforyou(actualoutcome).(Goesbacktothe

endofthesituationinStep1)

5. Step5:Describehowyouwantedtheeventtocomeoutforyou(desiredoutcome).

(Lookingattheendpointofthissituation,whatisthebestyoucoulddoatthat

point?Remember,goalsmustberealisticandattainable.)

6. Step6:Wasthedesiredoutcomeachieved?YES___NO____

7. (Step7:WhyorWhyNot?)

II. TheElicitationStage

A. Step1

1. Steps1-6comprisetheElicitationStageofSituationalAnalysis.

LightUniversity57

2. Aninitialgoalissimplytogetthechronicallydepressedpatienttopayattentionto

his/herinterpersonalinteractions.

3. ThiscanmakeStep1verychallenging.

4. Thetherapist’sjobistodirectthepatient’sattentiontoabriefsliceoftimewitha

beginning,anend,andashortstoryin-between.

B. Step2

1. Thetherapistwillalsoassistthepatientinidentifyinghis/herinterpretations

(“reads”)inStep2.

2. Initialreadsareoften“editorial”innature(asisthenarrativeinStep1),giving

reasons,background,ascribingother’smotivations,etc.

3. Thegoalistodirectthepatient’sattentiontowardreadsthatareaccurate(not

guesses)andrelevant(movehim/hertowardthedesiredoutcomeand/orare

groundedintheflowofeventsinthesituation).

C. Step3

1. Thetherapisthelpsthepatientdescribewhathe/shesaidanddidduringthe

problematicsituationintermsthatareobservableandbehavioral.

2. Mostofteninearlysessionsthepatientwilldescribefeelingstates(“Iwasangry”).

LightUniversity58

D. Step4

1. Thedisciplineforthetherapistinthisstepistohelpthepatientidentifyan

“endpoint”tothesituation(theActualOutcome)thatcanbedescribedin

observable,behavioralterms.

2. Feelings/emotionscanbenoted,butshouldnotbethemainfocusofdescribingthe

ActualOutcome.

E. Step5

1. Asthepatientbeginstopayattentiontohis/herinterpersonalsituations,the

therapistwillthenbegintoshiftthepatient’sattentiontowardhis/herDesired

Outcome(goal)inthesituation.

2. ThechronicallydepressedpatientisusuallyNOTusedtothinkingintermsofwhat

he/shewantsinasituation(pre-operationalstageofdevelopment).

3. AswiththeActualOutcome,theDesiredOutcomemustbeexpressedinobservable,

behavioralterms.

4. Oftenbesttofocusonwhatthepatientcandirectlysayordoinearlystagesto

teachingSituationalAnalysis.

5. ADesiredOutcomethatmeetscriteriaisthekeyelementofaSituationalAnalysis

thatcanbesuccessfullyremediatedorofasituationwithasuccessfuloutcome.

LightUniversity59

III. CaseExample:Mary

A. Step1

Iwasfeedingmysonlunch.Thedoorbellrang.Istoppedfeedingmysonandlefthimin

hischair.Myneighborwantedtoborrowacupofsugar.Itoldherthiswasnotagood

time.Sheinsisted.Iaskedhertocomeback.Shemumbledsomethingabouthowthis

won’ttakelongandaskedwherethesugarwas.Iopenedthedoorandshecamein.She

wentintothekitchenandgotacupofsugar.Thensheleft.Iwasfrustrated,mad,and

thengotdepressedandthought,“I’vebeenscrewedagain.”

B. Step2

1. “Iliketoanswerthedoorbellwhenitrings”

2. “Peopleareinsensitivetomyneeds”

3. “Icannotcontrolmylife”

4. Revisedreads(accurate,relevant):

• “Idon’twanttointerruptfeedingmyson”

• “Ihavetellmyneighborshemustcomebacklater”

• Actionread–“Speakup!”

C. Step3

1. Iansweredthedoorbellandtoldmyneighborthatthisisnotagoodtime.Iaskedher

tocomeback.Iopenedthedoorandletherin.Ipointedhertothesugarbin,then

wentbacktofeedingmyson.

LightUniversity60

2. Inremediation,assertivebehaviorwouldbeaddedtomatchDesiredOutcome(Tell

theneighbor“No,comeback”ratherthanlettingherin).

D. Step4

1. ActualOutcome–“myson’slunchwasinterruptedwhenmyneighborcamein.”

E. Step5

1. DesiredOutcome–“Iwantedmyneighbortocomebackatamoreconvenienttime.”

2. TomovetowardthisDesiredOutcome,thepatientneedstosaytotheneighbor,“I’m

feedingmysonnow,canyoucomebacklater?”

LightUniversity61

TRD108:

CBASPToolsandTechniques:SituationalAnalysisPartII

LightUniversity62

Summary:

In this presentation, Drs. Vance and Sibcy continue to unpack situational analysis and its use

withchronicallydepressedpatients.Unlikemanyoftheothertoolsandtechniques,situational

analysisisatoolthatwillbeutilizedinnearlyeverycounselingsession.Dr.Vancewalksviewers

throughthestep-by-stepprocessofconductingasituationalanalysiswithclientsandprovides

anin-depthcasestudy.

LearningObjectives

1. Participantswillwalkthrougheachstepofsituationalanalysisin-depth.

2. Participantswillbeabletoconducttheirownsituationalanalyseswithclients.

3. Participantswillexploreacasestudyillustratingasuccessfulsituationalanalysis.

LightUniversity63

I. SituationalAnalysisCaseStudyContinued

A. Situation

“MyhusbandandIwereeatingdinner.Hegotup,wenttothedoorandsaid,‘I’mgoing

downstairstoplayvideogames.’Ilookedathimandnoddedmyhead.”

B. Interpretation

1. “Herewegoagain”

2. “What’sthepoint?”

• Feelinghurtandlonely

3. “Nothingworksforme.”

• Speakupandtellhimwhatyouwant

C. Behavior

“Ijustnoddedmyhead.”

D. ActualOutcome

“Ilookedathimandnoddedmyhead.”

E. DesiredOutcome:

1. “WatchTVwithme.”

2. “Iwouldhaveasked,‘WouldyouwatchTVwithmemaybesometimelater?’”

LightUniversity64

F. Didyougetit?

“No”

II. FurtherUnderstandingofSituationalAnalysis

A. Step1

1. AftertheElicitationphase,thepatient’sattentionisdirectedtoward“fixing”the

situationintheRemediationphase.

2. AgoodRemediationrequiresagoodDesiredOutcome(realisticandattainable).

3. Therefore,itisoftenbestintheearlystagestohelpthepatientfinddesired

outcomesthatinvolvewhathe/shecandirectlydoorsay.

B. Step2

1. AfterthetherapistandpatienthavereviewedtheCopingSurveyQuestionnaireand

determinedthatthepatient’sDesiredOutcomewasnotobtained,thepatient’s

interpretations(“reads”)inStep2arerevisited.

2. Eachreadisfirstexaminedusingtwocriteria:

• 1)Isthereadaccurate?(i.e.,notaguess,notmindreading,notassuming,etc.)

• 2)Isthereadrelevant–relevanttogettingyourDesiredOutcomeorgroundedin

theflowofthesituation?(i.e.,Doesthereadinsomewaymoveyoutowardwhat

youwantinthesituation?Isthereadgroundedinwhatisactuallyhappening

duringthesituation?)

3. Eachreadisreviewedandevaluatedbyeachcriterion(accurateandrelevant).

LightUniversity65

4. Thetherapistthenhelpsthepatientidentifymoreaccuratereadsandreadsthatare

relevanttoachievingtheDesiredOutcome.

5. Thisisusuallydifficultforthepatient.

6. Thetherapistmustbedisciplinedtonotdotheworkforthepatient!

7. Itcanhelptogroundthepatienttemporallyinthe“sliceoftime”inStep1(i.e.,

“Okay,aswelookatthisread,atwhatpointinthesliceoftimedidyouhavethis

read?”Gosentence-by-sentenceifneeded.)

8. Usingawhiteboardorflipchartisveryhelpfulandrecommended.Lookingatthe

problemtogethergivesthepatientadifferent,therapeuticinterpersonalexperience.

9. ThetherapistmayneedtorevisitStep1togetthestory

• VeryoftentheinitialslicesoftimeinStep1aretoolong,“editorial”(mixingreads

andassumptionsintothestory),andnotverbatim

• Thetherapist’sjobistohelpthepatient“draintheswamp”ofemotionand

extraneousinformationinStep1andfocusonJUSTTHEFACTS

• Getaperson-by-personverbatimaccountofthestory

10. Thegoalistoeventuallyarriveatreadsthatmeetbothcriteria(thereadsare

accurateandrelevant)

11. Usuallyactioninterpretations(alsocalled“actionreads”)areneeded

12. Actionreadsareshortinternalpromptsthatmovethepatienttowardactiontaking

• “Speakup”

• “Staycalm”

LightUniversity66

C. Step3

1. Step3isrevisitedintheRemediationphase.

2. ThetherapistasksifthepatientseesanythinginStep3thatmayhaveinfluencedthe

outcomeofthesituation.

3. Thegoalistohelpthepatientbecomeabetterobserverofhimself/herself–body

language,toneofvoice,attention,eyecontact,gestures,etc.

• Thishelpsthepatientbegintoseeandunderstandreciprocalrelationships(PxE)

D. PersonbyEnvironmentInteraction

1. Forthechronicallydepressed,theenvironmentdoesnotinformbehavior.

2. OneoftheoverarchinggoalsofCBASPistoteachthepatienthowtointeractin

reciprocalrelationshipsinwhichtheenvironment(otherpeople,context)informs

behaviorandhe/shecancommunicateinwaythattheiseffectiveinthe

environment.

E. FinalSteps

1. AttheendoftheRemediationPhase,thetherapistasks,“Ifyouhadsaid/donethe

thingsyouhavenowidentified,woulditmoveyouclosertoyourDesiredOutcome?

Wouldyougetclosertowhatyouwantedinthatsituation?”

2. Thetherapistthenhelpsthepatientgeneralizethelearningtoother,similar

situations(therearealmostalwaysrecurringthemes).

LightUniversity67

3. Thetherapistasks,“Canyouthinkofatleastonemoresituationinwhichyou

behavedinasimilarway?”

4. Finally,thetherapistasks,“If,moreoftenthannot,youhandledsimilarsituationsin

thisnewway,whatwouldyourlifebelike?”

III. CaseStudy

A. Ralph’sStory

RalphforgetshisappointmenttimewithDr.Vanceiswhenheissupposedtobehometo

gethischildrenoffthebusafterschool.

B. Step1

“ItoldmywifeIhadanappointmentwithyouatthesametimeIwassupposedtogetthe

kids.Shegotangry.IsaidIwouldnotchangetheappointmentbutIwouldmakeother

arrangementsforthekids.Shecalledmeafailure.IfeltguiltybutsaidIwouldgetasitter

andIdid.”

C. Step2

1. “Iforgotaboutourappointmentandmyagreementwithmywifetopickupthe

kids.”

2. “Iwon’tbreakmyappointmentwithDr.Vance.”

3. “MywifethinksI’mafailure.”

4. “I’vegottoscheduleasittertogetthekidsby3:30(actioninterpretation/read).”

LightUniversity68

D. Step3

“Ilistenedtomywife.ItoldherIwassorrybutwouldn’tchangemyappointment.I

listenedtohersayIwasafailureanddidn’tcarrymyshareoftheloadinthefamily.Ina

matter-of-factway,IsaidIwouldgetasitter.Idid.”

E. Step4

ActualOutcome–“Igotasitterandkeptmyappointment.”

F. Step5

DesiredOutcome–“Iwantedtogetasitterandseeyou.”

G. Step6

1. WastheDesiredOutcomeachieved?YES!

2. Why?“BecauseIstayedfocusedonwhatIwantedandIfoundawaytomakethat

happen,ratherthanfallingintothetrapofthinking‘nothingIdomatters.’”

LightUniversity69

TRD109:

CBASPToolsandTechniques:DisciplinedPersonalInvolvement

LightUniversity70

Summary

In this presentation, Drs. Sibcy and Vance explore and explain the role and purpose of

Disciplined Personal Involvement. Techniques, such as Interpersonal Discrimination Exercises

and Contingent Personal Reactivity, are discussed. Throughout this lecture, participants will

overview and realize a deeper understanding of the core steps of Disciplined Personal

Involvement and discover how it can be used to help clients work through their emotional

issues.

LearningObjectives

1. Participantswilldiscuss the theorybehindCBASPandunderstandhow it ties in toother

theoreticalmodels.

2. Participantswillexplorethetechniquesusedindisciplinedpersonalinvolvementandhow

theycanbenefitclientsstrugglingwithdepression.

3. Participantswillanalyzehowthetherapistcanutilizedisciplinedpersonal involvementto

establishconnectionswithclients.

LightUniversity71

I. DisciplinedPersonalInvolvement

A. Theory

1. CBASPisanempiricallysupportedtherapywithmanualizedaspects.

2. DisciplinePersonalInvolvementisoneofthedistinctivesofCBASP

• TreatingChronicDepressionwithDisciplinedPersonalInvolvement:Cognitive

BehavioralAnalysisSystemofPsychotherapy(2006)

B. PerceivedFunctionality

1. CBASP’sbasicmotifistoconnectthepatientperceptuallytotheenvironment.

2. Perceivedfunctionality,aprimarygoaloftreatment,meansthatthepatientisable

toidentifyandusetheconsequencesofhis/herbehaviorinwaysthatleadtoDesired

Outcomes.

3. UsingDisciplinedPersonalInvolvementisgroundedinthePersonxEnvironment

behavioralmodel:

• B=f(PxE)

4. ThisisderivedfromtheworkofAlbertBandura(1977:SocialLearningTheory).

5. InCBASPtheequationissimplifiedinthatthetherapistisfunctioningasanEforthe

patientandthepatientisintheroleofthePintheequation.

6. Thetherapistisaffectedbythepatientandthepatientisaffectedbythetherapist.

LightUniversity72

7. Withthepre-operational,chronicallydepressedpatient,theenvironmentdoesnot

informhis/herbehavior.

8. OneofthegoalsofCBASPistohelpthepatientacquiretheskillstohaveeffective,

reciprocalrelationshipswithhis/herenvironment.

9. Thepatient’sbehaviorisinformedbyhis/herenvironmentANDthepatienthasthe

skillsandabilitiestohavetheenvironmentreceiveinformationfromthepatient.

C. Discipline

1. The“disciplined”componentmeansthatthetherapistisawareoftheimpactsthe

patientishavingonhim/herandisNOTreactinginthewaymostpeoplereacttothe

patientoutsideoftherapy.

2. Instead,he/shechoreographshis/herreactionsinawaythatteachesthepatientthat

he/sheisconnectedwiththepatient(“Iaffectandyouaffectme,likeitornot!”).

3. Asthepatientachievesincreasinglevelsofperceivedfunctionality,thenatureofthe

relationshipchangesandbecomesmuchmorereciprocal.

II. TypesofDisciplinedPersonalInvolvement

A. Overview

1. InterpersonalDiscriminationExercise

2. ContingentPersonalReactivity

LightUniversity73

B. InterpersonalDiscrimination

1. Thetherapistmustbecomea“safetysignal”forthepatient

2. Patientscomefromearlytraumaticenvironmentswhereothersareexperiencedas

3. Pavlovianlearningmustbeaddressed

4. Therapistmustlookforopportunitiestoallowpatienttoexperienceinterpersonal

discrimination,becomeasafetysignal

5. IDErequiresthetherapisttobeawareofthepatient’stransferencehotspots,then

useopportunitiestocompareandcontrastthetherapist’sinteractionwiththe

patienttothoseoftoxicSignificantOthers

6. Thegoalisforthetherapisttoarrangethecontingenciesintheenvironmentsothat

thepatienthasadifferent,therapeuticinterpersonalexperience

7. Thetherapistisdiscriminatinghimself/herselffromthepatient’stoxicSignificant

Others

C. InterpersonalDiscriminationExercise

1. Thetherapistlooksforopportunitiestocompareandcontrasthis/herbehaviorto

thatoftoxicSignificantOthers

2. CaseExample:Lori,a35-year-oldfemale,getsthedateandtimeofhernext

appointmentconfusedandarrivesattheofficeexpectingtoseeDr.Vance

LightUniversity74

3. Dr.VanceremembersoneofLori’stransferencehotspotsis,“IfImakeamistake,I’ll

bepunished.”

4. Dr.VancespeakswithLori,worksoutthesituation,andcomparesandcontrastshis

behaviortospecificSignificantOthers(“Lori,I’mwondering,howwouldyourfather

havehandledthissamesituationyouandIjustdealtwith?”)

5. ThenDr.VancehelpsLorigeneralizethelearningtoothersituations(“IfyouandIcan

workthisout,whatdoesthatmeanforyououtsideofthisoffice?”)

6. DONOTdotheworkforthepatientatthispoint!

D. ContingentPersonalReactivity

1. Incertaintherapeuticsituations,thetherapistbecomesaninterpersonalproblemfor

thepatienttodealwith.

2. Thistypicallyinvolvesproblematicbehaviorbythepatient(e.g.,beinghabituallylate

forappointments,noshows,suicidalthreats,discountingthetherapist’smotivations,

etc.).

3. Butcanalsobeusedtoreinforcedesiredbehaviors(e.g.,asuccessfulSA,inquiring

aboutthetherapist’swell-being,etc.)–reactBIGinthesesituations.

4. Thetherapistnoticesthebehaviorandasksthepatienttoconsiderhowthatbehavior

affectsthetherapist.

LightUniversity75

5. Thetherapist“consequates”thebehaviorofthepatientbydisclosingpersonal

responsesandfeelingsproducedintherapistbythebehaviorofthepatient.

6. SeveralthingsmusthappenwhenthisformofDPIisused:

• Thetherapist’spersonalreactionmustbestatedopenly(“I’mgettingpessimistic

aboutourworkjustlisteningtoyoutellmethatyouarewastingyourtimehere.”)

• Thepatient’sbehaviorthatpulledforthereactionmustbeidentified(“Your

continualattemptstopersuademethatnothingcanhelpyou.”)

• Thepatientmustbeshownexplicitlythattheeffectonthetherapistderivesfrom

thePxEconnection(“DidyourealizethatwhatyoudoaffectshowIfeel,whatI

think,andmyreactionstoyoumoment-by-moment?)

7. Goals:

• TeachthePxEconnectiontothepatient

• Modifybehaviorsthatarehurtfulandlimitthepatient/therapistrelationship

• Transferthenewlylearnedinterpersonalskillstorelationshipsoutsideoftherapy

• ThetherapistservesasanENVIRONMENTALCONSEQUENCEforin-sessionpatient

behavior

E. AdditionalInformation

1. DisciplinedPersonalInvolvementisapowerfultoolthatmustalwaysbeused

therapeutically,forthebenefitofthepatient.

2. DPIisusedbythetherapist:

• Tomodifypatientbehaviorbydisclosingpersonalresponsesandfeelingsthe

patienthaspulledfromthetherapist

• TohealearlytraumaperpetratedbytoxicSignificantOthers

LightUniversity76

TRD110:

MeasuringProgressandChangeThroughoutTherapy

LightUniversity77

Summary

Togetanaccuratereadontheefficacyoftreatmentwithclients,itisessentialtomeasure

progressandchangethroughoutthecourseoftherapy.Drs.SibcyandVancedescribethe

importanceandbenefitsofmeasurementinCBASPtherapyforbothcounselorsandclients.The

presentersdiscussseveralcasestudiesandillustratehowmeasurementcanshedlightonthe

treatmentforallinvolved.

LearningObjectives

1. Participantswillevaluatetheimportanceofaccurateandthoroughmeasurementin

therapy.

2. ParticipantswillanalyzethetypesofmeasurementusedinCBASPtherapysessions.

3. Participantswillexplorecasestudiesanddiscoverthepracticalapplicationof

measurementintherapy.

LightUniversity78

I. MeasuringProgressandChangethroughoutTherapy

A. TheImportanceofMeasurement

1. Whilemuchismadeof“empiricallysupportedtherapies”theessenceofthe

empiricalapproachissimple

2. Thetherapistmeasuresthepatient’sprogressatbaselineandthroughouttherapy

3. Thesedataareusedtoinformthepatientandtherapistofthepatient’sprogress

B. TypesofMeasurement

1. Targetedthoughtsandbehaviorsaremadeexplicittothepatientandmeasured

• Distressatbaseline(BDI-II,PHQ-9,HAM-D,etc.)

• TransferenceDomains:CBASPInterpersonalQuestionnaire(CIQ)

• SituationalAnalysis:PatientPerformanceRatingForm(PPRF)

• GeneralizedTreatmentEffects(BDI-II,PHQ-9,HAM-D,etc.)

C. BaselineMeasurement

1. Takenatthetimeofintake/diagnosticinterview

2. Multiplemeasurescanbeused,ifdesired

3. Inmanycases,thechronicallydepressedpatient’sresultswithbeatornear

maximumseveritylevels

4. Onemacroassessmentoftreatmentsuccessiswhenthepatientdoesnotreactto

normal,dailystresswithdepression

LightUniversity79

D. EarlyPhaseMeasurement

1. CBASPInterpersonalQuestionnaire(CIQ)isadministeredatthetimeofthe

SignificantOtherHistory(firstsessionafterintakeanddiagnosis).

2. TheCIQmeasurefourtransferencehypothesisdomainstodeterminewhicharemost

presentforthepatient.

3. FourDomains:

• Intimacy

• EmotionalNeeds/PersonalDisclosure

• MakingMistakes

• ExpressingNegativeAffect

E. MeasurementDuringTherapy

1. Atregularintervals(ideallyeverytwoweeks),askthepatienttotakeonemeasure

(PHQ-9orBDI-IIaregood)beforeyoursessionbegins

2. Thereareprosandconstoeachmeasure

3. Useoneconsistently

4. Trackthisovertimeanddiscussitwithyourpatient

LightUniversity80

II. CaseStudies

A. Jill

1. Co-morbidPTSDandDepression

2. MedsandPsychotherapy

3. 20therapysessionswithabreakofmorethansixweeksattheendoftherapy

4. Depressionsymptomswithinnormallimitsatsession14

5. DepressionsymptomsremainedWNLaftersix-weekbreak

051015202530354045

1 2 3 4 5 6 7 8 9 10

Bi-Weekly Measurement

BDI-II Scores

LightUniversity81

B. Mary

1. 50-year-oldfemale

2. Historyofsexualtrauma,ChronicDepression,PTSD

3. Depressivesymptomsinthesevererangeatbaseline

4. Declinedmedications,thereforeCBASPonly

5. Triggeredbytraumareminderduringtherapy,referredfortrauma-specifictherapy

Depression Symptom Severity

1 4 7 10 13 16 19 22 25 28 31 34 37

Tx Sessions

Series1

LightUniversity82

C. Joe

1. 48-year-oldmale

2. ReferredforCBASPafterbeingnon-responsetoout-patientdepressiongroup

III. MeasuringSkillsAcquisition

A. PatientPerformanceRatingForm

1. Usedtomeasurepatient’sabilitytocompleteSituationalAnalysishimself/herself

withoutthetherapist’sassistanceduringthesession.

2. PatientmustbeabletocompletebothElicitationandRemediationphasesatalevel

of5ona0-5ratingscale.

BDI-II Scores

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Sessions

Series1

LightUniversity83

B. FiveRatedSteps

1. Step1–describingthesituation

2. Step2–interpretations/readsmustbeaccurateandrelevant(groundedinsituation

beinganalyzed)

3. Step3–patient’sbehaviorwasinserviceoftheDO(presupposesagoodDO)

4. Step4–actualoutcomedescribedinbehaviorallanguagethatisobservable

5. Step5–agood(meetscriteria)DOspecifiedinbehaviorallanguage(donotrate

feelings/emotions)

C. MeasuringGeneralizedTreatmentEffects

1. Overtime,thegoalisforthepatient’sdepressivesymptomstoremit.

2. TheBDI-II,PHQ-9,andothermeasuresshowevidenceofgeneralizedtreatment

effects.

3. Theidealisforthepatienttonotreacttonormalstresswithdepressionandfor

treatmenteffectstobedurableovertime.

4. Ifpossible,scheduleathree-monthfollow-upaftertreatmentiscompleted.

LightUniversity84

TRD111:

ChristianIntegrationandAccommodation

LightUniversity85

Summary

CBASPisaversatiletreatmentthatcanbeeasilyintegratedwiththeChristianfaith.Inthis

presentation,Drs.SibcyandVancewalkthroughwayscounselorscanincorporateChristian

principlesandtechniquesintoCBASPtherapyifworkingwithclientsoffaith.Viewerslearnhow

tointegrateChristianprinciplesonboththetherapistandclientlevelinawaythatisbeneficial

toclients.

LearningObjectives

1. Participantswillidentifythefouraspectsofdepression.

2. Participantswillexaminetheimportanceofrelationshipinchronicdepression.

3. ParticipantswillanalyzethetwoplanesofChristianintegrationwithCBASPpatients.

LightUniversity86

I. ChristianIntegrationandAccommodation

A. UnderstandingDepression

1. Biological

2. Psychological

3. Social

4. Spiritual

5. CBASP–chronicdepressionisarelationalproblem

B. ChristianFaithisInherentlyRelational

1. Genesis2:18–Itisnotgoodformantobealone

2. Relationshipisabiologicalimperative(Porges,2011)

II. TwoPlanesofIntegration

A. TheTherapistLevel

1. Implicit/explicitpractice

2. Linkingyourpracticeofcounselingandpsychotherapytorelationshipimperative

3. Justasyoucarryoutyourplansandintentionsthroughyourbody,soChrist/God

carriesoutHisthroughHisbody,theChurch.

4. 1Peter2:5–livingstones

LightUniversity87

5. ICorinthians12:12ff–thediversityandunityofthebody

6. WeareinhabitedbytheHolySpirit,whoprompts,direct,supportsyouasyougo

throughthisprocess

7. John7:37-38–RiverofLifeMetaphor

B. TheClientLevel

1. Differenttypesofpatients:

• AretheyseekingChristiancounseling?

• AretheyChristian’sseekingcounseling?

• Aretheyexplicitlywantingyoutoaddresstheirfaithinthecourse?

2. Keythemes:

• “I’mspiritualbutnotreligious”Christians

• Explorehowchurchhaspossiblydamagedthem

• Considerthesefactorsintransferencehypothesis

• TheroleDPI

C. OvercomingInterpersonalFear

1. OutofEgypt

2. Leavingthewilderness

• CrossingtheJordanRiver

• Enteringthepromisedland

LightUniversity88

TRD112:

Role-play:ClinicalDiagnosisofPersistentDepression

LightUniversity89

Summary

How do you diagnose chronic depression? Should you always use CBASP or are there times

when it would be better to use other treatments? Drs. Sibcy and Vance demonstrate this

throughrole-play.Viewerswillwitnessrole-playsthatrevealwhatquestionstoaskintheinitial

diagnosticinterview,howtointroduceCBASPtoaclient,andhowtosetthestageforCBASP.

LearningObjectives

1. Participants will explore how to conduct a diagnostic interview and the types of

informationthatshouldbegathered.

2. Participantswillcompilealistofhelpfuldiagnosticquestions.

3. Participantswillpinpointthetypeofdepressionexhibitedbythepatientintherole-play.

LightUniversity90

I. TheDiagnosticInterview

A. GatheringInformation

1. Generaloverview

• Age

• Reasonfortreatment

2. Backgroundinformation

• Placeoforigin

• Familysituation

• Relationshiptoparents

• Childhoodexperiences

3. Currentsituation

• Maritalstatus

• Children

• Homelife

4. Historyofabuse

5. Religiousbeliefs

6. Previoustreatment

• Medications

• Counseling

7. Familyoforigin

• Mentalillness

• Physicalproblems

8. Employment

LightUniversity91

B. DiagnosticQuestions

1. Inthepasttwoweeks,wouldyousayyouhavefeltdown,sad,anddepressedmore

daysthannot?

2. Haveyoufoundyourselflessinterestedinthingsyouusuallyenjoyorlessmotivated

thanyouwouldliketobe?

3. Inthepasttwoweekshaveyounoticedanychangeinappetite?

4. Inthepasttwoweeks,haveyounoticedanychangeinyoursleeppattern?

5. Wouldpeoplearoundyounoticeyoubeingsluggish,lethargic,ortheopposite;keyed

uporedgy?

6. Howhasyourenergylevelbeen?

7. Haveyoufoundyourselfbeingparticularlyhardonyourselfinthelasttwoweeks?

8. Hasitbeenharderthanusualtoconcentrate?

9. Haveyouhadanythoughtsofsuicide?

C. PinpointingtheTypeofDepression

1. Ifyouwentbacktwoyears,wouldyousayyouhavebeendepressedmoredaysthan

notforthepasttwoyears?

2. Doyougenerallyhavepoorappetiteortendtoovereat?

LightUniversity92

3. Howdoyoufeelaboutyourself?

4. Howdoyoudowithdecisionmaking?

5. Doyoueverwrestlewithfeelingsofhopelessness?

6. Haveyoueverhadadistinctperiodoftimethatotherswouldnoticewhereitwasthe

completeoppositeofdepression?

7. Haveyouhadanytraumaticexperiencesthatcontinuetohauntyou?

D. GivingFeedback

1. Diagnosis

2. TreatmentPlan

II. Observations

A. AskingSpecificQuestions

B. FurtherPointstoConsider

LightUniversity93

TRD113:

Role-play:SignificantOtherHistory

LightUniversity94

Summary

How do you conduct a Situational Analysis? Drawing from the information presented in the

previouslectures,Drs.SibcyandVancerole-playasessionwherethecounselorandclientwork

throughcreatingaSituationalAnalysis.Viewerswillbeabletowatchasthepresentersportraya

scenarioinwhichaclientishelpedtounderstandwhatneedstotakeplaceforhimtoreceivehis

desiredoutcome.

LearningObjectives

1. Participantswilldiscovertechniquesusefulforhelpingapatientidentifysignificantothers.

2. Participantswillexplorewaystoanalyzethemesandrelationshippatternswiththeclient.

3. Participantswilldiscoverhowtobalancetherapeuticinsightandallowingclientstocome

totheirownrealizations.

LightUniversity95

I. ConductingaSignificantOtherHistory

A. TheFourSignificantOthers

1. Mother

• Controlling

• Negative

• Unpleasant

2. Father

• Pleasant

• Rarelyaround

• Goodrelationship

3. John

• Friend’sfather

• Treatedlikeason

4. Sandy

• Wife

• Controlling

• Complainer

B. GoingDeeper

1. Whatmarkhavetheyleftonyou?

• Mother

• Father

• John

• Sandy

LightUniversity96

C. IdentifyingThemes

1. Avoidance

2. “IfIaskforwhatIneed,___________________.”

II. Observations

A. TypicalSignificantOtherHistoryPatterns

B. UnresolvedLoss

C. Chronicsvs.Non-chronics

D. LetthePatientConnecttheDots

LightUniversity97

TRD114:

Role-play:SituationalAnalysis

LightUniversity98

Summary

How do you conduct a Situational Analysis? Drawing from the information presented in the

previouslectures,Drs.SibcyandVancerole-playasessionwherethecounselorandclientwork

throughcreatingaSituationalAnalysis.Viewerswillbeabletowatchasthepresentersportraya

scenarioinwhichaclientishelpedtounderstandwhatneedstotakeplaceforhimtoreceivehis

desiredoutcome.

LearningObjectives

1. Participantswill identifypractical tools and techniquesuseful in conductinga situational

analysiswithaCBASPclient.

2. Participantswillobservethetherapistwalkthroughthesevenstepswiththeclient.

3. Participantswillanalyzetheefficacyofthesituationalanalysiswiththeclient.

LightUniversity99

I. ConductingaSituationalAnalysis

A. TheSituationalArea

1. Spouseorpartner

2. Children

3. Extendedfamily

4. Workorschool

5. Social

B. TheSevenSteps

1. Step1:Describewhathappened

2. Step2:Describeyourinterpretationofwhathappened

3. Step3:Describewhatanobserverwouldhaveseen

4. Step4:Describehowtheeventturnedout

5. Step5:Describehowyouwantedtoeventtoturnout

6. Step6:Describewhetheryouachievethedesiredoutcome

7. Step7:Describewhyorwhynot

LightUniversity100

II. WalkingThroughaSituationalAnalysis

A. Situation

Fredwalksintothegrocerystore.Hiswifecallsandaskswhatheisdoing.Fredreplies

thatheisgoingtothestoretopickupsomethings.Hiswifeaskswhyheisdoingthat

sinceshejustwentyesterdayandtheydon’tneedanything,it’snotgoodforhim,and

it’llmakehimfat.Fredreplies,“Whatever,”hangsup,andwalksoutofthestorewithout

purchasinganything.

B. TheElicitationPhase

1. Walkthroughthestepswiththeclient

2. Writedownresponses

C. TheRemediationPhase

1. Evaluateeachreadbyrelevance

2. Evaluateeachreadbyaccuracy

III. Observations

A. CommentsontheSituationalAnalysis

B. AdditionalAdvice

LightUniversity101

TRD115:

Role-play:DisciplinedPersonalInvolvement

LightUniversity102

Summary

In this final segment of the CBASP role-play, Drs. Sibcy and Vance role-play how to use

Disciplined Personal Involvement to demonstrate to clients that their actions impact those

around them. Particular emphasis is placed on working through issues in counseling in a

therapeuticway.Withcareandintentionality,therapistscanhelpclientsdiscoverhowtowork

throughconflictinahealthymanner.

LearningObjectives

1. Participantswillexplorewaystoefficientlyandeffectivelyutilizedisciplinedpersonal

involvementwithCBASPclients.

2. Participantswilldiscoverhowtobalancebetweenencouragingtheclienttotakethings

seriouslyandrefrainingfromemotionallyoverwhelmingtheclient.

3. Participantswilldiscoverhowtouseatherapysatisfactionscaleasateachingtoolin

therapy.

LightUniversity103

I. Role-play:DisciplinedPersonalInvolvement

A. AddressingtheIssues

1. Howdoesano-showaffectthecounselor?

2. Whatcanbedonetofixtheproblem?

B. DifferencesinTherapist’sResponsevs.Client’sExpectations

1. WhathappenedwhenFredaskedforwhatheneeded?

2. HowwouldFred’smotherhavehandledthesituation?

3. Howwouldothershandlethesituation?

II. Observations

A. TheArtofCBASP

1. Findingthefinelinebetweenencouragingtheclienttotakethecounselorseriously

ratherthanoverwhelmingthememotionally.

2. Generalizethelearning(“Hasanybodyeverreactedthisway?”)

3. Makeyourselfaproblemforthepatientinatherapeuticway

B. TheAttachmentSystem

1. Thefearfulavoidanceismaintainedbyescapinganxiety.

LightUniversity104

2. Earlyon,thereistypicallyverylittlereciprocity.

3. Itisverycommonforpatientstofearexpressingnegativeemotion.

III. Role-play:TherapySatisfactionScale

A. TheClient’sPerspective

B. TheTherapist’sResponse

C. WorkingthroughtheIssuesTherapeutically

1. Howdidthetherapistrespond?

2. Howwouldpeopleintheclient’spasthaveresponded?

3. Howwillothersrespond?

LightUniversity105

ReferenceList

Bandura,A.(1977).Sociallearningtheory.EnglewoodCliffs,NJ:Prentice-Hall,Inc.

Beck,A.T.(1964).Thinkinganddepression:II.Theoryandtherapy.ArchivesofGeneral

Psychiatry,10,561–571.

Beck,A.T.(1976).Cognitivetherapyandtheemotionaldisorders.NewYork:International

UniversitiesPress.

Beck,J.S.(1995).Cognitivetherapy:Basicsandbeyond.NewYork:GuilfordPress.

Beck,A.T.(1996).BeckDepressionInventory-II.SanAntonia:PsychologicalCorporation.

Beck,J.S.(2005).Cognitivetherapyforchallengingproblems.NewYork:GuilfordPress.

Beck,A.T.,Rush,A.J.,Shaw,B.F.,&EmeryG.(1979).Cognitivetherapyofdepression.NewYork:

GuilfordPress.

Belz,M.,Caspar,F.,&Schramm,E.(Eds.)(2012).CBASPinpractice:Basicconceptsandnew

developments.München,Germany:Elsevier.

Bouton,M.E.(2007).Learningandbehavior:Acontemporarysynthesis.Sunderland,MA:Sinauer

Associates,Inc.(Chapter10,pp.371-417.)

Bowlby,J.(1973).Separation:Anxietyandanger(Vol.II).NewYork:BasicBooks.

Brakemeier,E.L.,Engel,V.,Schramm,L.,Zobel,I.,Schmidt,T.,Hautzinger,M.,Berger,M.,&

Norman,C.(2011).Feasibilityandoutcomeofcognitivebehavioralanalysissystemof

psychotherapy(CBASP)forchronicallydepressedinpatients:apilotstudy.Letter-to-the-

Editor.PsychotherapyandPsychosomatics,80,191-194.

Cicchhetti,D.,&Toth,S.L.(1998).Thedevelopmentofdepressioninchildrenandadolescents.

AmericanPsychologist,53,221-241.

Greenberg,P.E.,Kessler,R.C.,Brinbaum,H.G.,Leong,S.A.,Lowe,S.W.,Berglund,P.A.,&Corey-

Lisle,P.K.(2003).TheeconomicburdenofdepressionintheUnitedStates:Howdidit

changebetween1990and2000?JournalofClinicalPsychiatry,64(12),1465-75.

Kasnetz,M.D.(1986).Theinterpersonalimpactofdepressives.Richmond,VA:Virginia

CommonwealthUniversity.UnpublishedManuscript.

LightUniversity106

Kasnetz,M.D.,&McCullough,J.P.,Jr.(1983).Patientmanualforthecognitivebehavioranalysis

systemofpsychotherapy[CBASP].Richmond,VA:VirginiaCommonwealthUniversity.

UnpublishedManual.

Keller,M.B.,&Shapiro,R.W.(1982).“Doubledepression:”Superimpositionofacutedepression

episodesonchronicdepressionepisodes.AmericanJournalofPsychiatry,139,438-442.

Keller,M.B.,McCullough,J.P.,Klein,D.N.,Arnow,B.A.,Dunner,D.L.,Gelenberg,A.J.,…Zajecka,

J.(2000).Acomparisonofnefazadone:Thecognitivebehavioralanalysissystemof

psychotherapyandtheircombinationforthetreatmentofchronicdepression.New

EnglandJournalofMedicine,322,1462-1470.

Kessler,R.C.,Berglund,P.,Demler,O.,Jim,R.,Koretz,D.,Merikangas,K.R.,…Wang,P.S.(2003).

Theepidemiologyofmajordepressivedisorder:Resultsfromthenationalcomorbidity

surveyreplication(NCS-R).JAMA,218(23),3095-105.

Kiesler,D.J.(1982).The1982interpersonalcircle:Ataxonomyforcomplementarityforhuman

transaction.PsychologicalReview,90,185-214.

Kiesler,D.J.(1988).Therapeuticmetacommunication:Therapistimpactdisclosureasfeedbackin

psychotherapy.PaloAlto,CA:ConsultingPsychologistPress.

Kiesler,D.J.(1996).Contemporaryinterpersonaltheoryandresearch:Personality,

psychopathology,andpsychotherapy.NewYork:JohnWiley.

Kiesler,D.J.,&Schmidt,J.A.(1993).Theimpactmessageinventory:FormIIoctantscaleversion.

PaloAlto,CA:MindGarden.

Klein,D.N.,Santiago,N.J.,Vivian,D.,Arnow,B.A.,Blalock,J.A.,Dunner,D.L.,…Keller,M.B.

(2004).Cognitivebehavioralanalysissystemofpsychotherapyasamaintenance

treatmentforchronicdepression.JournalofConsultingandClinicalPsychology,72,681-

Lin,E.H.,Katon,W.J.,Simon,G.E.,VonKorff,M.,Bush,T.M.,Rutter,C.M.,...&Walker,E.A.

(1997).Achievingguidelinesforthetreatmentofdepressioninprimarycare:Isphysician

educationenough?.MedicalCare35(8),831-842.

LightUniversity107

Manber,R.,Arnow,B.A.,Blasey,C.,Vivian,D.,McCullough,J.P.,Blalock,J.A.,…Keller,M.B.

(2003).Patient’stherapeuticskillacquisitionandresponsetopsychotherapy,aloneand

incombinationwithmedication.JournalofPsychologicalMedicine,33,693-702.

McCullough,J.P.,Jr.(2000).Treatmentforchronicdepression:CBASP.NewYork:Guilford.

McCullough,J.P.,Jr.(2001).Skillstrainingmanualfordiagnosingandtreatingchronic

depression:CBASP.NewYork:Guilford.

McCullough,J.P.,Jr.(2006).Treatingchronicdepressionwithdisciplinedpersonalinvolvement:

CBASP.NewYork:Springer.

McCullough,J.P.,Jr.(2008).CBASPpsychotherapyforchronicdepression:Avalueadded

strategyforchronicdepression.PsychiatricTimes,25,26-34.

McCullough,J.P.,Jr.(2010).CBASP,thethirdwaveandthetreatmentofchronicdepression.

JournalofEuropeanPsychotherapy,9,169-190.

McCullough,J.P.,Jr.(2012).Thewayearly-onsetchronicallydepressedpatientsaretreated

todaymakesmesad.OpenJournalofPsychiatry,2,9-11.

McCullough,J.P.,Jr.,Lord,B.D.,Martin,A.M.,&Conley,K.A.(2010).Amethodforconducting

intensivepsychologicalstudieswithearly-onsetchronicallydepressedpatients.American

JournalofPsychotherapy,64,317-337.

McCullough,J.P.,Jr.,Lord,B.D.,Conley,K.A.,Martin,A.M.,Schramm,L.,&Klein,D.N.(2011).

Thesignificantotherhistory:Aninterpersonal-emotionalhistoryprocedureusedwiththe

early-onsetchronicallydepressedpatient.AmericanJournalofPsychotherapy,65,225-

Murray,C.J.L.,&Lopez,A.D.(Eds.).(1996).Theglobalburdenofdisease:Acomprehensive

assessmentofmortalityanddisabilityfromdiseases,injuries,andriskfactorsin1990and

projectedto2020:Asummary.Boston,MA:HarvardUniversityPress.

Penberthy,J.K.(2012).CBASPforco-occurringchronicdepressionandalcoholdependence.In

M.Belz,F.Caspar,&E.Schramm(Eds)CBASPinpractice:Basicconceptsandnew

developments(SectionII,Chapter2).München,Germany:Elsevier.

LightUniversity108

Penberthy,J.K.,Gioia,C.J.,Konig,A.,Martin,A.M.,Cockrell,S.A.,&Meshberg-Cohen,S.

(January,2013).Co-occurringchronicdepressionandalcoholdependence:Anovel

treatmentapproach.AddictiveDisordersandTheirTreatment.Publishedonlineaheadof

print.

Piaget,J.(1926/1923).Thelanguageandthoughtofthechild.NewYork:Harcourt,Brace.

Porges,S.W.(2011).Thepolyvagaltheory:Neurophysiologicalfoundationsofemotions,

attachment,communication,andself-regulation.NewYork,NY:W.W.Norton&

Company.

Rost,K.,Nutting,P.,Smith,J.L.,Elliott,C.E.,&Dickinson,M.(2002).Managingdepressionasa

chronicdisease:Arandomisedtrialofongoingtreatmentinprimarycare.BMJ,

325(7370),934.

Rush,A.J.,Fava,M.,Wisniewski,S.R.,Lavori,P.W.,Trivedi,M.H.,Sackeim,H.A.,...&Kupfer,

D.J.(2004).Sequencedtreatmentalternativestorelievedepression(STAR*D):Rationale

anddesign.ControlledClinicalTrials,25(1),119-142.

Schramm,E.,Zobel,I.,Dykierek,P.,Kech,S.,Brakemeier,E.L.,Külz,A.,&Berger,M.(2011).

Cognitivebehavioralanalysissystemofpsychotherapyversusinterpersonal

psychotherapyforearly-onsetchronicdepression:Arandomizedpilotstudy.Journalof

AffectiveDisorders,129,109-116.

Wiersma,J.E.,Digna,J.F.,VanSchaik,D.J.F.,Hoogendom,A.,Dekker,J.J.,Hendrikus,L.V.,…Van

Oppen,P.(2008).Treatmentofchronicallydepressedpatients:Amultisiterandomized

controlledtrialtestingtheeffectivenessofCBASPforchronicdepressionsversususual

secondarycare.BiologicalMedicalCentralPsychiatry,8,1-13.

Winnicott,D.W.(1949).Hateinthecountertransference.InternationalJournalofPsycho-

Analysis,30,69-75.

LightUniversity109

AllRightsReserved.

Nopartofthispublicationmaybereproducedinanyformwithouttheexpressedwritten

permissionofLightUniversityortheAmericanAssociationofChristianCounselors.

LightUniversity

P.O.Box739

Forest,VA24551

MemberServices:1-800-526-8673

Treatment Resistant Depression...Treatment Resistant Depression Light University 6 Video-based...

Documents