By Rich Simon There was a time not so long ago that only those who had the time and money to attend workshops around the country had the opportunity for a close-up view of psychotherapy’s leading figures. I remember as a grad student my only access to people whose work I revered like Sal Minuchin, Virginia Satir, and Carl Whitaker — as much as I would have liked to swing by their offices to ask my endless list of clinical questions–was through their writing. Read more …
The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is coming, are you prepared? Have you asked yourself ‘As a therapist how will this affect my practice? My clients?’ Join Allen Frances as he explains the major differences between DSM-IV and DSM-5 and how you can improve your psychiatric diagnosis.
Learn how to sidestep common clinical mistakes that promote resistance, and ways to overcome resistance if it does occur. Professor and author of Effective Techniques for Dealing with Highly Resistant Clients, Clifton Mitchell describes the best approaches to circumvent resistance, from clarifying goals, slowing down the pace, and helping clients find emotionally compelling reasons to change.
Explore a treatment plan for clients with narcissistic personality disorder that helps you maintain compassion while achieving leverage. Wendy Behary, author of Disarming the Narcissist: Surviving and Thriving with the Self-Absorbed, teaches how to use tactical confrontation, cognitive restructuring, behavioral therapy and skills training, experiential psychotherapy, and more.
How do you work with borderline personality disorder clients without lapsing into feelings of defensiveness? Richard Schwartz, originator of the Internal Family Systems model, describes working with borderline personality disorder clients who are preoccupied with protecting their vulnerable inner “parts” and can respond to mental health treatment with anger, impulsiveness, and aggressiveness.
Discover how to join with self-loathing clients who are so filled with feelings of shame and worthlessness that they find little benefit from the therapeutic relationship. Janina Fisher, who lectures and writes about integrating neuroscience research and body-centered approaches into psychotherapy, guides the viewer on how to help clients heal their attachment issues and gain self-compassion and acceptance.
In this session, marriage and family therapist William Doherty highlights some techniques to follow when a client isn’t following the treatment plan, continues to follow a self-destructive path, or simply isn’t making progress. Learn how to avoid sounding like a disappointed parent or threatening to abandon the client when therapy stalls.
Discover an assessment protocol to identify six personal characteristics that’ll allow you to customize treatment to match clients’ needs. Distinguished professor of psychology and clinical psychologist John Norcross explores how to identify these personal characteristics to achieve more effective treatment.
Gary Greenberg On The Role Of Economic Factors In The DSM
Creating useful constructs that enable clinicians to communicate more effectively is the intended purpose of the Diagnostic & Statistical Manual. The reality is that by giving diagnostic criteria and a name to a specific human suffering, an entry in the DSM increases the likelihood of research and treatment dollars going to that condition. Read more …
It’s usually easy to see when clients are tuned out or turned off, simply not absorbing what you’re trying to get across. What’s puzzling is when things seem to be really clicking in session—when you’re sure clients will return to report their success at having applied the new awareness and skills they’ve just acquired to their lives—and then you find that they haven’t followed through.
A study by David Atkins and colleagues, published in the June 2012 issue of Behaviour Research & Therapy, found that clients in couples therapy are less likely to recall communication skills learned during high levels of emotional arousal. As the authors report, “Greater emotional arousal predicts remembering fewer skills,” and “sustained emotional arousal may impact memory through encoding, retrieval, or both.” Other studies have also established how strongly stress hormones can affect learning and memory. However, in the June 2013 issue of Couple and Family Psychology: Research and Practice, couples therapist Brent Atkinson offers some practical suggestions for addressing this obstacle to therapeutic change. He proposes that combining our emerging understanding of brain science with the power of deliberate practice gives us effective tools for mitigating the power of emotionally charged situations. Keeping emotions in check would then prevent clients from losing access to the insights and skills they’ve presumably acquired in the consulting room.
“Many clients don’t have a basic level of mental fitness required to make changes,” says Atkinson. For these clients, despite their best intentions, being in conflicts with their partner or in other triggering circumstances results in flooding, or becoming overwhelmed by negative emotions. This often triggers diffuse physiological arousal (DPA)—activation of the autonomic nervous system’s alarm response, which initiates changes like increased heart rate, blood pressure, and levels of stress hormones like cortisol, all of which help prepare the body to deal with threats. In spite of the new insights and skills explored in therapy, the chance of new responses being tried out when a client’s nervous system has been hijacked by DPA are radically diminished. So before clients can make changes in their relationship with a partner, before therapy can really begin to have any real impact, the first order of business is to change clients’ relationship with their nervous system.
In Atkinson’s treatment model, the therapist first works with clients to get them motivated to tune up their nervous system, helping them understand why it’s important and introducing them to the concept of mindfulness. The couples then participate in an eight-week mindfulness course, and during concurrent couples therapy sessions, they practice extending the skills they’re learning to their relationships. If clients need help mindfully responding during stressful partner interactions, they listen to their partner’s criticisms via prerecorded voice messages, during which they practice using mindfulness skills to turn down their physiological and emotional arousal. As clients become more skilled at self-soothing, the therapist helps them to identify their typical sequence of conflict and to mentally rehearse how to respond more effectively when conflict arises—much like how athletes or musicians might engage in mental practice to enhance their skills.
Treatment models like Atkinson’s move the field of therapy away from a faith in the magical power of insight, or even the generalized benefits of the therapeutic alliance, toward a closer look at how to concretely make the process of emotional learning more efficient and sustainable. Since therapy outcome studies consistently show a discouraging overall finding—the average results of psychotherapy haven’t improved over the last 50 years—this new research certainly seems to be a step in the right direction.