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Each program consists of informative and engaging conversations with fascinating professionals in the psychotherapy industry. All courses come with a downloadable audio file, transcript, online test, and certificate upon completion. Click on the program title for more details, including learning objectives, speaker information, interview summary and to hear a sample of the program.
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The Addictions Curriculum
With such an intractable foe as addictions, it is important to have an arsenal of approaches available within your repertoire of thinking so you, as a counselor or therapist, are better equipped to do battle. This program highlights a variety of models forunderstanding and treating addictions, ranging from the traditional 12-step model (which is conitive-behavioral), systemic family therapy, developmental, self psychology, and traditional psychoanalytic.
Adolescent Substance Abuse
Adolescents have always posed a unique challenge to therapists, and substance abusing adolescents push us to an even higher frequency. Here, Peter Palanca shares his methods of getting resistant adolescents to talk to him.
Alcoholism in Couples
Dr. Rorhbaugh has studied the role of couple and family interaction in maintaining alcohol abuse. He has developed a couple-based treatment approach, which incorporates systemic principles and practices.
Eating Disorders
Joan Ebbitt presents a clear understanding of how eating disorders develop. Like the old joke, "How do you get to Carnegie Hall?" full-blown eating disorders don't just happen. It takes a lot of practice to get there.
Engaging the Gambler
Dr. Mary Rich views gambling from a developmental perspective. Getting addicted patients engaged in therapy is a serious problem, major challenge, and not for the thin-skinned. Dr. Rich explains why so many addicts can't attach.
Perversions
In this interview, Dr. Goldberg discusses his book and work on the topic of perversions. We present his interview first because Dr. Goldberg's explanation of "splitting" is so crucial to the understanding of addictions.
Relapse Treatment
In these next two interviews, we look at the subject of relapse and hear two very different treatment approaches. First, Susan Flynn of Haymarket House in Chicago, discusses the approach used at her center.
Our culture supports addictive behavior. Mental health practitioners are on the front lines, dealing with the repercussions of our addictive society. This program presents new theoretical and treatment approaches to various addictive disorders.
A Quick Alcoholism Assessment
Father Bob Taylor will give us a quick way to assess the presence of alcoholism.
Codependency
Nancy Smith defines and examines the development of codependence in families, as well as the need for people to redefine the identities lost in childhood.
Eating Disorders and Attachment Theory
Dr. Linda Chassler discusses eating disorders from the point of view of attachment theory and the work of Daniel Stern.
Narrative Theory and A.A.
Dr. Carolyn Saari is the author of The Creation of Meaning in Clinical Social Work, the former editor of the Clinical Social Work Journal, and former Director of the Loyola University School of Social Work's Doctoral Program. She discusses narrative theory and its particular relevance in treating addictions.
Resilience
Dr. Wolin discusses “The Challenge Model,” which focuses on strengths honed in childhood under adverse childhood circumstances. This emphasis provides an alternative to the “damage-pathology” bias, which currently pervades the research and clinical establishments in psychology and psychiatry fields.
Response
Ms. Smith explains the focus of treatment or intervention with adult children of alcoholics and codependents is not on their functioning. Rather, it’s on their feelings and how they deal with such areas as trust, control, fear, their own needs and wants, and all of the ingredients that go into establishing and maintaining an intimate relationship.
“Empty Core” Theory and Substance Abuse
Dr. Jeffrey Seinfeld, PhD explores the treatment of substance abusers
from a British object relations perspective, focusing on the abuser's
use of chemicals as a replacement for the lost early nurturing
relationship.
Truth is stranger than fiction. We’ve seen a president get impeached after having—or not having --sex -- in the Oval Office with a young intern. We’ve seen the best golfer in a generation become a broken man after the discovery of his outrageous infidelities. His now ex-wife wound up with $110 million dollars and he hasn’t won a tournament since. Then there’s the now ex- governor of New York, who spent tens of thousands of dollars on prostitutes.
Wait! There's more! The governor of California, who has a history of groping woman, was discovered to have had a now teen-aged child by his housekeeper. And two notorious European satyrs have been in the news: one, the elderly prime minister of Italy, is said to have flown prostitutes on his government paid airplane, among other outrageous behavior, and of course, there is the Former International Monetary Fund chief who was accused of attempted rape. And how can we ignore the Congressman who posted photos of a key part of his anatomy, and whose unfortunate surname is also the nickname of said body part. As they say, “You can’t make these things up!”
Are these men of privilege and power whose narcissism and grandiosity backfired? A dream team of lechers? Or are they tortured souls, looking for love and connection in all the wrong places?
Here to explain the differences between the two situations is Sharon O’Hara, Clinical Director of the Sexual Recovery Institute in Los Angeles.
Bad Boys: Sexual Addiction or Entitlement?
Sexual Addictions expert, Sharon O’Hara explains the difference between the outrageous sexual behavior of some noted powerful politicians and celebrities and the desperate behavior of sexual addicts, whose brains are hijacked by the intensity of their own fantasies.
More than 23 million Americans are believed to have an addiction disorder, yet only 10 percent of those receive treatment. Many addicts come to get help through the process known as Intervention.
Our speaker in this interview uses the Systemic Model, which is both invitational and educational. It focuses on the disease and the family system, with the goal being family (systemic) health. During the intervention, the family must come to understand the difference between co-dependency and responsible relationships. The intervention process is non-confrontational and the message is “WE need help.” The role of the interventionist is to lead the way to recovery rather than pushing. There is no secrecy or deception; it is gentle and respectful.
Interventions
More than 23 million Americans are believed to have an addiction disorder, yet only 10 percent of those receive treatment. Many addicts come to get help through the process known as Intervention.
Interventions have come a long way since the process was first developed by Vernon Johnson in the 1960’s. Today there are two basic models of professional intervention in use and they differ from each other in very significant ways.
The Systemic Family Intervention (SFI) differs from the Johnson Model in that it is both invitational and educational. It focuses on the disease and the family system, with the goal being family (systemic) health. During the intervention, the family must come to understand the difference between co-dependency and responsible relationships. The intervention process is non-confrontational and the message is “WE need help.” The role of the interventionist is to lead the way to recovery rather than pushing. There is no secrecy or deception; it is gentle and respectful.
Our speaker in this interview works in the Systemic Family Intervention method, and she shares her approach to this work here.
Sobriety alone doesn't guarantee a good life. Medication may not be enough and the talking approach of AA and NA has never proven to be enough. Through addiction, the neurology, biology and psychology of the addict has been altered, maybe forever.
A number of psychological treatments have developed to treat the addict, such as cognitive behavioral therapy. But the last treatment one would expect to be useful is psychoanalysis, or psychoanalytic psychotherapy. Now with the integration of neuroscience and psychoanalytically oriented approaches, therapists have a new weapon to understand and deeply help addicts. We can finally begin to understand that one aspect of the personality of the addict does not always know what the other is doing! We can understand why addicts would choose their drug dealer over their closest and dearest relatives and friends.
The topic of addiction and recovery is filled with myths, half- truths and misinformation. Rehab facilities nationwide have a range of programmed responses, most of which are unsatisfactory or effective. It's little wonder that the frequency of one-year relapse is high.
In this interview,Dr. Mark Willenbring lists a number of currently accepted facts about addictions for the falsehoods they are, including: Myth #1) Rehab is necessary for most people to recover from addictions; Myth #2.) Highly trained professionals provide most of the treatment in addictions programs; Myth #3.) Drugs should not be used to treat a drug addict because total abstinence is required.
And, most importantly, he states that there is an alarming discrepancy between the treatments employed at many rehab centers and the treatments recommended by leading experts and supported by scientific research! Moreover, he states that substance abuse treatment begins with research, which most rehab facilities and Twelve Step programs ignore!
OPIATE ADDICTION TREATMENT: Science vs Ideology and the End of One-Size-Fits-All Treatment
In this interview,Dr. Mark Willenbring lists a number of currently accepted facts about addictions for the falsehoods they are, including: Myth #1) Rehab is necessary for most people to recover from addictions; Myth #2.) Highly trained professionals provide most of the treatment in addictions programs; Myth #3.) Drugs should not be used to treat a drug addict because total abstinence is required.
And, most importantly, he states that there is an alarming discrepancy between the treatments employed at many rehab centers and the treatments recommended by leading experts and supported by scientific research! Moreover, he states that substance abuse treatment begins with research, which most rehab facilities and Twelve Step programs ignore!
Our current state of knowledge points to many hypotheses, explanations and corresponding treatment methods, and growing all the time. There are many effective biological treatments for addiction that can help decrease drug craving and reduce relapse. As well, many varieties of talk-therapy are effective, depending, of course, on who is using the treatment and who is providing it.
In this interview, Dr. Ishani Dalal, a psychiatrist specializing in the treatment of opiate addicts, describes her work at the Positive Sobriety Institute, which combines medication and talk therapy.
OPIATE ADDICTION TREATMENT: An Integrated Approach
Our current state of knowledge points to many hypotheses, explanations and corresponding treatment methods, and growing all the time. There are many effective biological treatments for addiction that can help decrease drug craving and reduce relapse. As well, many varieties of talk-therapy are effective, depending, of course, on who is using the treatment and who is providing it.
Dr. Ishani Dalal describes her work at the Positive Sobriety Institute, which combines medication and talk therapy.
Purchase all 3 Opioid Addictions programs and save 20%
OPIATE ADDICTION TREATMENT: A Neuropsychoanalytic Approach
Sobriety alone doesn't guarantee a good life. Medication may not be enough and the talking approach of AA and NA has never proven to be enough. Through addiction, the neurology, biology and psychology of the addict has been altered, maybe forever.
A number of psychological treatments have developed to treat the addict, such as cognitive behavioral therapy. But the last treatment one would expect to be useful is psychoanalysis, or psychoanalytic psychotherapy. Now with the integration of neuroscience and psychoanalytically oriented approaches, therapists have a new weapon to understand and deeply help addicts. We can finally begin to understand that one aspect of the personality of the addict does not always know what the other is doing! We can understand why addicts would choose their drug dealer over their closest and dearest relatives and friends.
OPIATE ADDICTION TREATMENT: An Integrated Approach
Our current state of knowledge points to many hypotheses, explanations and corresponding treatment methods, and growing all the time. There are many effective biological treatments for addiction that can help decrease drug craving and reduce relapse. As well, many varieties of talk-therapy are effective, depending, of course, on who is using the treatment and who is providing it.
Dr. Ishani Dalal describes her work at the Positive Sobriety Institute, which combines medication and talk therapy.
OPIATE ADDICTION TREATMENT: Science vs Ideology and the End of One-Size-Fits-All Treatment
In this interview,Dr. Mark Willenbring lists a number of currently accepted facts about addictions for the falsehoods they are, including: Myth #1) Rehab is necessary for most people to recover from addictions; Myth #2.) Highly trained professionals provide most of the treatment in addictions programs; Myth #3.) Drugs should not be used to treat a drug addict because total abstinence is required.
And, most importantly, he states that there is an alarming discrepancy between the treatments employed at many rehab centers and the treatments recommended by leading experts and supported by scientific research! Moreover, he states that substance abuse treatment begins with research, which most rehab facilities and Twelve Step programs ignore!
Addiction is characterized by profound craving for a drug or behavior that so dominates the life of an addict that virtually nothing can stop the person from engaging in the addictive behavior.
This program covers the definition and the etiology of the problem. Our speaker has been in the forefront of treatment of sexual addictions and he has developed a model describing six types of sexual addictions and the particular treatment methods for each.
Six Types of Sexual Addiction
Addiction is characterized by profound craving for a drug or behavior that so dominates the life of an addict that virtually nothing can stop the person from engaging in the addictive behavior.
This program covers the definition of six types of sexual addiction, the etiology of the problem, and looks at some treatment methods.
The explosion of the Internet into the day-to-day lives of your average Joe has transformed the use and popularity of pornography and has ratcheted up the rates of cyber-porn addiction. Those vulnerable to sexual addiction no longer have to leave the safety of their own homes and confront embarrassment and shame about buying porn; they simply surf from their home computer or hand-held device
Why is this so addictive and so powerful? We know that the most powerful sexual part of our bodies is what lives between our ears! Exposure to these images and experiences activates the pleasure centers of the brain and if the firing of synapse in these pleasure centers is excessive, a faulty wiring system can set in. Addictions actually hijack our reward systems, causing a reprogramming of the reward system with sometimes lasting brain changes.
What eventually motivates the person to seek treatment is that this behavior begins to significantly affect his mood, functioning or and/or relationship. Mental anguish, profound worry and dismay, shame, anxiety and depression accompany this addiction as well as feelings of being out of control.
Our speaker in this interview has been in the forefront of treatment of sexual addictions and he has developed a model describing six types of sexual addictions, which he shares with us in this interview.
The Psychotherapy Curriculum
Perhaps the most significant development in contemporary psychoanalytic thought has been attachment theory. This program consists of two interviews with Dr. David Wallin.
In the first, which also appears in the program, “The Therapeutic Relationship,” Dr. Wallin translates attachment theory and research into a framework that integrates key attachment principles with psychopathology, with neuroscience, with relational and intersubjective psychotherapeutic approaches, with mentalization, and with mindfulness.
In the second, Dr. Wallin provides a detailed case example of attachment theory in action: how Dr. Wallin used his knowledge of the patient’s attachment style and Wallin’s own self- awareness to salvage a difficult session and deepen his relationship with the patient.
Attachment in the Clinical Context: Case Example
Dr. Wallin provides a detailed case example of attachment theory in action: how Dr. Wallin used his knowledge of the patient’s attachment style and Wallin’s own self- awareness to salvage a difficult session and deepen his relationship with the patient.
Attachment-Oriented Psychotherapy
Perhaps the most significant development in contemporary psychoanalytic thought has been attachment theory. In this interview, Dr. David Wallin translates attachment theory and research into a framework that integrates key attachment principles with psychopathology, neuroscience, relational and intersubjective psychotherapeutic approaches, mentalization, and mindfulness.
People with Borderline Personality Disorder are probably the most challenging of all the patients most of us see. Many show a profound lack of integration of their personal identity, and some cling to their therapists, refusing to leave when the session is over. Two out of five will quit treatment prematurely. They act out just when things start to be improving, and they’re seen by most clinicians as confusing, upsetting, draining, and notoriously difficult to treat. However, many BPD patients eventually make modest and even splendid recoveries.
An Object-Relations Approach
Frank Summers, PhD, author of Transcending the Self: An Object Relations Model of Psychoanalytic Therapy, provides case discussions demonstrating how psychoanalytic therapy informed by an object relations model can effect radical personality change.
Attachment Styles in BPD
Dr. Karla Clark, an educator and speaker, discusses understanding patients with Borderline Personality Disorder based on their attachment styles.
Borderline Marriages
Anyone doing marital therapy knows there are couples, and then, there are couples! The "normal" couple rapidly incorporates the therapist's help with communication and conflict resolution issues. On the other hand, the personality-disordered marriage seems impervious to change and, in fact, seems to get worse in treatment. Charles McCormack is the author of Treating Borderline States in Marriage: Dealing with Ruthless Aggression, Severe Resistance and Oppositionalism. He describes marriage as containing both the dream and the nightmare of the couple's way of being in a relationship. The couple presents a tangle, which all three in the room must work to sort out.
Borderline Mothers
Research is beginning to show the development of BPD depends on an interaction of constitutional biologic vulnerabilities with often adverse environmental circumstances during development. Christine Lawson, PhD is the author of Understanding the Borderline Mother: Helping her Children Transcend the Intense, Unpredictable, and Volatile Relationship. She describes how the neurological functioning of borderline mothers' children is impacted by deficits in early parenting and the projection of massive states of confusion and terror onto the children by these borderline mothers. She also explains how she uses EMDR in her therapeutic work.
Brief Treatment
Here, Ms. Hotchkiss summarizes three levels of a borderline personality so we can have more nuanced criteria for this disorder. These will help us predict the kinds of treatment and transference issues that may arise in treatment, and thus, may help our decision making about what to offer to the patient.
Development and Film Discussion
Ed Kaufman, a clinician, educator, and film discussion leader, discusses some of the developmental issues leading to the Borderline Personality, especially as these are portrayed in the film, “You Can Count On Me.”
Dialectical Behavior Therapy
Charles Swenson directed one of the first psychoanalytically oriented in-patient programs for BPD, which switched to the use of DBT under his leadership. Here, Dr. Swenson gives an overview of DBT, its basis from a bio-social theory of BPD, its synthesis of principles and strategies from behaviorism, Zen, and dialectical philosophy, and how DBT actually works.
Education and Crisis Intervention with Families of Patients Having BPD
Dialectical Behavior Therapy (DBT) is a comprehensive, cognitive-behavioral treatment for individuals meeting criteria for a borderline personality. Research has shown DBT has reduced suicidal episodes, hospitalizations, and dropout from treatment, while reducing anger and improving social adjustment. Valerie Porr is founder and director of TARA, the only national, nonprofit, educational and advocacy organization for BPD. In this interview, she discusses how she uses DBT in crisis intervention on the telephone and in her educational groups for family and friends of people with BPD.
Impact on Families
Paul Mason is co-author of the best-selling book, Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder. In this interview, he describes how family and friends can learn what to do to cope with borderline behavior and take care of themselves.
Neuroscience and Medication
Larry Siever, author of "The New View of Self: How Genes and Neurotransmitters Shape Your Mind, Your Personality, and Your Mental Health," believes knowledge of the biology of Borderline Personality Disorder helps us better understand and treat it. In this interview, he explains a person with BPD is a emotionally vulnerable, has an autonomic nervous system that reacts excessively to relatively low levels of stress, and takes longer than normal to return to baseline once the stress is removed. He also describes how medication can help.
Self-Injurious Behavior
A history of self-mutilating behavior is one of the nine indicators of Borderline Personality Disorder. How can things like cutting, gouging, and burning one's body actually make the injurer feel better? That being the case, what possible therapeutic intervention can compete? Karen Conterio and Wendy Lader, co-authors of Bodily Harm, founded the first treatment program in the nation specifically for people who harm themselves. In this interview, they describe a course of treatment based on years of experience and extensive clinical research, as well as compassion, advice, hope, and humor. They use innovative techniques, including cognitive analytic therapy, to look at the underlying dynamics driving the behavior.
Formerly entitled "Critical Issues in Psychotherapy, Volume 3," this program is dedicated to bringing you the latest thoughts from some of the leading experts in the brief treatment field. Brief treatment is presented from a number of theoretical perspectives and treatment approaches, and these interviews show brief treatment is no second choice substitute for long-term treatment. Despite their many differences, these speakers all believe and make a strong case to show brief treatment is often a stronger, more progressive, and more optimistic mode of promoting growth and change.
A Psychodynamic Approach to Brief Treatment
Learn about Dr. Baschs developmental model for brief treatment, in which the therapist focuses on the patients strengths and doesnt allow a regressive, dependent relationship to develop. Many detailed case examples are presented.
An Overview to Brief Treatment
Dr. Maria Corwin presents an overview of the various theories and methods utilized in brief treatment and the common elements in all of them.
Anxiety-Provoking Brief Therapy
Professor Emeritus of Psychiatry at Harvard and author of Short-Term, Anxiety Provoking Psychotherapy, Dr. Peter Sifneos discusses his method, the criteria used in selection of patients, treatment methods, and the use of interpretation.
Brief Group Therapy with Children with Affective Disorders
Drs. Anastasiades and Harris describe their method of treating children with affective and anxiety disorders in brief treatment groups. Parents also are seen in parent groups and brought together with the children in multi-family group sessions.
Brief Treatment of the Borderline Personality
Sandy Hotchkiss outlines three different types or levels of borderline personalities and how each type can or cannot be successfully treated using brief therapy. In particular, for some borderline personalities, leaving the door open to return for more treatment is an invitation for regression.
Brief Treatment with Difficult Adolescents
Learn how Mr. Selekman works with difficult, acting-out adolescents in brief treatment, using the solution-focused model. In this model, work often is completed in one session.
Narrative Constructivist Brief Treatment with Families
Learn about the use of narrative constructivist theory in the brief treatment of families. In this model, the therapist is not in a position of power, but rather, is a partner with the family in solving the problems.
The overall theme of this volume is the treatment of difficult patients and patients in very difficult situations.
Biologically Informed Treatment of Depression
Dr. Shuchter presents his model for the treatment of depression and the latest group of medications for depression.
Children Who Kill
Dr. Garbarino, author of Lost Boys, discusses the reasons for the emergence of aggressive behavior in children. He discusses why our society is toxic and gives suggestions for making an adolescent intervention program effective.
Disorders of the Self
Dr. Karla Clark presents her model of conceptualization and treatment of the borderline personality disorder, as well as individuals with attachment disorders.
DSM IV and Personality Disorders
Dr. Millon, who was one of the developers of DSM IV, discusses how the definition of "personality disorders" differs from that in DSM III. He elaborates on the eleven personality disorders described in DSM IV and presents the often subtle differential diagnostic issues between them.
Manipulative Suicide Threats
Suicide and death pose significant challenges for loved ones and survivors. Assessing suicide talk is one of the most anxiety-ridden tasks of psychotherapy because we can't afford to be wrong. Plus, the bereaved's intense grief can be overwhelming to their loved ones and even the therapist.
Parent Loss in Adolescence
Dr. Neimeyer presents his conceptualization of grief and loss from a narrative-constructivist point of view. He suggests the problem with using "stage" theories of grief is they distort the human experience of grieving.
Treatment of the Elderly
Dr. Knight discusses methods of assessing older adults, how to complete a therapeutic life review, and how treatment of the older adult differs from that of younger adults.
Hear an overview of the prevalence and causes of domestic violence, and learn about one of the main treatment approaches.
Anger Management
Dr. Barris recommends a type of treatment for anger management closely related to cognitive behavior therapy. He describes his theories on the causes of anger and presents his model of treatment.
Overview to Domestic Violence
Dr. Hanson defines domestic violence as involving a broad spectrum of abusive behavior and discusses the phases in the cycle of violence. Because many battered women are ashamed to admit they are being hurt, Dr. Hanson recommends a number of "red flags" the clinician should look for. Dr. Hanson also presents the primary goals of treatment for a battered woman and the steps in a treatment plan.
The study of domestic violence has been politicized and disputed by feminists and family theorists. Treatment theory has rapidly evolved, with feminist theory and family systems theory becoming the dominant theoretical perspectives. Proponents of both models maintain intractably opposed positions and have experienced impassioned and bitter debate. Here, we present an alternative and a discussion of the legal and psychological issues involved.
An Object-Relations Approach
Diane Zosky states current approaches to domestic violence, which focus on the sociopolitical and the family system, can overlook the meaning of this behavior to the offender and the victim. She discusses how object relations theory can be valuable in work with domestic violence victims and offenders.
Protecting the Victim
Dr. Galatzer-Levy presents the first steps for a clinician to take when working with a battered woman and explains why many clinicians fail in their treatment of women experiencing domestic violence. Attorney Murphy explains the legal issues involved and how the therapist and attorney can work together on behalf of the victim.
You can teach an old dog new tricks. Using a maturity-based, challenge specific model, therapists can have gratifying clinical and personal experiences in working with elderly individuals and couples. We can never give up on the elderly, even those who are suicidally depressed.
Elderly Suicide
In this interview, we look at current knowledge about suicidal behavior in the elderly and translate this knowledge nto practical treatment considerations.
Treatment of the Elderly
Dr. Knight discusses methods of assessing older adults, how to complete a therapeutic life review, and how treatment of the older adult differs from that of younger adults.
How does a child become an adult? What propels development from late adolescence to adulthood? In this program, we explore “becoming.” Jeffrey Arnett gives us an overview about what he has termed the stage of “Emerging Adulthood.” Harry Bendicsen describes the deep and personal work that goes into what he has called, “The Transitional Self.” Maxine Wintre reviews her research findings about what happens to families during these years, and Jesse Viner explains the neurological developments that take place as one moves from adolescence into full adulthood.
Neurobiological Changes in Emerging Adulthood
Dr Jesse Viner explains the neuroscience findings that propel emerging adulthood, an active and essential window of time in the maturational unfolding of identity.
OVERVIEW
Sociologists define the “transition to adulthood” as marked by five milestones: completing school; leaving home; becoming financially independent; marrying; and having a child. Dr. Arnett presents an overview to the subject of Emerging Adulthood, a term he devised.
The Old/New Family
Dr. Maxine Wintre’s research addresses the ignored role of parents in the psychological health and life transitions of emerging adults. In part, it explains why parents have been left out of the picture and then describes more recent theories and research, investigating perceived reciprocity with parents and social support, perceived stress, depression, anxiety, transition to university, to the army, etc that pave the way for practical implications and interventions and further research.
The Transformational Self
Harry Bendicsen, LCSW, is concerned with the processes that propel the transition from adolescence to adulthood. In his book, "The Transformational Self: Attachment and the End of the Adolescent Phase", he takes major trends in psychological thinking: psychoanalytic theory; complexity theory; attachment theory; relational theories; linguistic theory; and neurological research, and integrates them to create a new framework of interdisciplinary process that he names, “Regulation Theory.” Using these insights, he shows how this becomes the “gateway” to young adulthood.
This program is about chronic illness. This type of illness or condition will not be cured, although the patient may get better and be able to maintain himself at a high level. In this program, we’ll be discussing the impact of chronic illness on the self, the family, and the therapist, as well as how chronic illness impacts the work of therapists who are ill.
The movie, "The Doctor," is the story of a rather arrogant physician who develops cancer, becomes a patient undergoing radiation, and has to deal with being on the other side of the coin. The film is used as a backdrop to this program.
Adolescent Daughters of Mothers with Breast Cancer
Adolescence is the transitional period between childhood and adulthood characterized by dramatic biologic, physical, cognitive, emotional, and social changes. Hormonal changes trigger the onset of puberty and, with it, preoccupation with body image. Compared to other family members, daughters of women with breast cancer are particularly and poignantly affected. They also may be at an increased risk of emotional problems when their mothers are diagnosed with cancer. In the light of the high incidence of breast cancer and recent developments in breast cancer genetics, it's important to develop effective ways of educating and treating these possible patients of the future. Dr. Marcia Spira discusses her work with these young women.
Cognitive Coping Skills
Dr. Kenneth Sharoff has developed a cognitive coping skills approach. This is a prospective form of treatment. It looks forward in time and plots the steps needed to accomplish a goal. He tells us there are positive ways of coping, and of course, there are negative ways. One way or another, everyone copes. The concern of the therapist is whether their way of coping is adaptive, rational and realistic, or pathological and resulting in a backfire.
Group Therapy with the Medically Ill
Group therapy specifically designed for people with medical illness is one of the most powerful forms of intervention available to them. In fact, it's often the treatment of choice. Dr. Spira reports there are several curative factors in the group setting which contribute to patient improvement. First, there is universality, the opportunity for group members to feel they're not alone in their situation. Second, there is altruism, which gives group members a sense of purpose through lending support to others in the group. Third, there is hope, where group members can see others experience the same emotions and find meaning in life.
Impact of the Patient's Chronic illness on the Therapist
Working with chronically ill patients presents many challenges to the patient and the therapist. A countertransferential risk in working with this client population is the therapist’s own fears and vulnerabilities about illness. This may arouse the need to distance from the client’s emotions in order to ease the therapist’s discomfort. Empathic failure is expected to occur during the course of treatment, as feelings of hopelessness, helplessness, and loss often interfere with the therapist’s ability to maintain their experience-near stance. Drs. Garrett and Greene-Weisman discuss their work with AIDS and terminal cancer patients, as well as its impact on them.
Impact on the Self
Life-threatening illness takes us to a place of fear and deep soul-searching rapidly and without warning. Dr. Mark Smaller discusses the impact of a chronic illness diagnosis through the lens of self psychology. There is no doubt the minute a person hears those dreaded words, their identities are permanently altered, as they begin their struggle for life.
Jungian Dream Work with Cancer Patients
In her research and clinical work, Ann Goelitz has found the use of dream work as a component of individual counseling can often jumpstart a therapeutic process and encourage clients to discuss topics which are normally difficult to talk about. Not only did the dream work help the patient come to terms with the dying process, but it also seemed to reduce his sense of isolation.
Psychosocial Factors
Gary Gilles, LCPC discusses the psychosocial aspects of chronic illness. New medical and technological advances don’t address the psychosocial needs of patients, family members, and caregivers, and the emotional burdens they encounter in living with and taking care of a chronically ill person.
The Impact of Brain Injury on the Self
When a chronic medical situation arises from trauma, such as a brain injury, the patient has to deal with rehabilitation and whatever recovery can be achieved, as well as come to terms with a totally different world and a self. Traumatic brain injuries now account for an estimated 400,000 new hospital admissions yearly in the U.S. Head injury patients have specific difficulties with affect management and problems with identity and self-esteem. Dr. Miller views brain injury as a blow to one's integrity beyond any compromised functioning and stresses we must shore up the shattered sense of self and core identity before trying to resolve other conflictual issues.
The Impact of Diabetes on the Family
In no disease is successful management more dependent on the attitude of the patient relationship within the family. The complex nature of control, the need for frequent monitoring, the dietary restrictions, and the limitations on activity all have an impact on the life of the individual and other members of the family. Further, like other families in which there is a chronic disease, the disease may be blamed for every problem. Joseph McBride presents a systemic framing to illustrate the coping strategies necessary to deal with the diagnosis, management of the illness, and restructuring of the family system.
The Therapist Has Cancer
Marcia Adler and Dr. Roneen Blank are friends and colleagues, who were diagnosed with breast cancer within one week of each other and formed their own support group as they each went through radiation and chemotherapy. Here, they discuss how they told their patients, how the patients reacted, and their own thought process.
In the wake of the incomprehensible events of September 11th, the nature of the losses posed unbelievable challenges to counselors and therapists. The shock of this event traumatized all of us, and our nation went through a mourning process.
Therapists were grappling with their trauma as well because, in a sense, we are all survivors. The enormity of this catastrophe made our work even harder. We felt personally vulnerable, and at the same time, we had to be there for others. These catastrophic events are professionally difficult and, as therapists, we have to find our own sources of renewal. The emotional demands are great, and there is no preset formula for this work.
All of our speakers share the view that adhering to the notion of recovery “stages” does a disservice to the client and oversimplifies a very personal, complex, and intimate process. One thing has been certain: we will be dealing with the post traumatic effects of this event for a very long time.
In response to the events of September 11th, we compiled previously recorded interviews on the subject of grief work, in addition to new interviews.
A Narrative-Constructivist Approach
Dr. Neimeyer presents his conceptualization of grief and loss from a narrative-constructivist point of view. He suggests the problem with using stage theories of grief is they simplistically distort the human experience of grieving.
AIDS Partners and Loss
Dennis Shelby, PhD, BCD, is the author of If a Partner Has AIDS: A Guide to Clinical Intervention. He discusses his research with patients whose life partners have died of AIDS, the complex mourning that ensues, and how to treat it.
Dealing with Death in Families
Dr. Froma Walsh, author of Living Beyond Loss, discusses her work with families of dying patients, how to work with denial, and how to decide if and when to push people to talk.
Disaster Mental Health
Author of Disasters: Mental Health Interventions, John Weaver discusses disaster mental health work with many examples from actual disasters.
Families of Homicide Victims
Learn how to work with families of murder victims and prevent compassion fatigue.
Parent Loss in Adolescence
Colin Webber, who has worked with parent loss for many years, describes the coping styles of children who have lost a parent, the difference between adjustment and internal processing, the challenges faced by adolescents dealing with the death of a parent due to their stage of development, and the defense mechanisms most likely to be used by a bereaved adolescent to protect against narcissistic injury.
Work with the Grieving
Mila Tecala is an internationally renowned expert on grief and mourning in the face of catastrophic events. In the wake of September 11th, she worked with employees of American Airlines based at Dulles Airport. She discusses how to prevent grief from turning into complicated and unresolved mourning.
Is seeing a therapist online an oxymoron? Though the idea of “seeing” a therapist online doesn’t make immediate sense, e-therapy is most definitely finding its market. In 2000, more than 60,000 therapy sessions occurred over the Internet. That doesn’t include hundreds of therapists who offered clients private online chat or email sessions. The numbers continue to grow daily. Does this mean we should leap onto the bandwagon? Just because many are doing this, is it ethical? Is it efficacious? What do we need to know in order to begin making a decision?
In this program, we present an overview of the mechanics, legalities, ethical issues, and treatment modalities that seem to be best suited to online therapy.
Clinical Examples
Here we present interviews with two therapists who are working exclusively or almost exclusively with clients online. First, Barbara Adams, M.S.Ed., LPC describes her clinical work.
Clinical Theories and Skills
Is online therapy a form of therapy in its own right? Originally, it started out as a method of delivery of therapy, a means of communicating between two or more persons usually separated by large distances. The next two interviews continue our introductory interviews. These speakers present some of the emerging theory underpinning online therapy and the clinical skills necessary to do it. Susan Mankita, LCSW, who led AOL's Social Work Forum, presents some of the communication, sociological, and clinical theory.
Ethical Issues
Kathleen Murphy, PhD addresses some of the serious legal and ethical issues raised by online therapy, including the problems, negatives, and real concerns about it. Then, we issue an appeal to our professional organizations and regulatory boards to begin developing guidelines and promoting research to address these issues.
Online Supervision
Dr. Allen Siegel began email supervision with a psychiatrist in Germany, who wished to learn about self psychology. In the first part of this interview, he describes how they developed a method where the psychiatrist submitted process recordings of her therapy sessions through email, and Dr. Siegel responded to her with didactic and clinical supervision. We interviewed him again for a follow up on how his work has been going. In addition to his work with the German psychiatrist, he describes his work with a group of psychiatrists in Turkey. This program includes samples of the email correspondence between him and his German supervisee, containing very detailed case process recordings from the supervisee and Dr. Siegel's remarks on those interviews.
Overview to Online Therapy
Our first speaker, Michael Freeny, LCSW, offers a lively and humorous look at the range of clinical uses (and misuses) of the Internet. We'll learn how to find resources for ourselves and our clients on the Web, as well as how to plug in to this new medium.
Psychoanalytic Therapy Online
Kerry Sulkowicz, MD shares his thoughts on and experience with the use of psychodynamic psychotherapy online.
Rational Emotive Therapy, Online
Richard Sansbury, PhD presents his clinical work and innovative use of rational emotive therapy online.
Pain serves as a danger signal to warn us that part of the body is being injured. Acute pain is adaptive, protective, and usually abates with physical recovery. In comparison, chronic pain is defined by the persistence of pain beyond the usual healing time. Unlike acute pain, chronic pain typically has no adaptive purpose, and the onset and cause may be unclear. It can evolve into an entrenched, self-perpetuating cycle of psychological distress and suffering.
In this two-part program on pain, we cover the latest and miraculous new innovations in the treatment of acute pain. Then, we look at a cognitive approach to work with pain.
Cognitive Coping Skills for Pain and Suffering
In this interview, which also appears in our program, “Emotional Responses to Chronic Medical Illness,” Dr. Sharoff presents his cognitive coping skills approach. He tells us there are positive and negative ways of coping with pain, but one way or another, everyone copes. The concern of the therapist is whether these coping methods are adaptive, rational, and realistic, or pathological and likely to backfire. He describes his methods and procedures.
Medical Innovations
Dr. Randall, a pain management specialist, explains the mechanisms of pain and describes new techniques to treat chronic pain.
PTSD is one of the very few psychiatric disorders that comes under attack in almost every way. Every assumption and theoretical underpinning is up for grabs. Nothing about the diagnosis and its treatment has gone unchallenged. In fact, the controversy extends to a debate about our whole Western culture, a culture that tends to make every wrong a legal issue, open to lawsuits and turns “the human condition” into medical entities. Meanwhile, our soldiers are returning from Iraq and Afghanistan broken in body and suffering in spirit. The stigma associated with mental illness is a factor that often keeps them from getting the help they need. We are only beginning to understand the complexities of post-traumatic reactions.
Cognitive-Behavioral Treatment
Trauma outcome studies have consistently found the most effective PTSD treatments to be cognitive and exposure-based therapies that focus on emotional processing of the trauma material. According to Dr. Steven Taylor, a number of cognitive and behaviors distinguish people with PTSD. In this interview, Dr. Taylor discusses how and why CBT works.
Engaging Survivors of Extreme Violence
Engaging survivors of extreme violence in treatment requires the therapist’s ability to understand and tolerate the awareness of terrible, unacceptable events in the world and themselves.
Dr. Martha Bragin has spent her professional career working with survivors of extreme violence. For her, the work of Melanie Klein, a post-Freudian psychoanalyst, provides a springboard for understanding and connecting to these survivors, who feel isolated by their experiences. She discusses her work in this interview.
Malingering
Malingering is a medical and psychological term that refers to an individual fabricating or exaggerating the symptoms of mental or physical disorders for a variety of motives, including getting financial compensation (often tied to fraud), avoiding work, obtaining drugs, getting lighter criminal sentences, trying to get out of going to school, or simply to attract attention or sympathy.
At the present time, there are no clear methodologies that allow researchers and clinicians to fulfill the guideline of the DSM IV and rule out malingering. The shame of this is that malingering in PTSD casts doubt on everyone who is actually suffering.
In this interview, we look at the impact of malingering and how to assess it.
Post-traumatic Growth
Bill O’Hanlon presents alternative perspectives on the development of trauma-related disorders, as well as powerful new methods for their successful resolution. His approach incorporates a treatment philosophy and methodology of hope for the future. Clients are left with a feeling of freedom and a sense of renewed possibilities, which are sometimes missing from more traditional approaches.
Resilience
Dr. Froma Walsh has developed core principles and values for a family and community resilience-oriented approach to recovery from traumatic loss when catastrophic events occur. In contrast to individually based, symptom-focused approaches to trauma recovery, this multi-systemic practice approach contextualizes the distress in the traumatic experience and taps strengths and resources in relational networks to foster healing and post-traumatic growth.
The Body Remembers
The goal of Babette Rothschild is “to inspire psychotherapists working with traumatized individuals to learn as much as possible about theory, tools and treatment so that they can be well-equipped in working with the unpredictability of trauma and the diverse needs of clients.” In her books and in this interview, she encourages therapists to learn to trust and use their own common sense, often in lieu of what they have been taught. She states, “When therapy methods are applied uniformly like a recipe, their potential for harm increases, no matter how good they are.”
The Brain, Trauma, and Medication
PTSD is characterized by symptoms that reflect some form of persistent re-experiencing of the original traumatic event. Research has repeatedly shown many individuals with PTSD produce significantly larger psychophysiologic responses upon exposure to trauma-related cues compared to individuals without the disorder. Moreover, trauma has been found to make the brain’s emotional processing centers (particularly the amygdalae) more sensitive in cases of PTSD.
In this interview, a practicing psychiatrist discusses the uses neurological findings and medication to treat adults and children with PTSD.
The Culture of PTSD
The understanding and treatment of post-traumatic stress has changed over the years, especially between the two World Wars, the Vietnam conflict, and the war in Iraq and Afghanistan. Dr. Herbert reviews and explains these views.
This program is a joint project with the Chicago Institute for Psychoanalysis, in celebration of 100 years of psychoanalytic thought. Our goal is to share some of the many new ideas which have revolutionized psychoanalysis and made it more relevant for modern psychotherapy than ever. Many clinical examples are presented, and a refresher course on traditional Freudian theory is included.
A Freud Refresher mini-course
Well review the basic core ideas of psychoanalytic theory developed by Freud in order to have a basis for contrast with the interviews in this program.
An Object Relations View of the Mind
Author of Freud and Beyond, Stephen Mitchell, PhD, shares his clinical experiences of using object relations to help bring about profound changes in the world view of the patient.
Freud and Women
We'll learn about Freud's thoughts regarding women and the current views of the psychoanalytic community. Masculinity is no longer the baseline against which femaleness is contrasted.
Homosexuality
Dr. Isay, author of Being Gay, who argues sexual orientation is fundamentally constitutional and not subject to change. His ideas and activism were responsible for moving the traditional goals of the psychiatric establishment with regard to homosexuals away from its longstanding aim of using psychotherapy to turn them into heterosexuals.
Impasses
Dr. Mark, Gehrie, author of Impasse and Innovation in Psychoanalysis: Clinical Case Seminars, explains how these new views can be helpful in times of impasse (or being stuck) in a difficult period with a patient.
Intersubjectivity
According to Dr. Robert Stolorow, author of The Intersubjective Perspective, therapy is a system in which everything about the therapist and the patient combine and interact, as both parties attempt to make sense of and heal the patient's suffering together. In this conversation, we'll gain a basic understanding of intersubjectivity.
Learning in Psychotherapy
Dr. Levin, author of Mapping the Mind: the Intersection of Psychoanalysis and Neuroscience, discusses how learning takes place in psychotherapy and therapists can help bring about change in the patient.
Self Psychology
Author of "The Problem of Perversion: A View from Self-Psychology", Dr. Arnold Goldberg gives us a basic understanding of self psychology and its importance in today's clinical practice.
Violent Children
We'll learn how these new principles apply in the streets and habitats of violent children.
Dr. Robert Galatzer-Levy has been a favorite interviewee of On Good Authority due to his clarity of thought, knowledge, and presentation. We’ve gathered four of his interviews for this special collection.
Custody Evaluation
No one suffers more or has more to lose from a divorce than the children involved. Awarding custody is a crucial issue in helping to minimize the potential damage to these young people. Psychotherapists are increasingly being called upon to render opinions in custody controversies. Dr. Galatzer-Levy provides a clear and sensible approach to doing ethical and professional custody evaluations.
Legal Issues in the Treatment of Domestic Violence
Dr. Galatzer-Levy presents the first steps for a clinician to take in working with a battered woman and explains why many clinicians fail in their treatment of women experiencing domestic violence. Attorney Murphy explains the legal issues involved and how the therapist and attorney can work together on behalf of the victim.
The Assessment of Violent Adolescents
What should we do when presented with a case of a potentially violent child? Certainly we shouldn't assume their behavior and fantasies are understandable and not of concern (as one of the Columbine counselors is reputed to have done). We turn to Dr. Robert Galatzer-Levy, a psychiatrist and psychoanalyst of children, adolescents and adults, for clear and direct advice on what to do and not to do in assessing for violence.
The Meaning of Money
Talking about money with our clients or patients is difficult and often avoided. This can lead to misdiagnosis, premature termination, unresolved transference and countertransference, inconsistencies in payment practices, and undue anxiety. In this interview, Dr. Galatzer-Levy discusses the psychological meaning of money in the therapeutic relationship.
Suffering is not restricted by age, nor prohibited to the young. In his book, "Man’s Search for Meaning," Victor Frankel says we must make larger sense out of our suffering. To survive is to find meaning in the suffering. Each person must find out for himself the purpose of his suffering. No one else can fix it.
No stranger to suffering, Robert A. Neimeyer, Ph.D. knows about the trauma of loss and its aftermath from the inside out. In his compassionate work about coping with loss, he makes a strong case that traditional theories of grief are too superficial and simplistic. He has developed a fresh theory of grieving as a meaning-reconstruction process, which he discusses in the first of two interviews in this collection.
A Narrative-Constructivist Approach
Dr. Neimeyer presents his conceptualization of grief and loss from a narrative-constructivist point of view. He suggests the problem with using stage theories of grief is they simplistically distort the human experience of grieving.
Bereavement in Early Childhood
D.W. Winnicott said healthy children are better at dealing with death than healthy adults. Every child has a different coping mechanism for dealing with the news that a parent had died, and the most important thing is for the child to know her remaining parent is available. After the initial shock is over, the surviving parent or guardian must ensure the child’s life remains stable. Plus, children need adults to help them navigate through the chaos of death, the many questions, the magical thinking, and all the intense feelings of grief and loss.
The second interview references the award winning movie Ponette, the fictional story of a 4-year-old girl, whose mother is killed in an accident. There is no greater loss for a child than the loss of her mother. It’s a loss that is truly forever, and a child’s sense of being safe in the world is shattered. Even at Ponette’s young age, she must make meaning for herself and find a way to go on living. As painful as it is for any of us to accept such a tragedy, imagine the difficulty of coming to terms with this when you don’t yet comprehend the whole concept of death in all its finality.
Robert Neimeyer, PhD and Froma Walsh, PhD, a grief and loss expert, share their thoughts on how to best help young children deal with bereavement.
Parent Loss in Adolescence
Dr. Neimeyer presents his conceptualization of grief and loss from a narrative-constructivist point of view. He suggests the problem with using "stage" theories of grief is they distort the human experience of grieving.
More than two million people in the United States have a diagnosis of schizophrenia. For the last half century until even now, the treatment for most has consisted mainly of strong doses of antipsychotic drugs that blunt hallucinations and delusions but come with significant and unpleasant side effects. Now, there has been remarkable research leading to what will be a revolution in understanding and treating this debilitating mental illness.
In this program we interview first, a neuropsychologist who reports on new neurodevelopmental models of etiology, showing that many risk factors can give rise to schizophrenia and to the psychosis-spectrum disorders. Next, moving to treatment, we speak with the program director of one of the clinical sites which was used to study how psychosis might be treated in its early stage. Following that we interview a psychiatrist who applies self-psychology in his very close and connected treatment of early episode patients. Finally, we hear from the mother of a schizophrenic child who tells us very directly what the families of these patients need -- and don't receive.
Connecting with the Schizophrenic Patient
Regardless the level or type of medication used, the demands of working with psychotic/schizophrenic patients are enormous. In this interview, Dr. Garfield reminds us of the importance of listening, from the very first minutes of the very first sessions, to our schizophrenic patients with empathy, reminding us to see our patients as whole persons.
Early Intervention in First Episode Schizophrenia Makes the Difference
Tia Dole, Ph.D. is program director of the OnTrackNY site at the Mental Health Association of Westchester, New York, which runs a program that seeks input from psychosis patients about their treatment. This program is one of a number of new first-break programs which includes people struggling with a first psychotic break from reality, most of them in their late teens and 20s as equals in decisions about care, including drug dosage. In addition to drugs and some psychotherapy, these new programs offer other forms of support, such as help with jobs and school, as well as family counseling.
In a landmark study published in fall, 2015, government-backed researchers reported that after two years, people who had this combined package were doing better on a variety of measures than those who received treatment as usual.
Life with a Schizophrenia Child
When schizophrenia appears in early childhood, not only does the family struggle to cope, but also the family must grieve the loss of hope of normalcy at every stage in the child's life.
Here to tell us in brutal frankness about what life with a schizophrenic child is like is Karen Mellow, a retired administrative law judge and parent of a schizophrenic child, who has advocated for and spoken frequently on behalf of the families of schizophrenic children.
Neurodevelopment and the Etiology of Schizophrenia
Dr. Elaine Walker. a neuropsychologist reports on new neurodevelopmental models of etiology of Schizophrenia. While there is variability among contemporary models with respect to the behavioral and biological factors they emphasize, Dr. Walker states that most share in common the assumption that congenital vulnerabilities, normal developmental processes, and environmental factors interact in the etiological process. In other words, many risk factors can give rise to schizophrenia and to the psychosis-spectrum disorders.
If you've ever been sexually harassed by a co-worker or boss, and wanted to know what to do about it, and if you've ever wondered what was going on in their heads, you'll find answers here.
This program covers the legal definitions of sexual harassment, how to manage these situation, and the psychological make-up of the harasser.
Sexual Harassment Prevention Training (Illinois)
This program covers the legal definitions of sexual harassment, how to manage these situation, and the psychological make-up of the harasser.
Two skilled psychotherapists discuss their work with patients using Skype Therapy, including logistics, diagnostic considerations, the use of EMDR, and the importance of attachment styles.
Introduction to Skype Therapy
The magazine, Scientific American Mind, listed as fast facts about distance therapy, that research
demonstrates that psychotherapy delivered via e-mail, video, chat, voice or texting can
effectively treat cognitive, emotional and behavioral disorders, and that even brief therapeutic
communiques using mobile phones can help combat eating disorders, alcohol abuse, cigarette
smoking and anxiety.
Although numerous studies show that video-based therapy can be as effective as in-person therapy, needless to say, there are many complex clinical issues to consider, as well as legal and ethical issues.
In this program, first, Dr. Stephan Tobin will explain to us how he uses Skype Therapy.
Long-Term Therapy using Skype
Can therapy, especially long-term psychotherapy, really be effective over a computer screen?
And over a distance of many miles? According to a clinical psychologist quoted in Scientific American Mind, “the important thing is that you’re practicing competently, no matter how you’re delivering the therapy.”
Still, there are some issues and problems. Most providers of Skype Therapy seen to agree that it works best when the initial contact is face-to face, as is the case in the therapy Kevin McMahon will present in this interview.
There’s little more terrifying to a therapist then the thought of patient suicide. The alarming reality is any therapist involved in direct patient care is likely to have this experience. For psychologists, the chance of losing a patient to suicide is greater than 1 in 5. For the average psychiatrist, the odds are greater than 50/50. While death by suicide is as old as mankind, the study of suicide prevention is a fairly recent phenomenon. Our speakers in this program are in the forefront of studying the two age groups at highest risk, adolescents and the elderly. Additionally, we tackle the topic of manipulative suicide threats. How do we know when the patient is serious? We’ll learn about suicide, its causes, its risk factors, and prevention.
Adolescent Suicide
Any therapist involved in direct patient care has a 1 in 5 chance of losing a patient to suicide during the course of his or her professional career. Psychotherapists who study suicidal behavior in young people have uncovered many clues that can help mental health professionals take appropriate action to prevent a suicide. Dr. Ostrander discusses how to assess and prevent suicide in adolescents.
Elderly Suicide
In this interview, we look at current knowledge about suicidal behavior in the elderly and translate this knowledge nto practical treatment considerations.
Manipulative Suicide Threats
Suicide and death pose significant challenges for loved ones and survivors. Assessing suicide talk is one of the most anxiety-ridden tasks of psychotherapy because we can't afford to be wrong. Plus, the bereaved's intense grief can be overwhelming to their loved ones and even the therapist.
Suicide is America's hidden epidemic leaving loved ones bereft and traumatized. Dr. Robert Neimeyer shares his insights into how we can work with the families and friends of suicide victims and help them through this traumatic event, even decades later.
Suicide and its Impact on Survivors
In this interview, Dr. Robert Neimeyer shares his insights into how we can work with the families and friends of suicide victims and help them through this traumatic event, even decades later.
Suicide is the 11th leading cause of death in the United States and the third leading cause of death for young people aged 15-24. A psychologist involved in direct patient care has greater than a one in five chance of losing a patient to suicide during his or her professional career. For the average psychiatrist, the odds are greater than 50/50. Additionally, approximately 33% of social workers have experienced a client suicide.
This program aims to understand the “tipping point,” the suicidal person’s critical decision to take the final step. We dispel the myths of blissful childhood and look at the person’s mindset. We cover how to respond to those at risk (using the suicide continuum and understandings from self psychology), how to understand and listen to the most horrible and frightening thoughts, how to engage the suicidal person through deep connections, and how practical help can restore hope to the terminally ill patient.
Battling Bullying to Prevent Suicide
Dr. Mark Smaller has developed a very successful anti-bullying program in an alternative high school, using psychoanalytic ideas to work with the traumatic helplessness bullied people experience. The concept of “the forward edge,” is particularly important because it uses children’s hopes and aspirations to help them move ahead.
Interview #3: Sherry Bryant, LCSW, LMFT, CADC “Surviving the Suicide of a Patient and Understanding the Suicide Continuum”
Sherry Bryant, whose son committed suicide, has developed a suicide continuum and detailed interventions that can be used session by session to move an at-risk person further toward affirming life.
Connecting with Combat Veteran
All combat veterans are changed by their experience, and it has become harder and harder for soldier and civilian therapists to connect. Their lives are incomprehensible to each other. Dr. Bragin explains why this is so. Soldiers are not “the other,” but their experiences echo our deepest, most buried emotions of anger and aggression.
School-Based Suicide Prevention with African American Youth in an Urban Setting
Dr. Goldstein-Grumet surveyed 800 schoolchildren in Washington DC about their thoughts regarding suicide. Her findings revealed 45% of these students have suicidal ideation. In this interview, she explains the meaning of this.
Suicidal Ideation at End of Life
The desire for hastened death in terminally ill patients is a controversial topic, posing numerous challenges for the palliative care team. Dr. Ann Goelitz discusses how this desire may be influenced by factors controlled by the palliative care team.
Suicide Prevention for Veterans
It’s no secret soldiers often return from war with lasting psychological damage, and suicides are occurring at record levels. The Veterans’ Administration has learned homecoming from deployment is critical, and they’re working hard to educate returning soldiers and their families on how to rebuild connections. Tousha West, a suicide prevention coordinator for the Atlanta VA, describes the VA’s work for returning veterans.
Surviving the Suicide of a Patient and Understanding the Suicide Continuum
Sherry Bryant, whose son committed suicide, has developed a suicide continuum and detailed interventions that can be used session by session to move an at-risk person further toward affirming life.
Survivors of Suicide
Few events in life are more devastating than the loss of a loved one to suicide. Joseph McBride explores and discusses the complicated grieving process of those dealing with these tragic situations.
Clinical supervision, while appearing on the surface to be similar to psychotherapy, is a different relationship and set of skills, with unique qualities and characteristics that set it apart. In this program on supervision, we’ll hear about five different aspects of supervision.
Professionals often advance to supervisory roles with little or no formal training in ways to conceptualize the supervisory process or transmit knowledge. Now, it’s no longer enough for clinicians to say, “I’m an experienced and competent therapist (counselor, psychologist or psychiatrist), so therefore, I can be a competent supervisor.” The making of a psychotherapist is as complex as making a supervisor, involving education, a craving for understanding, self-esteem, and imagination. It also requires the capability to move from an understanding of psychotherapy to transmitting that understanding to others.
Deepening the Supervisory Experience
Dr. Wendy Haskell elaborates on the relational model of supervision, discussing the “positioning” of the supervisor, how the supervisor decides what to focus on, and how the diversity of supervisors and supervisees (e.g., culture, character, and gender, etc.) all impact and deepen the learning process.
Dimensions of Supervision
Russell Haber, PhD discusses the dimensions of supervision from a systemic point of view, including how the intellect, skills, emotions, and intuition all play a crucial role in the supervisor, supervisee, and client system.
Focal Conflict Analysis
Jerrold Brandell, PhD presents Focal Process Analysis, an example of the “classical” model of supervision and a method for beginning therapists learn to listen carefully to the clinical process of their patients.
Online Supervision
Dr. Allen Siegel began email supervision with a psychiatrist in Germany, who wished to learn about self psychology. In the first part of this interview, he describes how they developed a method where the psychiatrist submitted process recordings of her therapy sessions through email, and Dr. Siegel responded to her with didactic and clinical supervision. We interviewed him again for a follow up on how his work has been going. In addition to his work with the German psychiatrist, he describes his work with a group of psychiatrists in Turkey. This program includes samples of the email correspondence between him and his German supervisee, containing very detailed case process recordings from the supervisee and Dr. Siegel's remarks on those interviews.
Supervisory Ethics
Dr. Carlton Munson, author of Clinical Social Work Supervision, Third Edition, discusses the ways in which supervision presents the supervisor with a complex balancing act between the rights and welfare of the clients, ethical codes of the various disciplines, policies and procedures of the organization or agency, and of course, the supervisee’s learning. Ultimately, the supervisor is the “gatekeeper of the profession,” responsible for cultivating effective professionals.
The Supervisory Relationship
Drs. Mary Gail Frawley O’Dea and Joan Sarnat, co-authors of The Supervisory Relationship: A Contemporary Psychodynamic Approach, present “relational supervision,” a contemporary model of supervision based upon mutuality between supervisor and supervisee. Psychodynamic therapists have begun to view the relational processes between patient and therapist as a central source of transformation. Similarly, working within the changes of the supervisory relationship can allow the supervisee to gain a deeper understanding of the treatment method being taught. This makes the process of supervision more parallel to the therapeutic work.
This is the second of two interviews on how understanding neuroscience can help us with patients having attachment issues as well as how attachment plays out in the transference/countertransference.
The Neuroscience of Attachment
This is the second of two interviews on how understanding neuroscience can help us with patients having attachment issues as well as how attachment plays out in the transference/countertransference.
Our brains have one main job: to keep us safe. Trauma can alter the structure and function of the brain.
When a person experiences something traumatic, the brain shuts down all nonessential systems, signals the release of stress hormones, and moves you into survival mode: flight, fight, freeze, or fawn. When the threat has passed, your brain resumes normal functioning so you can rest and digest what has happened. However, for some, this switch back does not occur and in essence, the brain stays in survival mode all the time, unable to relax, so the person can’t tell the difference between a threat then and now. The person remains in a constant state of hypervigilance or strong emotional reactivity.
In this interview, Dr. Montgomery explains how the brain functions during this process.
The Neuroscience of Trauma and Shame
In this interview, Dr. Montgomery explains how the brain functions when traumatized.
The therapeutic relationship is the heart of therapeutic practice. Decades of research indicate that the provision of therapy is an interpersonal process in which the main curative component is the nature of the therapeutic relationship. In this program, we look at many aspects of the constantly evolving therapeutic relationship, taking into account important new knowledge gained from neuroscience, infant research, theory about attachment, and the seismic changes in our culture which affect all aspects of our world view.
The therapeutic treatment process has significantly opened up. It used to be a stiff, one-person, “blank screen” model, where the therapist was the all-knowing and powerful “expert.” Now, psychotherapy is viewed in virtually all the varieties of “talk therapy” as a collaborative process.
Attachment-Oriented Psychotherapy
Perhaps the most significant development in contemporary psychoanalytic thought has been attachment theory. In this interview, Dr. David Wallin translates attachment theory and research into a framework that integrates key attachment principles with psychopathology, neuroscience, relational and intersubjective psychotherapeutic approaches, mentalization, and mindfulness.
Crying in Psychotherapy
The default reason for crying is separation. The same biological and psychobiological behavior that occurs in infants to bring about reunion with the caregiver also occurs at the death of a close loved one. Judith Nelson, PhD has translated this into an understanding of crying in psychotherapy.
Cultural Complexities
Diverse cultural influences have required contemporary therapists to modify their world views. To work effectively with people of diverse identities, we must learn to deal with difference and conflict in ways that empower and show respect for one another. Dr. Pamela Hays presents a paradigm for identifying one’s own biases.
Psychotherapy and the Economy, Part 1
Frank Summers, PhD shares his observations on the economy’s impact on his practice. He also discusses the dilemmas this situation raises, explaining the factors involved in modifying one’s stance on fees.
Psychotherapy and the Economy, Part 2
Karla Clark, PhD discusses the dilemmas involved in making a decision to reduce a patient’s fee. She also stresses why the therapeutic frame can be vital to keeping one’s clarity and perspective on this subject and why the therapeutic relationship cannot be a sale item.
Self Disclosure-a New Paradigm
Dr. Richard Geist is interested in the clinical possibilities offered by the concept of connectedness. Therapists can use connection as a central organizing principle in the way we listen, interpret, make interventions, and experience our patients. Connectedness is bidirectional. With bidirectionality, therapists experience and empathizes with the patient, while the patient also experiences and empathizes with the therapist. This has opened up the subject of self-disclosure. In this new paradigm, the therapist’s “deliberate” self-disclosure often enhances our therapeutic effectiveness.
Self Psychology and Neuroscience”
Infant research and neuroscience add additional ways to understand and interact with patients in the clinical encounter, as well as specificity and nuance to basic self-psychological concepts. Findings from infant research delineate the nature of attunement in early mother-infant and therapist-patient interactions, while neuroscientific research reveals how early mother-infant experiences are encoded in implicit memory and profoundly impact affects and feelings. To Judith Rustin, LCSW, the concept of “implicit memory,” defined as unspoken aspects of communication and interaction formed in infancy and early childhood, is a major contributor to therapeutic action and a powerful tool. It enables the therapist to “know” the patient more fully.
Super Shrinks
To begin our program, we’ll take a look at what makes one therapist “better” than another. Some therapists can be better, as indicated by their higher scores on all sorts of performance measures. In our first interview, Dr. Scott MIller shows us we can (and must) measure and evaluate our work.
Termination
As a result of her research, Dr. Denise Davis has been able to identify five types of terminations. In this interview, she discusses how clinicians can end therapy responsibly, even when conditions are challenging. She discusses how to handle pitfalls in the process and presents a number of essential steps for negotiating a clinically and ethically sound termination.
The First Session, as Seen in ‘In Treatment
The true core of all psychotherapy is always the intimate relationship that forms between therapist and patient, containing emotion and drama. The first session in any therapy present a unique opportunity, which has been recognized by experts for decades and even referred to as having “a sacred nature.” Everything the therapist says and does in this first session conveys his or her concern, competence, and interest in helping the patient, and it evokes intense feelings in both patient and therapist. Dr. Arthur Nielsen discusses the HBO program, “In Treatment,” and first sessions.
Therapists using zoom and other forms of teletherapy are experiencing feelings of exhaustion. None of us expected we would be spending our time as therapists sitting at our computers or tablets or phones all day long. Certainly none of us could have expected we would not be able to work with our clients in-person – how much we would learn from the simple experience of being in the same room as our clients, and how much we would miss that.
In this interview, Dr. Allen Siegel reflects on what he has learned in this therapeutic process and why.
The Childrens Issues
Today’s adolescents are experiencing more diverse and difficult societal challenges on top of their developmental stresses. The main developmental task of adolescence – the establishing of one’s identity – presents some real mine fields for therapists. First of all, adolescents don’t want an adult to judge their behavior or give them advice. Second, adolescents can’t stand regression or anything that even suggests it. This situation places special importance on the therapeutic relationship. All of our speakers address this issue, whether in the context of psychodynamic, solution-focused, family, or cognitive/behavioral treatment.
Adolescent Psychology and Development
Dr. Bloch explains his model of conceptualizing acting-out behaviors in adolescence, developmental difficulties, predictors of an adolescent's ability to use peer relationships to facilitate emancipation, and the unique challenges faced by adolescents today.
Adolescents in Managed Care
Dr. Alexander has developed a model for work with acting-out adolescents within a managed care environment. He discusses the goals of the first session, the motivation phase of treatment, positive predictors of outcome, and the biggest obstacles in overcoming delinquent conduct.
Angry Adolescents
Dr. Masi describes his model of therapy for treating aggressive adolescent clients, the primary tasks of this model, the important interactions which take place, and how to make connections with the adolescent.
Cognitive Treatment with Depressed Adolescents
Dr. Wexler discusses his "freeze frame" technique in working with adolescents and how this strategy can be used to short circuit the behavioral pattern when the trigger is encountered. He also addresses the comments of his critics.
Early Adolescence in Girls
Dr. Lloyd Mayer discusses differences in male and female development in early adolescence, how the interaction of social learning and biology produces salient differences, why adolescent girls experience pressure from parents, and how the gender of the therapist affects the treatment of an adolescent female.
Parent Loss in Adolescence
Colin Webber, who has worked with parent loss for many years, describes the coping styles of children who have lost a parent, the difference between adjustment and internal processing, the challenges faced by adolescents dealing with the death of a parent due to their stage of development, and the defense mechanisms most likely to be used by a bereaved adolescent to protect against narcissistic injury.
Dr. Amy Groessl shares her research and insights into how mental health clinicians and professionals working in adoption-related fields can develop a better understanding of how Fetal Alcohol Spectrum Disorders may impact a child and their family.
ADOPTION, PART 1: FETAL ALCOHOL SPECTRUM DISORDERS
Dr. Amy Groessl shares her research and insights into how mental health clinicians and professionals working in adoption-related fields can develop a better understanding of how Fetal Alcohol Spectrum Disorders may impact a child and their family.
Technological developments in genealogical internet searching and in the sequencing of DNA and its genealogical meaning has made it much easier for adoptees to locate their biological families than ever before.
But there are some risks and implications. What if the search leads to rejection? To disappointment? And what could be the impact on the relationship of the adoptees to their adoptive families?
Listen and learn.
ADOPTION PART 2 When Adoptees Find Their Biological Parents
Techological developments in genealogical internet searching and in the sequencing of the DNA and its genealogical meaning has made it much easier for adoptees to locate their biological families than ever before.
But there are some risks and implications. What if the search leads to rejection? To disappointment? And what could be the impact on the relationship of the adoptees to their adoptive families?
Listen and learn.
Alternative to the Adult/Child Movement
Our speaker, Geoff Magnus, takes a positive approach to his work with latency and teen-aged Aspies. He has found that because of an early lack of social information, the kids can very easily get overstimulated and overexcited. Because facial information is not particularly meaningful to them, they have trouble coordinating that with what’s going on in their lives, and recognizing the feelings of others. But even so, to kids with Aspergers, relationships are very important. They are highly motivated to interact with each other and actually that’s the basis of his group treatment. By putting the kids in a group together with very little intervention, they have amazing results.
Asperger's Syndrome: Group Treatment.
Our speaker, Geoff Magnus, takes a positive approach to his work with latency and teen-aged “Aspies.” He has found that because of an early lack of social information, the kids can very easily get overstimulated and overexcited. Because facial information is not particularly meaningful to them, they have trouble coordinating that with what’s going on in their lives, and recognizing the feelings of others. But even so, to kids with Asperger’s, relationships are very important. They are highly motivated to interact with each other and actually that’s the basis of his group treatment. By putting the kids in a group together with very little intervention, they have amazing results.
Recent advances in clinical research have made it possible to diagnose Autism Spectrum Disorders as early as the second year of life. These assessments often take place in school settings, made possible by the Individuals with Disabilities Education Act.
In this interview, Mrs. Paula Leifer, long-time school social worker and consultant discusses this assessment process.
ASSESSMENT OF AUTISM SPECTRUM DISORDER in EARLY CHILDHOOD
Recent advances in clinical research have made it possible to diagnose Autism Spectrum Disorders as early as the second year of life. These assessments often take place in school settings, made possible by the Individuals with Disabilities Education Act.
In this interview, Mrs. Paula Leifer, long-time school social worker and consultant discusses this assessment process.
Suffering is not restricted by age nor prohibited to the young.
In Victor Frankel’s book, "Man’s Search for Meaning," he says that we must make larger sense out of our suffering. To survive is to find meaning in the suffering. Each person must find out for himself the purpose of his suffering. No one can fix it for anyone else. With this preface, we turn to the award winning film, “Ponette,” the fictional story of a 4-year-old girl, whose mother is killed in an accident. Even at this young age, Ponette must make meaning for herself and find a way to go on living. As painful as it is for any of us to accept such a tragedy, imagine the difficulty of coming to terms with this when you don’t yet comprehend the concept of death in all its finality.
The Making of Ponette
There is no greater loss for a child than the loss of her mother. It's a loss that is truly forever. A child's sense of being safe in the world is shattered. Jacques Doillon captures the process involved in this marvelous film. We'll hear in his words how he did this. In this remarkable interview, Mr. Doillon he tells us about his research and how he prepared the script by really listening to children. We'll hear how he worked with the little actors and thoughtfully protected them throughout the filming. Since Doillon's directorial debut in 1972, he has carved out a niche with his intelligent films. In this film, he offers a new variation on a theme familiar from his previous work: the innocence of children contrasted with the reality of adult experience. Amid the pressure of adult reality, Doillon seems to be saying, "Don't give up on your desires."
Treating the Grieving Child
D.W. Winnicott said healthy children are better at dealing with death than healthy adults. Every child has a different coping mechanism for dealing with the news that a parent had died, and the most important thing is for the child to know her remaining parent is available. After the initial shock is over, the surviving parent or guardian must ensure the child's life remains stable. Plus, children need adults to help them navigate through the chaos of death, the many questions, the magical thinking, and all the intense feelings of grief and loss. The second interview references the award winning movie Ponette, the fictional story of a 4-year-old girl, whose mother is killed in an accident. There is no greater loss for a child than the loss of her mother. It's a loss that is truly forever, and a child's sense of being safe in the world is shattered. Even at Ponette's young age, she must make meaning for herself and find a way to go on living. As painful as it is for any of us to accept such a tragedy, imagine the difficulty of coming to terms with this when you don't yet comprehend the whole concept of death in all its finality.
Understanding Children's Art
For many children, drawings are the only means of communicating the unspeakable. As we just heard, Jacques Doillon prepared for his film by asking children to draw pictures of their idea of death and then to explain these drawings. We provide a few of these drawings, and Cathy Malchiodi, an expert in children's art, discusses using children's art in our work with them.
Recent figures show 513,000 children were in foster care in the United States, and as many as 5.4 million children live with their grandparents. In this program, we explore the issues of foster care and parental alternatives from a number of viewpoints, with a special emphasis on understanding attachment theory and trauma, which are both the backdrops and main features in work with this population.
Attachment Issues in Children in Foster Care
Dr. Webb discusses the ramifications of grief and loss in children in foster care and offers specific play therapy methods for assessing the attachment levels of these children.
Grandparents Raising Grandchildren
When grandparents take responsibility for their grandchildren, three relationship processes simultaneously occur: attachment disruptions, revised attachment relationships, and challenged internal working models of attachment. Dr. Poehlmann discusses this phenomenon through her research of children living with grandparents due to the incarceration of their mothers.
Overview to Attachment Theory
Dr. Stott discusses attachment theory and the attachment issues experienced by high-risk children in foster care. Attachment theory posits children instinctively attach to caretakers in order to achieve security and survival.
Psychotherapy with Psychologically Traumatized Children
Dr. Monahon takes us through several years of psychotherapy with a preschool girl, who was severely abused as a toddler by her parents and then moved from multiple foster homes until finding adoptive parents. Using drawings and doll play, Dr. Monahon tenderly helped the adoptive mother weather the turbulence in her relationship with this little girl.
Rebuilding Family Ties
Most children do not remain in foster care forever. To aid these high-risk, fragile situations, Dr. Kagan has developed tools practitioners can use to provide a coordinated effort to rebuild family ties and change cycles of crisis.
Sexual Abuse and Foster Care
Current statistics show as many as 75% of children in foster care have been sexually abused. Of these children who receive psychotherapy, treatment is a rocky road. Recognizing these challenges and the need of these children for long-term therapy, Dr. Heineman established A Home Within, the only national organization focused on the emotional well-being of foster youth. Therapists in this program treat these children for as long as they need at no charge. In this interview, Dr. Heineman discusses psychotherapy with children living in foster care who have suffered sexual abuse.
Real changes in politics, laws, and consciousness toward gay people have raised the possibility that sexual orientation is or will soon be pretty irrelevant. According to our first speaker, Dr. Ritch Savin-Williams, in his book, "The New Gay Teenager," the vast majority of same sex-attracted teens, simultaneously highlight their commonalities while challenging stereotypes. The culture of contemporary teenagers easily incorporates its homoerotic members: “It’s more than being gay-friendly. It’s being gay-blind.” The “new gay” or “post gay” students believe that the only way to lift the stigma of homosexuality is to be matter-of-fact about it.
Moreover, the gay-straight divide is becoming blurred. What’s becoming clear is that there is a highly variable continuum of sexual orientation, depending on the individual, ranging from exclusive attraction to the other sex to exclusive attraction to the same sex. Pretty obvious, really, and Dr. Savin-Williams has created a “Differential Developmental Trajectories Perspective,” to understand this.
How early does a child develop the awareness that he or she is drawn to others of the same sex? What goes into making a gay identity, especially at a young age when adolescent developmental issues are just beginning. How can parents understand that homosexual orientation is not a mental disorder and is not a matter of choice? In this interview, Dr. Robert Galatzer-Levy discusses his understanding and approach to working with these young children and their families.
Gay Boys: Coming Out in Middle School
Dr. Savin-Williams discusses the concepts of "Gay Blindness" and the "Differential Developmental Trajectory."
Gay Boys: Sexual Orientation and Psychotherapy
Dr. Galatzer-Levy discusses his work with young homosexual adolescents and their parents.
Beginning therapy with a small child can be confusing and intense. It requires that the therapist balance the regression necessary to engage the treatment process with maintaining a therapeutic stance. In this interview, Peter Shaft candidly describes how he was able to tolerate the experience of a young chaotic child with energy, humor and insight.
Play Therapy with Traumatized and Chaotic Children
Beginning therapy with a small child can be confusing and intense. It requires that the therapist balance the regression necessary to engage the treatment process with maintaining a therapeutic stance. In this interview, Peter Shaft candidly describes how he was able to tolerate the experience of a young chaotic child with energy, humor and insight.
The prevalence of violence in our schools is a national tragedy and embarrassment. Who can explain the Littleton, Colorado, shootings and other tragedies in which children have been murdered by other school children? Yet, as mental health professionals, people turn to us for answers.
In these interviews, we’ll hear national experts discuss the causes of violence in children, how to begin to deal with our “toxic” culture, how to manage engaging parents and assessing violence in children, how to work with families of murder victims and prevent compassion fatigue, and how to teach skills for dealing with aggressive, bullying children.
Assessment
What should we do when presented with a case of a potentially violent child? Certainly we shouldn't assume their behavior and fantasies are understandable and not of concern (as one of the Columbine counselors is reputed to have done). We turn to Dr. Robert Galatzer-Levy, a psychiatrist and psychoanalyst of children, adolescents and adults, for clear and direct advice on what to do and not to do in assessing for violence.
Bully-proofing
We conclude this program on school violence on a very hopeful note — a prevention program that really works.
Bullies once were considered an inevitable fact of school life. Today, experts are absorbing the revelation that bullying is more common and consequential than previously realized. Now, we know the victims can turn violent too.
A group of Denver psychologists and social workers have devised a bully-proofing system. They realized the only way to neutralize bullies is to lessen their opportunities. The best way to do that is to empower potential victims with behavioral strategies and back them up with a supportive school community. In the forefront of this movement is Dr. William Porter. Currently, he is working on developing a safe climate for children in school and communities through his authoring of “Bully-Proofing Your Schools,” a program which trains personnel and develops character in students. His efforts have received both local and national acclaim.
Children Who Kill
Dr. Garbarino, author of Lost Boys, discusses the reasons for the emergence of aggressive behavior in children. He discusses why our society is toxic and gives suggestions for making an adolescent intervention program effective.
Families of Homicide Victims
Learn how to work with families of murder victims and prevent compassion fatigue.
One of the biggest challenges for today’s clinicians is working with high-risk adolescents and their families, who come to therapy angry, frustrated, and demoralized. Our speaker, Matthew Selekman, emphasizes the need to tailor therapy to the needs and resources of each adolescent and family. He demonstrates this with a lengthy case example.
Working with High Risk Adoolescents
One of the biggest challenges for today’s clinicians is working with high-risk adolescents and their families, who come to therapy angry, frustrated, and demoralized. Our speaker, Matthew Selekman, emphasizes the need to tailor therapy to the needs and resources of each adolescent and family. He demonstrates this iwith a lengthy case example.
The Ethics Curriculum
The curious thing about boundaries is that the more you get into it, the less clear-cut it becomes. While there is certainly a need for careful maintenance of the most obvious boundaries (the real no-nos, like sexual relations with patients) and sanctions for those who violate, there are many situations, traditions, and practices in other forms of therapy where boundaries are murky. The speakers in this program address when these boundary crossings constitute negligence (justifying licensing sanctions and financial settlements) and when they are just plain good care.
Boundaries
Barbara Herlihy, PhD presents an overview and discusses boundaries in clinical practice.
Boundaries and Confidentiality
Dr. Ted Remley discusses confidentiality in clinical practice. He presents an alternative to the extreme positions of documenting everything in ultimate self-protection and revealing nothing in the interest of patient protection.
Boundaries and Custody Evaluations
Dr. Brandt Caudill discusses the problem of boundaries in custody evaluations. This is a major source of ethical complaints.
Cooperative Relationships with Managed Care
Kathleen Desgranges has been very successful in communication with managed care companies. In the first of these two interviews, Ms. Desgranges discusses how to establish positive working relationships with managed care companies. In the second interview, Ms. Desgranges discusses the most current, more relaxed trends of managed care.
Child abuse and neglect result in five deaths every day in the United States. Against the feudal backdrop of children as quasi-property, there is always a tension between the rights of a child and the rights of parents. All states have laws guiding child protection and child welfare interventions. These laws override confidentiality. In cases of abuse, therapists (as mandated reporters) must notify child welfare, which often triggers removal of the child from the family.
The sheer numbers of children in foster care show there are situations where the biological parent can never become an available or safe parent. However, children need permanence. They need stability and a sense of belonging to a family, so there are times when family ties are severed. This program covers the topics of mandated reporting, confidentiality with children, and severing family ties.
Children’s Confidentiality Rights
Ethical codes are not typically written with minor clients in mind, especially when these children are in foster care. Do our ethical standards of confidentiality change when we’re working with children? Dr. Frederic Reamer answers this question.
Implementation of Mandated Reporting
What actually happens to a child when a mandated reporter submits a report? How safe is that child? Kendall Marlowe, Director of Communications for the Illinois Department of Children and Family Services and a foster parent himself, discusses how mandated reporting gets implemented.
Mandated Reporting
Specific legal duties are imposed on mental health professionals regarding the reporting of suspected abuse and neglect of children. Helene Snyder discusses these requirements and explains how these laws override confidentiality, so one must report incidents of suspected child abuse to designated authorities. She also discusses recordkeeping.
Severing Family Ties
Forever severing a parent’s legal ties to his or her own child is a drastic move and one that is never taken lightly. Anita Weinberg discusses the ethical responsibility and allegiance of the therapist in freeing children for adoption.
In dealing with those who are chroncially and/or terminally ill, one's ethical decisions truly can have life and death consequences. But now, the complicated interactions between providers, patient, family, governmental regulations, practice parameters, and payers for this health care make it ever more difficult for a patient to make a decision. How can non-medical therapists help a patient understand the changing medical research, when we are torn between the desire for eternal life and the cost of achieving that, when we consider the increasing number of people with no access to health care, and when the money supply is limited and medical demand insatiable? And what if the patient cannot speak for himself or herself?
Further, when the patient is an adolescent, the complications increase. Who controls what the adolescent can know about his or her condition? Who makes the decisions?
The four speakers in this program will try to shed some light on these situations.
Decision Making
Ms. Manselle discusses decision making in serious medical situations, urging the mental health practitioner to be the patient advocate and lobby for full information. She defines guardianship and the standard for being decisional, explains advanced directives, and discusses the role of ageism as a deterrent to objective decision making.
Decision Making with Seriously ill Adolescents
Mr. Wolf discusses the rights of children to know their diagnosis and who legally has the right to tell the child. He explains how a therapist could intervene and help the child make decisions he or she is able to make.
Medical Errors
Ms. Escott explains why medical error training is important for non-medical health providers and discusses the most common errors that occur.
Understanding HIPPA
Here, we look at the baffling and worrisome topic of HIPAA. Should we be paranoid about it, or should we view it as good for our patients and, therefore, good for us? Sandra Nye, an attorney and social worker, explains why it's in everyone's best interest to comply with these regulations.
We live in a time of murky and very informal boundaries. Nowadays, personal and social boundaries have become so loose and blurry that it’s possible to transgress them without even realizing it. Privacy is a fundamental right and while the general public may be throwing away that right, it is the responsibility of all therapists to keep client information private. This is because the therapeutic/counseling relationship is predicated on respecting human dignity.
Psychotherapists and counselors today must make thoughtful decisions about whether and to what extent they will incorporate digital and other electronic technology into their professional lives. To practice ethically, therapists of all professional disciplines who use digital and other technology must develop privacy and confidentiality protocols. One of the speakers in this program states that the four biggest issues regarding confidentiality and ethics in these times are training, supervision, understanding technology, and being competent in an online environment to be able to handle these particular issues. .
We address these issues in this program.
Confidentiality and Risk Management
Privacy is a fundamental right and while the general public may be throwing away that right, it is the responsibility of all therapists to keep client information private. This is because the therapeutic/counseling relationship is predicated on respecting human dignity.
Whenever we conduct a therapy session—whether in person, on the phone, or in cyberspace—ethical rules are always implicitly present, insuring that whatever therapeutic space is being created is truly a safe haven in a world in which circles of emotional safety and protection are in exceedingly short supply.
In this interview, Allan Barsky discusses how therapists and counselors can maintain the privacy of their patients/clients in a time of murky boundaries.
HIPAA
The growth of electronic counseling and psychotherapy has taken place with relatively little regulation regarding the protection of patient confidentiality. And where there is a vacuum, in comes government, to wit, HIPAA, which regulates the transmission of information using electronic means.
Here to guide us through HIPAA rules and requirements is Laura Groshong, who will give us an overview on what we need to do to be compliant with these regulations.
Protecting Confidentiality in Online Counselling
Online therapy and counseling have become increasingly common over the past several years. Face to face or telephone forms of counselling are still the norm, recent times have witnessed an explosive growth in online mental health services, including email-based counselling, chat-based counselling, video-based counselling, and online self-help groups. Plus texting! These online services have been utilized both as a stand-alone method of treatment or as an adjunct to traditional counselling.
The area of risk we will be discussing in this interview concerns challenges for confidentiality and security of client information. Despite continual upgrades to technology, there are always breaches to technology where unauthorized individuals can intercept wireless signals and compromise what is thought to be secure information.
Mental health providers are so busy helping others that we often find ourselves flirting with trouble in terms of confidentiality and all that it includes. Do we understand just what “confidential communication” is? What is and is not the “Mental Health record?” Who gets to see the mental health record and who does not? What are “personal notes” and who can see them? What about HIPAA and what we absolutely must do in our electronic data? Are we using correct release of information forms? Listen and Learn!
Confidentiality: Back to Basics
Mental health providers are so busy helping others that we often find ourselves flirting with trouble in terms of confidentiality and all that it includes. Do we understand just what “confidential communication” is? What is and is not the “Mental Health record?” Who gets to see the mental health record and who does not? What are “personal notes” and who can see them? What about HIPAA and what we absolutely must do in our electronic data? Are we using correct release of information forms? Listen and Learn!
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Ethical Challenges and Personal Conundrums.
This program continues the conversation with Dr. Reamer in "New Ethical Standards in Use of Technology, and new Dangers! Here we cover conscience protections, life coaching, countertransference, personal questions, and more.
Thank you for your interest in this special combined program package. For detailed program descriptions, refer back to each individual program.
Ms. X Confesses
First, we hear from a mental health professional, who married her patient following a long series of boundary violations.
Imagine that in one year, you have lost everything in your life. Your marriage ends in divorce, your children leave the nest, you have declared bankruptcy, your work situation ends, your closest colleague rejects you, and a sibling and a parent die. However, you keep trying to work and hold on to some of the aspects of yourself which make you “you.”
Isn’t it possible that you could be vulnerable under stress like this and make some pretty big mistakes?
Overview to Sexual Misconduct
We’ll hear an overview about boundary violations, their causes, new findings in neurology, evolution’s role in boundaries, and how we can change a toxic work environment.
Psychodynamic Understandings
We’ll hear a psychodynamic explanation about the clinician’s experience when his “who-ness” (personal identity, needs, and vulnerabilities) interfere with his “what-ness” (professional role and the implicit trust).
Rehabilitation
There is a tendency to want to distance ourselves from the “bad apples” who have sexual contact with clients and to view them as the most marginal members of the profession. However, it goes against the history of our own profession to unilaterally separate those who have had romantic or sexual involvement with a client as uniquely dangerous, untreatable, and never worthy of return.
Risk Management Mania
In this interview, we’ll hear how the topic of boundary violations is being used and misused in lawsuits against therapists.
The Inner Workings of Ethics and Licensing
This interview comprises a panel discussion with a defense attorney who defends therapists before licensing board hearings, a former prosecuting attorney who brought these cases to the licensing board of his state, and a social worker who has chaired ethics hearings for his state professional association. They will share with us how these hearings proceed and what they think about during these hearings.
Thank you for your interest in this program. For a detailed program description, please look at the information for Ethics 9, MP3.
Children’s Confidentiality Rights
Ethical codes are not typically written with minor clients in mind, especially when these children are in foster care. Do our ethical standards of confidentiality change when we’re working with children? Dr. Frederic Reamer answers this question.
In this program, our speakers focus on the challenges facing us in a world where boundaries are loosened and technological developments allow for forms of therapy that are not always conducted face-to face. In addition, this program focuses on what it truly means to be an ethical therapist, not merely one who merely follows the codes or rules.
Ethics and Countertransference
We can know our ethical codes of our professions backwards and forwards, but when our personal feelings get involved, it’s awfully easy to find ways to rationalize and justify our actions. In this interview, we take a close look at countertransference, often at the root of ethical transgressions.
This program covers a variety of ethical issues, ranging from self-disclosure (which implicitly refers to boundaries) to personal/sexual relations with patients, ethical decision making, and what defines patient abandonment.
Ethical Reasoning
Ethical reasoning is a way of enabling us to discern for ourselves when we might be crossing the line. Kathleen Murphy, PhD, BCD discusses how to reason out clinical and ethical dilemmas using the client's best interest foremost.
Patient Abandonment
Must the therapist continue to provide treatment once managed care funding runs out? What is our duty to the patient, and what is our duty to ourselves? Dr. David Phillips explains “standard of care” and what the standard is in this situation.
Patient/Therapist Relations
Sandra Nye, JD, MSW discusses the legal repercussions of any personal involvement with patients and/or their families, as well as why we can never have sexual relationships with our patients.
Self-Disclosure
What should we know about self-disclosure? Are there clinical and ethical guidelines for the reality aspects of the therapeutic relationship? Dr. Stricker, author of many psychological texts, discusses his unique point of view on self-disclosure, its meaning to the patient and the therapeutic relationship, and how to decide whether or not to use it.
When it comes to ethics, fear is a great motivator. The quality, ethical practice of putting patients first is important to stop problems before they start. Our speakers take us through with consequences of unethical behavior and how not to be blinded by our own naivete, with a few words on how to handle tips and gifts.
(not available in Pennsylvania, which does not accept 1 credit programs)
Boundaries in Clinical Practice
Here is a mini-interview on the subject of Boundaries. Our speaker on ON GOOD AUTHORITY PLUS, #1 is Dr. Barbara Herlihy, and the topic is “Boundaries in Clinical Practice.”
The curious thing about the topic of boundaries is that the more one gets into it, the less clear cut it becomes. While there is certainly a need for careful maintenance of the most obvious boundaries–the real no-no’s like sexual relations with patients–and sanctions for those who violate, there are many situations and traditions and practices in other forms of therapy in which certain boundaries are murky.
There is a wide range of “boundary crossings” that are not violations and may be sensitive, sensible, and humane, and therefore justified and consistent with good care. For instance, the value of self disclosure is one arena around which theory is developing–and not only in individual therapy–group psychotherapists may–just as other members in the group–openly share their thoughts and feelings, respond to others authentically, and acknowledge or refute motives and feelings attributed to them.
Other forms of therapy may dictate that some boundaries be crossed, or disregard boundaries altogether. Some behavioral therapists, for instance, have little concern about socializing with patients outside of therapy sessions because they view their work as applying a set of technical procedures, and therefore not requiring special rules about relationships.
And of course there are the unavoidable boundary issues–you see your patients at the grocery store; or, you are the only marital counselor in an area and one of your patients is also the little league coach. The variety of situations is endless.
When is it negligence, justifying licensing sanctions and financial settlements, and when is good care? Listen in.
Gifts and Adjudication/Sanctions
In Ethics II, we presented speakers having radically different points of view of the topic of Confidentiality–one speaker admonishes us to document everything so as to protect ourselves from our patients, another says to document nothing in order to protect our patients from an ever more invasive and prying outside world.
Now we will hear a true alternative to both these positions–but I won’t give it away–you’ll just have to listen on.
The temptation to assign diagnostic labels to public figures is hard to resist, especially when the behavior of those public figures is particularly outlandish. But is it ethical to diagnose someone whom we have never met? On the other hand, is it immoral not to speak out, if we perceive that public figure as dangerous? These are not easy questions and frequent speaker Mark Smaller will address these issues.
Ethics: Diagnosing public figures from afar: Could we? Should we?
The temptation to assign diagnostic labels to public figures is hard to resist, especially when the behavior of those public figures is particularly outlandish. But is it ethical to diagnose someone whom we have never met? On the other hand, is it immoral not to speak out, if we perceive that public figure as dangerous? These are not easy questions and frequent speaker Mark Smaller will address these issues.
LEARNING OBJECTIVES
Review the implications of the Goldwater Rule
Understand when a professional can responsibly and ethically issue a mental health diagnosis.
Understand the limitations on professionals about making professional comments about public figures.
Be able to define “public opinion”
Learn about working with clients holding opposing political views.
The Ethics of diagnosing public figures from afar.
The temptation to assign diagnostic labels to public figures is hard to resist, especially when the behavior of those public figures is particularly outlandish. But is it ethical to diagnose someone whom we have never met? On the other hand, is it immoral not to speak out, if we perceive that public figure as dangerous? These are not easy questions and frequent speaker Mark Smaller will address these issues.
In this program, our speakers focus on the challenges facing us in a world where boundaries are loosened and technological developments allow for forms of therapy that are not always conducted face-to face. In addition, this program focuses on what it truly means to be an ethical therapist, not merely one who merely follows the codes or rules.
Ethics and Countertransference
We can know our ethical codes of our professions backwards and forwards, but when our personal feelings get involved, it’s awfully easy to find ways to rationalize and justify our actions. In this interview, we take a close look at countertransference, often at the root of ethical transgressions.
The Challenge and Dilemmas of Technology
The world of social media and texting has changed the art of communication beyond recognition. Move that into the world of psychotherapy and you have, “All-you-can-text therapy services,” where, for a flat fee, a client can chat about his or her woes to their heart’s content from the comfort of their own recliner, and you have a willing and licensed therapeutic listener.
Plus, ethical behavior does not exist in a vacuum and now we have a generation of therapists and clients who are unphased by all sorts of personal disclosures—we are conditioned to feel very natural about it. This is posing unprecendented challenges to our ethical codes and our deepest understanding of what is the true heart of ethical behavior.
The Ethics of Human Relating.
In his new book, The Psychoanalytic Vision, Dr Frank Summers contends that ethical transgressions constitute a sense of betrayal that is repressed or disavowed. The self of the therapist pays a price for this betrayal, although the cost might be hidden. Essentially, he writes that ethical behavior requires the recognition of the other person requiring the same empathic behavior as oneself. Conduct motivated by respect for others is part of achieving selfhood, which is why “it is good to be good.” He’ll explain this further in our interview.
The Internet and social networking offer new ethical and clinical challenges for those who provide face-to-face mental health services. As the line between public and private continues to blur in our culture, the tremendous availability of personal information online threatens to alter the sacred relationship between therapist and patient. Now, with the click of a mouse, tech-savvy therapists and patients are challenging the old rules and raising serious questions about how much each should know about the other and where boundaries should be drawn. In this program, four clinicians share their observations and experience.
A Social Media Policy for Clinicians
Social media and the Internet can be unpredictable. The complexities arising out of our personal and professional use of social networking and the Internet mean we should envision how this use might play out with our patients. We need to ask ourselves a series of “what if” questions. For example, what if you say on your Facebook page you need to have an operation, and you have not yet informed your patients? Is this how you want your patients to find out about this?
Ethical Standards for the Internet and Social Media
With more and more people “tweeting," “Facebooking,” and communicating in future, unimaginable ways, social networking and the Internet are here to stay and will continue to be alive. Thus, it’s important to have an ethical center in order to navigate through it in the best way. Here, we return to a frequent On Good Authority expert, Frederic Reamer.
My Patient wants to ‘Friend’ Me
What do you do when you receive an email informing you a patient wants to ‘friend’ you? It sounds innocent enough, but unless you adopt certain privacy options, you’re opening a door to all your contacts, friends, family, and personal information when you agree to “friend” someone. Is this what you want in your relationships with your patients? What if you decline the person’s request of “friendship?” How do you handle the feelings this may stir up in the patient? In this interview, Curt Kearney, MA, LCPC shares with us how he felt and how he handled it when a patient asked to be his Facebook friend.
Social Media Enhances Clinical Work
Lisa Johnson, PhD views social media as a tool for creating community, openly including current and former clients as “friends” on Facebook. She focuses her “status updates” on affirming life messages, hoping to create a community for individuals to read and share resources. Less rigid than some psychotherapists, she is readily self-disclosing and uses stories from her own life when it’s pertinent and seems useful in the therapeutic process. At the same time, she carefully adheres to the ethical guidelines from the American Association of Marriage and Family Therapy (AAMFT), which discourage dual relationships due to issues of power.
As bookkeeping requirements for payment increase and the current reimbursement system becomes ever more parsimonious, unfair and frequently cold-hearted ethical behavior becomes more complicated. Dueling interests can put our principles to the test, especially when it’s so easy to rationalize business judgments which compromise moral standards. Our ethical positions may have financial costs to us, and we must be willing to incur them. In this program, we’ll learn how to identify and resolve the key issues regarding money and the therapeutic relationship.
Ethical/Clinical Decisions
Dr. Kathleen Murphy, PhD presents the principles of ethical decisions. It's important to have these concepts in mind. Otherwise, we're just memorizing a cookbook of instructions.
Fees, Billing, Collections
Barton Bernstein, a lawyer and social worker who has written two books on legal/ethical issues for mental health professionals, shares his positions on fees, billing, and collections.
Gifts and Adjudication/Sanctions
Dr. Ted Remley, an attorney and licensed professional counselor, discusses two different topics. First, on the subject of gifts and tips, Dr. Remley discusses how to graciously decline them. Then, he presents the consequences of unethical behavior, adjudication and sanctions. This occurs when a therapist gets called before the ethics panel of his or her professional association or licensure board.
The Meaning of Money
Talking about money with our clients or patients is difficult and often avoided. This can lead to misdiagnosis, premature termination, unresolved transference and countertransference, inconsistencies in payment practices, and undue anxiety. In this interview, Dr. Galatzer-Levy discusses the psychological meaning of money in the therapeutic relationship.
Ideological conflicts can affect our clinical work and the therapeutic relationship in troubling ways. The advent of social media and social networking has intensified these challenges in unprecedented ways.
Dr. Frederic Reamer continues our discussion of the previous interview with us.
Ethical Challenges and Personal Conundrums.
This program continues the conversation with Dr. Reamer in "New Ethical Standards in Use of Technology, and new Dangers! Here we cover conscience protections, life coaching, countertransference, personal questions, and more.
For many clinicians, cybertechnology has become the principal tool in delivering services and communicating with patients. New technologies are developing and changing so rapidly that all the mental health professions are scrambling to develop standards of care to keep up.
Developed to provide clinicians with guidelines for decision making, these standards become incorporated into the licensing statutes, regulations and professional codes of ethics of all the mental health professions. And while the purpose of these guidelines is to protect the public, woe unto the clinician who has to face his or her licensing board for lapses in judgment.
Dr. Frederic Reamer discusses these standards and our ethical conundrums with us.
New Ethical Standards in Use of Technology, and new Dangers, part 1
As therapists increasingly use technology to deliver services to clients/patient, ethical challenges emerge and new ethical standards emerge. Dr. Reamer provides a syntheses of these emerging standards. We'd better read our revised ethics codes!
For many clinicians, cybertechnology has become the principal tool in delivering services and communicating with patients. New technologies are developing and changing so rapidly that all the mental health professions are scrambling to develop standards of care to keep up.
Developed to provide clinicians with guidelines for decision making, these standards become incorporated into the licensing statutes, regulations and professional codes of ethics of all the mental health professions. And while the purpose of these guidelines is to protect the public, woe unto the clinician who has to face his or her licensing board for lapses in judgment.
Dr. Frederic Reamer discusses these standards and our ethical conundrums with us.
New Ethical Standards in the Use of Technology -- and Danger! part 2
Ideological conflicts can affect our clinical work and the therapeutic relationship in troubling ways. The advent of social media and social networking has intensified these challenges in unprecedented ways.
Dr. Frederic Reamer continues our discussion of the previous interview with us, and here we cover the meaning and implications of “conscience protection” in our clinical decisions. For example, can we refuse to work with clients whose religious or political beliefs are abhorrent to us? And then there’s the ever present subject of how to answer personal questions? Another thorny issue has to do with becoming a Life Coach. Does that free us of the professional responsibilities laid out in our ethical codes? If we are, let’s say, a Licensed something something, are we still that “something” if we are in the Life Coach mode? If it looks like a duck, acts like a duck --- well, you know the rest of that.
New Ethical Standards in Use of Technology, and new Dangers, part 1
As therapists increasingly use technology to deliver services to clients/patient, ethical challenges emerge and new ethical standards emerge. Dr. Reamer provides a syntheses of these emerging standards. We'd better read our revised ethics codes!
In “Sexual Misconduct,” the partner program to this one, we explored the psychological and psychodynamic underpinnings of therapists who commit severe boundary violations. Now, in this program, we take a look at the repercussions.
Ms. X Confesses
First, we hear from a mental health professional, who married her patient following a long series of boundary violations.
Imagine that in one year, you have lost everything in your life. Your marriage ends in divorce, your children leave the nest, you have declared bankruptcy, your work situation ends, your closest colleague rejects you, and a sibling and a parent die. However, you keep trying to work and hold on to some of the aspects of yourself which make you “you.”
Isn’t it possible that you could be vulnerable under stress like this and make some pretty big mistakes?
Rehabilitation
There is a tendency to want to distance ourselves from the “bad apples” who have sexual contact with clients and to view them as the most marginal members of the profession. However, it goes against the history of our own profession to unilaterally separate those who have had romantic or sexual involvement with a client as uniquely dangerous, untreatable, and never worthy of return.
The Inner Workings of Ethics and Licensing
This interview comprises a panel discussion with a defense attorney who defends therapists before licensing board hearings, a former prosecuting attorney who brought these cases to the licensing board of his state, and a social worker who has chaired ethics hearings for his state professional association. They will share with us how these hearings proceed and what they think about during these hearings.
Dr. Richard Geist is interested in the clinical possibilities offered by the concept of connectedness. Therapists can use connection as a central organizing principle in the way we listen, interpret, make interventions, and experience our patients. Connectedness is bidirectional. With bidirectionality, therapists experience and empathizes with the patient, while the patient also experiences and empathizes with the therapist. This has opened up the subject of self-disclosure. In this new paradigm, the therapist’s “deliberate” self-disclosure often enhances our therapeutic effectiveness.
Self-Disclosure and Connectedness
Dr. Richard Geist is interested in the clinical possibilities offered by the concept of connectedness. Therapists can use connection as a central organizing principle in the way we listen, interpret, make interventions, and experience our patients. Connectedness is bidirectional. With bidirectionality, therapists experience and empathizes with the patient, while the patient also experiences and empathizes with the therapist. This has opened up the subject of self-disclosure. In this new paradigm, the therapist’s “deliberate” self-disclosure often enhances our therapeutic effectiveness.
After all these years of having it pounded into our heads, one would think sexual misconduct (entering into a sexual relationship with our clients or patients) would be a thing of the past? However, next to suicide, boundary problems and sexual misconduct rank highest as causes of malpractice actions against mental health providers. Repercussions to the therapist are stringent, ranging from loss of license to criminal and civil prosecutions, monetary fines, and even prison. One would think it wouldn’t be worth the risk. Obviously, knowing the rules isn’t always enough to override the risk factors that make us vulnerable. These factors can have disastrous consequences when combined with a variety of factors in our clients and patients.
This ethics program is not the typical ethics program, which focuses specifically on the rules. Rather, we aim at something that Aristotle might have referred to as “developing virtuous character” through a more in-depth look at how these situations can develop. We’ll be focusing on the ethical decision maker vs. the decision making process within ourselves. Our premise is our moral and psychological identity is fundamental to one’s decision making.
Overview to Sexual Misconduct
We’ll hear an overview about boundary violations, their causes, new findings in neurology, evolution’s role in boundaries, and how we can change a toxic work environment.
Psychodynamic Understandings
We’ll hear a psychodynamic explanation about the clinician’s experience when his “who-ness” (personal identity, needs, and vulnerabilities) interfere with his “what-ness” (professional role and the implicit trust).
Risk Management Mania
In this interview, we’ll hear how the topic of boundary violations is being used and misused in lawsuits against therapists.
The most hidden subject in therapy is not sex or money; it’s faith, religion, and spirituality. The spiritual direction of the therapy/counseling process is highly influenced by the therapist’s basic perspective. The issue for each of us to consider is this: To what degree are we open to discussing spiritual and/or religious issues? At a minimum, we need to be open to hearing spiritual content. More and more, our clients want to discuss this part of their lives and draw on their spirituality as a resource and part of their recovery. Many want to do this with a therapist or counselor who shares their sentiments, if not their faith tradition. If we want to have access to this part of our clients’ worlds, we have to be open to spirituality in ourselves. While the mental health world is coming to (and perhaps has already reached) a collision between the scientific/empirical approach and the spiritual, we must continue to abide by our professional mantra: start where the client is.
Ethical Codes and Violations
Dr. Reamer discusses the one feature common to all codes of ethics: the client’s right to self-determination. He also covers the use of self in ethical practice and adjudication/legal issues, arising out of the misuse of spirituality in clinical practice.
Ethics and Character
Dr. Haynes points out most mental health workers make their ethical decisions based on the policies and procedures of their agency, rather than on their own inner sense of what is right and virtuous.
Handling Ethical Issues
Dr. Northcut discusses the importance of training and competence in incorporating spirituality into one’s practice.
Spirituality Sensitive Practice
Dr. Canda defines “spirituality sensitive practice” and emphasizes how it’s impossible and undesirable to separate spirituality from clinical practice.
In these times of quarantines, isolation, stay-at-home orders, and fears of contagion, our clients need us now more than ever. Frankly, we need them too! Anxiety is flooding their lives as they worry about loved ones, health, finances, stability and futures. And we can’t see them face to face, in person. Our ability to work with them safely and responsibly in-person has been drastically altered, even halted. So now has been the time for therapist to begin providing distance therapy services.
Here Laura Groshong explains some of the mechanics involved in doing teletherapy, such as the platforms to use, how to be HIPPA compliant, appreciating the changes in boundaries, how to protect confidentiality, and more.
TELE-THERAPY: an overview plus thoughts about returning to the office
In these times of quarantines, isolation, stay-at-home orders, and fears of contagion, our clients need us now more than ever. Frankly, we need them too! Anxiety is flooding their lives as they worry about loved ones, health, finances, stability and futures. And we can’t see them face to face, in person. Our ability to work with them safely and responsibly in-person has been drastically altered, even halted. So now has been the time for therapist to begin providing distance therapy services.
Here Laura Groshong explains some of the issues involved in doing teletherapy, such as the platforms to use, how to be HIPPA compliant, appreciating the changes in boundaries, how to protect confidentiality, and more.
The economy goes up, and the economy goes down. When it’s down, people lose jobs, lose their incomes, and deplete their savings. Then, they have to make some tough decisions about what is most important to them. This obviously makes an impact on the therapist. It’s not only the patient who may have to make some tough decisions. Here we are, with psychotherapy and counseling as our livelihood. This requires ethical, clinical, and profoundly personal self-examination. Do we reduce our fees or not? Do we cut back on the frequency of sessions? How do we explore the meaning of this with our patients, who may be in reduced circumstances and also may have other issues specifically related to their therapy?
To Reduce the Fee or Not
Dr. Summers shares his observations on the impact of the economy on his practice and discusses the dilemmas this situation raises, explaining the factors involved in modifying one’s stance on fees.
To Reduce the Fee or Not? Part 2
Dr. Clark discusses the dilemmas involved in making a decision to reduce a patient’s fee, stresses why the therapeutic frame can be vital to keeping one’s clarity and perspective on this subject, and why the therapeutic relationship can’t be a sale item.
The MOST POPULAR INTERVIEWS
By reconciling recent clinical findings on adolescent development with well-established tenets of psychodynamic theory, Dr. Bloch gives us a new view for understanding how psychopathology develops during adolescence, and thus how therapeutic interventions can be directed.
Adolescent Psychology and Development
Dr. Bloch explains his model of conceptualizing acting-out behaviors in adolescence, developmental difficulties, predictors of an adolescent's ability to use peer relationships to facilitate emancipation, and the unique challenges faced by adolescents today.
In this interview, we take a close look at countertransference, often at the root of ethical transgressions. For clarification, briefly, countertransference is defined as redirection of a psychotherapist's feelings toward a client—or, more generally, as a therapist's emotional entanglement with a client.
We can know the ethical codes of our professions backwards and forwards, but when our personal feelings get involved, it’s awfully easy to find ways to rationalize and justify our actions.
Countertransference and Ethics
discussion
In their book Stuff: Compulsive Hoarding and the Meaning of Things, the two speakers in this program detail how compulsive behaviors drive sufferers to pile objects throughout their homes. Randy Frost, Ph.D. and Gail Steketee, Ph.D. illustrate the phenomenon through several case studies, identify the key traits that identify a hoarder, detail the underlying causes and explaining how to minimize the effects of the emotionally exhausting disorder.
Hoarders: Diagnosis and Treatment, Part 1
In this interview with Dr. Gail Stekette we cover the diagnostic issues involved in working with hoarders.
Hoarders: Diagnosis and Treatment, Part 2
In this interview, Frost outlines three problems that need to be understood regarding hoarders: first, the problem of excessive acquisition. Obviously, if someone keeps acquiring stuff, the stuff will accumulate. Next, there is the difficulty in discarding possessions, which takes in the hoarder’s beliefs about possessions. Last, there is the level of disorganization regarding the possessions – hoarders do not perceive space like non-hoarders.
Marcia Adler and Dr. Roneen Blank are friends and colleagues, who were diagnosed with breast cancer within one week of each other and formed their own support group as they each went through radiation and chemotherapy. Here, they discuss how they told their patients, how the patients reacted, and their own thought process.
My Therapist has Cancer
how therapists talk to their pateints about their cancer.
The Therapist Has Cancer
Marcia Adler and Dr. Roneen Blank are friends and colleagues, who were diagnosed with breast cancer within one week of each other and formed their own support group as they each went through radiation and chemotherapy. Here, they discuss how they told their patients, how the patients reacted, and their own thought process.
Post-traumatic growth refers to positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning. These sets of circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to their ways of understanding the world and their place in it.
Posttraumatic growth is not about returning to the same life as it was previously experienced before a period of traumatic suffering; but rather it is about undergoing significant 'life-changing' psychological shifts in thinking and relating to the world that contribute to a personal process of change that is deeply meaningful. It is often characterized by decreased reactivity and faster recovery in response to similar stressors in the future. This occurs as a result of exposure to the event and subsequent learning.
Here to discuss how she works with trauma survivors to embrace change, take healthy risks, and increase self-compassion is Lisa Ferentz, LCSW-C, DAPA, a recognized expert in the strengths-based, de-pathologized treatment of trauma.
Promoting Post-traumatic Growth
CURRICULUM SUMMARY
Post-traumatic growth refers to positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning. These sets of circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to their ways of understanding the world and their place in it.
Posttraumatic growth is not about returning to the same life as it was previously experienced before a period of traumatic suffering; but rather it is about undergoing significant 'life-changing' psychological shifts in thinking and relating to the world that contribute to a personal process of change that is deeply meaningful. It is often characterized by decreased reactivity and faster recovery in response to similar stressors in the future. This occurs as a result of exposure to the event and subsequent learning.
According to Richard G. Tedeschi, one of the founders of the post-traumatic growth movement, as many as 90 percent of survivors report at least one aspect of post-traumatic growth, such as a renewed appreciation for life.
LEARNING OBJECTIVES
Identify specific issues of transference and countertransference which may present work with these clients.
Learn how to respond to help clients who become very upset due to trauma.
Learn how to process trauma safely and effectively.
Become familiar with the parts of the brain affected by trauma memories.
Being able to assess suicidal risk is probably the most important single thing therapists need to be able to do. The alarming reality is any therapist involved in direct patient care is likely to have this experience. Here we tackle the topic of manipulative suicide threats. How do we know when the patient is serious? We'd better!
Manipulative Suicide Threats
Suicide and death pose significant challenges for loved ones and survivors. Assessing suicide talk is one of the most anxiety-ridden tasks of psychotherapy because we can't afford to be wrong. Plus, the bereaved's intense grief can be overwhelming to their loved ones and even the therapist.
Suicide Threats: Manipulative?
Being able to assess suicidal risk is probably the most important single thing therapists need to be able to do. The alarming reality is any therapist involved in direct patient care is likely to have this experience. Here we tackle the topic of manipulative suicide threats. How do we know when the patient is serious? We'd better!
The Cultural Competence
The domain of clinical practice currently faces a crisis of competence and conscience in the treatment of those clients whose ethnicity, race, or class renders them minority groups in American society. Even with the best of intentions and belief in our own objectivity/impartiality, we unwittingly, even unconsciously impose presumptuous interpretations and interventions on clients’ lives. So, we shouldn’t be shocked to learn that ethnic minority groups are the smallest users of mental health services. Furthermore, when these groups do use treatment, they show the highest premature termination rate of any social group. Something is wrong here! Our clinical training programs need to step up to this challenge.
Ethnicity and Immigration
Dr. McGoldrick discusses the ethno-centered value presuppositions that inform theories of normal human development and related views of psychopathology.
Jumping through the hoops of Immigration
Family reunification has stood as a central pillar of the US Immigration system. However, immigration laws have implications that go well beyond actual admissions. These laws not only determine who is allowed to immigrate and through which channels, but they also shape the composition of immigrant families and, by doing so, they affect immigrant households’ economic opportunities and their ability to integrate into American society.
In principle, our immigration law recognizes the right of US citizens and lawful permanent residents to be reunited with close family members born abroad. However, a closer look at the actual impact of current immigration laws on families reveals that many legal provisions of the laws threaten this reunification.
Here to give us an overview on the complexities of our immigration system and the concomitant emotional repercussions of these laws is attorney Kenneth Geman.
Migration and Separation
Latinos in the United States constitute a significant and sizable population that mental health professionals must serve appropriately. In her book, Latino Families in Therapy, our speaker in this interview, Dr. Celia Falicov, writes that, “Even when freely chosen, the transition of migration is replete with loss and disarray –there is loss of language, separation from loved ones, the intangible emotional vacuum left in the space where “home” used to be, the loss of community, and lack of understanding of how jobs, schools, banks, or hospitals work. Immigrants are rendered vulnerable, isolated, and susceptible to individual and family distress.” She states that it is impossible to do cross-cultural work without critical cultural and sociopolitical self-awareness on the part of the practitioner, and refers to the term, “Cultural Humility” to describe what this takes.
Diverse cultural influences have required contemporary therapists to modify their world views. To work effectively with people of diverse identities, we must learn to deal with difference and conflict in ways that empower and show respect for one another. Dr. Pamela Hays presents a paradigm for identifying one’s own biases.
Cultural Complexities
Diverse cultural influences have required contemporary therapists to modify their world views. To work effectively with people of diverse identities, we must learn to deal with difference and conflict in ways that empower and show respect for one another. Dr. Pamela Hays presents a paradigm for identifying one’s own biases.
In her book, Latino Families in Therapy, our speaker in this interview, Dr. Celia Falicov, writes that, “Even when freely chosen, the transition of migration is replete with loss and disarray." She discusses these issues here.
Migration and the Immigration Experience, by Celia Falcov
In her book, "Latino Families in Therapy," Dr. Celia Falicov, writes that, “Even when freely chosen, the transition of migration is replete with loss and disarray." She discusses these issues in this interview.
As traditional and legal constraints on men and women’s behavior loosen, growing numbers of people describe themselves as “non-binary.” As older adults who have lived as transgender for decades age and need more care, they are more likely to run into discrimination and lack of understanding.
Transgender older adults face profound challenges and experience striking disparities in areas such as health and health care access, physical and mental health, employment, housing and more.
Our speaker, Rena McDaniel has extensive experience working with trans people of all ages, and she shares this with us here.
Transgender in the Aging Community
We live in a binary world. Either/or. Male/Female. Most people are comfortable with their gender identities. It’s part of their nature and perhaps they rarely consider or have any strong sense of being male or female. Most gay people never doubt their gender identities. Plenty of transgender people are homosexual, but as we see with Katlyn Jenner (formerly Bruce Jenner), many are not. The Williams Institute, a think-tank in Los Angeles, recently came up with an estimate of 1.4 million Americans – 0.6% of those aged 16-65 -- who consider themselves transgender.
As traditional and legal constraints on men and women’s behavior loosen, growing numbers of people describe themselves as “non-binary.” Facebook offers users a list of over 70 gender identities, from “agender” to “two-spirit,” as well as the option to write in their own. The media has been covering this extensively, and especially controversy spins around the subject of young kids wanting to transition, which, of course, would be permanent.
There has been less coverage around the problems and issues of older adults who have lived as transgender for decades. As they age and need more care, they are more likely to run into discrimination and lack of understanding. Transgender older adults face profound challenges and experience striking disparities in areas such as health and health care access, physical and mental health, employment, housing and more.
Our speaker, Rena McDaniel has extensive experience working with trans people of all ages, and she shares this with us here.
The FAMILY/COUPLE THERAPY
Treatment of couples basically falls into three categories: systemic; psychodynamic; and behavioral/educational. Novice and experienced therapists alike struggle with the many challenges of couple psychotherapy. Teaching communication skills and pointing out behavior patterns can be helpful for many couples. But when feelings of rage or hopelessness prevail, or narcissistic vulnerabilities are present, the deeper roots of such difficulties need to be addressed and focused on.
Psychoanalytic theory, especially self-psychology is highly suited to understanding couples’ dynamics. Having an in-depth point of view and recognizing the influence of unconscious processes on these relationships can help therapists treat these couples and manage their own reactions to the couples as well.
Couple Therapy and Self-Psychology
Treatment of couples basically falls into three categories: systemic; psychodynamic; and behavioral/educational. Novice and experienced therapists alike struggle with the many challenges of couple psychotherapy. Teaching communication skills and pointing out behavior patterns can be helpful for many couples. But when feelings of rage or hopelessness prevail, or narcissistic vulnerabilities are present, the deeper roots of such difficulties need to be addressed and focused on.
Psychoanalytic theory, especially self-psychology is highly suited to understanding couples’ dynamics. Having an in-depth point of view and recognizing the influence of unconscious processes on these relationships can help therapists treat these couples and manage their own reactions to the couples as well.
Most children do not remain in foster care forever. To aid these high-risk, fragile situations, Dr. Kagan has developed tools practitioners can use to provide a coordinated effort to rebuild family ties and change cycles of crisis.
Foster Care and Rebuilding Family Ties
Most children do not remain in foster care forever. To aid these high-risk, fragile situations, Dr. Kagan has developed tools practitioners can use to provide a coordinated effort to rebuild family ties and change cycles of crisis.
Arthur Nielsen, MD, writes that understanding projective identification “offers a powerful lens through which therapists can examine and treat marital dysfunction and discontent.” Projective Identification is a defense mechanism by which individuals unconsciously recruit others to help them tolerate painful intrapsychic states of mind. Once therapists grasp the psychodynamics of projective identification, then, using tact and empathy, they will be able to significantly help couples become more self-reflective and aware of the minds of their partners.
In this interview, Dr Nielsen uses a number of clinical examples to demonstrate this.
This collection of interviews consists of conversations on the subjects of object relations work with couples; work with borderline couples; infidelity; work with difficult couples; and working with couples where one partner is an alcoholic.
Borderline Marriages
Anyone doing marital therapy knows there are couples, and then, there are couples! The "normal" couple rapidly incorporates the therapist's help with communication and conflict resolution issues. On the other hand, the personality-disordered marriage seems impervious to change and, in fact, seems to get worse in treatment. Charles McCormack is the author of Treating Borderline States in Marriage: Dealing with Ruthless Aggression, Severe Resistance and Oppositionalism. He describes marriage as containing both the dream and the nightmare of the couple's way of being in a relationship. The couple presents a tangle, which all three in the room must work to sort out.
Infidelity
Most therapists view affairs as expressive of troubled relationships. Quite to the contrary, Dr. Frank Pittman, author of Private Lies, views affairs as indications of a character flaw in the person to whom he refers as the "infidel." He will discuss four patterns of infidelity, each of which must be approached differently. He also has strong words of admonition for therapists about secrecy and honesty, how to limit the damage affairs do, and how to heal a relationship that has been hurt by infidelity.
Object-Relations Focused Marital Treatment
All the object relations theorists share the fundamental premise that attachment is centrally motivated by the need to be in relationships, and therefore, personality forms in a relational context. A couple is not simply a pair of individuals. According to Drs. Jill and David Scharff, co-authors of Object Relations Couples Therapy, a couple is a system of conscious and unconscious intrapsychic object relationships, which are experienced in the interpersonal area. The Scharffs, who are married to each other, discuss object relations theory as it applies to couples.
Work with Difficult Couples
Dr. Marlene Watson addresses breaking the destructive patterns that often exist in couples' relationships. She discusses marital therapy with hard-to-treat couples, how to break destructive patterns, how to view the relationship as a system, and how to deal with extramarital affairs. Additionally, she helps us understand the chronically stuck couple by looking at the meaning and purpose of conflict in a couples relationship and how to work creatively toward resolution.
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