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TreatmentResistantDepressionCognitiveBehavioralAnalysisSystemofPsychotherapy
TrainingProgram
P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net
TreatmentResistantDepression
LightUniversity2
WelcometoLightUniversityandthe“TreatmentResistantDepression”TrainingProgram.Ourprayeristhatyouwillbeblessedbyyourstudiesandincreaseyoureffectivenessinreachingout to others. We believe you will find this program to be academically-sound, clinically-excellentandbiblically-based.Our faculty represents some of the best in their field—including professors, counselors, andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.Wehavealsoworkedhardtoprovideyouwithaprogramthatisconvenientandflexible,givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,
RonHawkinsDean,LightUniversity
TreatmentResistantDepression
LightUniversity3
TheAmericanAssociationofChristianCounselors
• Representsthe largestorganizedmembershipofChristiancounselorsandcaregivers intheworld,havingjustcelebratedits30thanniversaryin2016.
• Known for its top-tier publications (Christian Counseling Today and Christian CounselingConnection), professional credentialing opportunities offered through the InternationalBoard of Christian Care (IBCC), excellence in Christian counseling education, an array ofbroad-basedconferencesandlivetrainingevents,radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode,andcollaborativepartnershipssuchasCompassion International, theAACChasbecomethefaceofChristiancounselingtoday.
• TheAACCalsohelpedlaunchtheInternationalChristianCoachingAssociation(ICCA)in2011,
andhasdevelopedanumberofeffectivetoolsandtrainingresourcesforLifeCoaches.OurMission
The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,andlaychurchmemberswithlittleornoformaltraining.Itisourintention to equip clinical, pastoral, and lay caregivers with biblical truth and psychosocialinsights that minister to hurting persons and help them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.
TreatmentResistantDepression
LightUniversity4
OurVision
TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Second, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting theChurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselectedlaypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmust be supported by three strong cords: the pastor, the lay helper, and the clinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).
OurCoreValues
InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:
VALUE1:OURSOURCEWearecommittedtohonor JesusChristandglorifyGod,remaining flexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,training,andbenefits.VALUE3:OURSERVICEWe are committed to effectively and competently serve the community of careworldwide—both ourmembership and the Church at large—with excellence and timeliness, and by over-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueand invest inourpeopleaspartners inourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resources God gives to us in order to continueservingtheneedsofhurtingpeople.
TreatmentResistantDepression
LightUniversity5
LightUniversity• Established in1999underthe leadershipofDr.TimClinton—hasnowseennearly300,000
students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and Webinar presentations, video-basedcertificationtraining,andastate-of-the-art,onlinedistanceteachingplatform).
• Thesepresentations, courses, and certificateanddiplomaprogramsofferoneof themostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determinedby itsworld-class faculty—more than150of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core group of facultymembers represents a literal “Who’sWho” in Christiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.
• Educational and training materials cover more than 40 relevant core areas in Christian
counseling, life coaching,mediation, and crisis response—equipping competent caregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.
OurMissionStatement
TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.
AcademicallySound•ClinicallyExcellent•DistinctivelyChristian
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Video-basedCurriculum
• Utilizes DVD presentations that incorporate more than 150 of the leading Christianeducators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.
• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorresponding text (inoutline format)anda10-questionexamination tomeasure learningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.
• Learning is self-directed and pacing is determined according to the individual time
parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official
Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.
! TheRegular Diploma is awarded by takingCaring for PeopleGod’sWay,BreakingFree,andoneadditionalElectiveamongtheavailableCoreCourses.
! TheAdvancedDiploma isawardedbytakingCaringforPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.
Credentialing
• LightUniversitycourses,programs,certificates,anddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).
• Credentialing is a separate process from certificate or diploma completion. However, theIBCCacceptsLightUniversityandLightUniversityOnlineprogramsasmeetingtheacademicrequirementsforcredentialingpurposes.Graduatesareeligibletoapplyforcredentialinginmostcases.
! Credentialinginvolvesanapplication,attestation,andpersonalreferences.
! Credential renewals includeContinuingEducation requirements, re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.
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OnlineTesting
TheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.
• TOLOGINTOYOURACCOUNT
! You should have received an e-mail upon checkout that included your username,password,andalinktologintoyouraccountonline.
• MYDASHBOARDPAGE
! Once registered, you will see theMy DVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbaroftheWebsite.Thispagewill include student PROFILE information and the COURSES for which you areregistered.TheLOG-OUTandMYDASHBOARD tabswillbeatthetoprightofeachscreen. Clicking on the > next to the course will take you to the course pagecontainingthequizzes.
• QUIZZES
! Simplyclickonthefirstquiztobegin.• PRINTCERTIFICATE
Afterallquizzesare successfully completed,a “PrintYourCertificate”buttonwill appearnearthetopofthecoursepage.YouwillnowbeabletoprintaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard for Certified Counselors (NBCC) Approved Continuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.
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Presentersfor
TreatmentResistantDepressionCognitiveBehavioralAnalysisSystemofPsychotherapy
TrainingProgram
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PresenterBiographiesGarySibcy,Ph.D.,isProfessorofCounselingintheSchoolofBehavioralSciencesandCenterforCounselorEducationandSupervisionatLibertyUniversity,whereheteachesdoctoralcoursesinadvancedpsychopathologyanditstreatment,empirically-supportedtreatmentsforchildrenandadults,andattachmenttheory.He isaLicensedClinicalPsychologist (LCP),hasbeen inprivateclinicalpracticeformorethan20years,andcurrentlyworksatthePiedmontPsychiatricCenter.Dr. Sibcy specializes in anxiety disorders, including OCD and panic disorder, and chronicdepression in adults, as well as the diagnosis and treatment of children with severe mooddysregulation. He is currently developing an empirically-supported treatment within theframework of interpersonal neurobiology and attachment theory. Dr. Sibcy has co-authoredseveralbookswithDr.TimClinton,includingAttachmentsandWhyYouDotheThingsYouDo.Todd Vance, Ph.D., is the founder of Breakforth Counseling and Consulting. He a LicensedClinical Psychologist in Virginia. His goal is to help each of his clients live their fullest, mostproductivelives.Dr.Vancespecializesinthetreatmentofchronicdepression,anxiety,PTSD,andrelated disorders. He also offers career coaching, couples counseling, performance masterycoaching,andenjoyshelpingothertherapistsovercomeobstaclesintheirpractices.
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TreatmentResistantDepressionTableofContents:
TRD101:AnOverviewofDepressionandtheStatusofCurrentTreatments...........................12GarySibcy,Ph.D.,andToddVance,Ph.D.TRD102:TheChronicallyDepressedPatient:ADeeperUnderstandingofDepression............19GarySibcy,Ph.D.,andToddVance,Ph.D.TRD103:ChronicDepressionandInterpersonalNeurobiology...............................................26GarySibcy,Ph.D.,andToddVance,Ph.D.TRD104:Attachment,InternalWorkingModels,andDepression...........................................31GarySibcy,Ph.D.,andToddVance,Ph.D.TRD105:Relationship,Healing,andTransformation:AnOverviewofCBASPandChristianIntegration.............................................................................................................................40GarySibcy,Ph.D.,andToddVance,Ph.D.TRD106:CBASPToolsandTechniques:SignificantOtherHistory...........................................46GarySibcy,Ph.D.,andToddVance,Ph.D.TRD107:CBASPToolsandTechniques:SituationalAnalysisPartI..........................................53GarySibcy,Ph.D.,andToddVance,Ph.D.TRD108:CBASPToolsandTechniques:SituationalAnalysisPartII.........................................61GarySibcy,Ph.D.,andToddVance,Ph.D.TRD109:CBASPToolsandTechniques:DisciplinedPersonalInvolvement..............................69GarySibcy,Ph.D.,andToddVance,Ph.D.TRD110:MeasuringProgressandChangeThroughoutTherapy.............................................76GarySibcy,Ph.D.,andToddVance,Ph.D.TRD111:ChristianIntegrationandAccommodation...............................................................84GarySibcy,Ph.D.,andToddVance,Ph.D.
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TRD112:Role-play:ClinicalDiagnosisofPersistentDepression..............................................88GarySibcy,Ph.D.,andToddVance,Ph.D.TRD113:Role-play:SignificantOtherHistory.........................................................................93GarySibcy,Ph.D.,andToddVance,Ph.D.TRD114:Role-play:SituationalAnalysis.................................................................................97GarySibcy,Ph.D.,andToddVance,Ph.D.TRD115:Role-play:DisciplinedPersonalInvolvement..........................................................101GarySibcy,Ph.D.,andToddVance,Ph.D.
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TRD101:
AnOverviewofDepressionandtheStatusofCurrentTreatments
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
Intoday’sworldofcounselingandpsychiatry,howdowetreatdepression?Whatarethe
“effective”treatments?Medications?Therapy?Self-help?Despitetheadvancesintreatment
thathavetakenplaceoverthelastfewdecades,theSTAR*Dstudyandotherresearchsuggest
thatwehavealongwaytogo,especiallyforchronic,refractorydepression.Inthispresentation,
Drs.SibcyandVancedefineanddiscusstheissueofPersistentDepressiveDisorderandthe
statusoftreatmentoptionsthatareavailabletoday.
LearningObjectives
1. Participantswillidentifyanddefinethecoresymptomsofdepression.
2. Participants will evaluate the scope of the problem and evaluate current treatment
methods.
3. Participants will analyze the results of the STAR*D study and its impact on further
treatmentneeds.
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I. CoreSymptomsofDepression
A. EmotionalSymptoms
1. Sadness
2. Lossofpleasure
B. SomaticSymptoms
1. Changeinappetite
2. Changeinsleep
3. Psychomotorchanges
4. Fatigue/lossofenergy
C. CognitiveSymptoms
1. Decreasedconcentration
2. Worthlessness/guilt
3. Thoughtsofdeath/suicidalideation
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II. TreatingDepression
A. TheScopeoftheProblem
1. MajorDepressiveDisorder(MDD)isarelativelycommonpsychiatricdisorder,witha
lifetimeprevalencerateof7%to12%formenand20%to25%forwomen(Kessleret
al.,2003).
2. TheannualcostofMDDintheU.S.wasestimatedat$83.1billion(Greenbergetal.,
2003)andtheWorldHealthOrganizationpredictedittobethesecond-leadingcause
offunctionalimpairmentanddisabilityworldwideby2020(MurryandLopez,1996).
B. EmpiricallySupportedTreatments
1. Required
• Demonstrationofefficacythroughatleastonerandomizedcontrolledtrialwith
goodexperimentaldesign,or
• Demonstrationofefficacythroughalarge,well-designedclinicalreplication
series.
2. PreferredEfficacy
• Hasbeenshownbymorethanonestudy.
• Efficacyhasbeendemonstratedbyindependentresearchgroups.
• Clientcharacteristicsforwhichthetreatmentwaseffectivewerespecified.
• Acleardescriptionofthetreatmentwasavailable.
C. StatisticalSignificancevs.ClinicalSignificance
1. StatisticalSignificance
• Betterthanchancethattreatmentwasbetterthancontrolgroup
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2. ClinicalSignificance
• Howmanypatients(ratherthantheentiregroupaverage)werereliablybetter?
• Howmanypatientsmadeatleast50%improvementfrombaseline?
• Howmanypatientsachievedremission(withinnormalrangeonoutcome
measure)?
D. EffectiveTreatment
1. Althoughseveraleffectivepsychiatricandpsychologicaltreatmentshavebeen
developed,asizeableportionofpatientshaveachronic,treatment-resistantcourse
ofillness,characterizedbyafailuretoreachfull-remissionandcontinuingtoexhibit
substantialsymptomology.
2. Inclinicaleffectivenessstudieswithrepresentativetreatmentsamples,70-89%of
patientsfailtoreachremissionafterrelativelyextendtreatmentcoursesofeightto
12months(Linetal.,1997;Rostetal.,2002;Rushetal.,2004)
E. TheSTAR*DStudy
1. Inthelargestreal-worldeffectivenessstudyofMDDeverconducted,theSequenced
TreatmentAlternativestoRelieveDepression(STAR*D).
2. Afour-steptreatmentprotocolwasdesignedtotreatpatientstoremission.
3. Eachleveloftreatmentlastedupto12weeks.AllpatientsenteredlevelIandifthey
achievedremission,theyremainedatthesamelevelandwerefolloweduptoone
year.
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4. Iftheyfailedtoreachremission,theywereupgradedtothenextlevel,offered
differentaugmentationstrategies.
5. 40%ofpatientsdroppedoutbeforecompletionofstudy.
6. Ofthe60%ofpatientswhocompletedthestudy,33%achievedremissionatLevelI,
57%atLevel2,and63%and67%achievedremissionatLevels3and4,respectively.
F. Upshot
1. Theupshotofthisstudywasthatwitheachsubsequentleveloftreatment,fewer
patientsachievedremission,withonlyabout10%oftreatmentresistantpatients
(i.e.,thosewhofailedtoreachremissionafterlevels1and2)achievingremission
afterlevel4.
2. Moreover,relapseratesincreasedwitheachtreatmentstep:40%instep1,53%in
step2,65%instep3,and71%instep4…andtheoveralldropoutratewas40%.
3. Thus,asubstantialproportionofpatientsfailtoachieveremission(33%ofthosewho
remainintreatmentoverthecourseofoneyear)andthemajorityoftreatment-resist
patientsrelapse(65%-71%)withinoneyear,evenwhencontinuingmaintenance
medication.
4. Consequently,theseresultsrepresentaneedtodevelopalternativetreatmentsthat
notonlyincreasetheproportionofpatientsachievingremission,butalsoreduce
bothrelapseanddropoutrates.
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G. Treatments
1. CognitiveBehavioralAnalysisSystemofPsychotherapy
• SpecificallydesignedforChronic,RefractoryDepression—especiallyEarlyOnset
2. SingleEpisodevs.Recurrent
3. PersistentDepressiveDisorder
4. EarlyOnsetvs.LateOnset
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TRD102:
TheChronicallyDepressedPatient:ADeeperUnderstandingofDepression
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
Depressionisamultifacetedproblem.Totrulyunderstandthisdisorder,itisbesttoexamineit
through an integrated model approach. In this presentation, Drs. Sibcy and Vance help
therapists identify the chronically depressed patient through extensive psychosocial profiles,
alongwithaddressingcommontreatmenthistory.
LearningObjectives
1. Participants will comprehend the social and neurocognitive patterns common to those
withdepression.
2. Participantswillidentifycharacteristicsofchronicdepression.
3. Participants will discover the typical psychological profile for a patient with chronic
depression.
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I. AnIntegrativeModelofDepression
A. SocialandNeurocognitiveSkills
1. Cognitiverigidity
2. Lackofself-monitoringskills
3. Highemotionalreactivity
4. Poorsensorymodulation
B. EarlyMaladaptiveSchema
1. Alsoknownascorebeliefsandinternalworkingmodelsofattachment
2. Corefeature:Perfectionism
3. PerformancePerfectionism
• “ImustalwayssucceedateverythingIdoorIcan’tbehappy/content.”
4. RelationshipPerfectionism
• “ImusthavetheapprovalandloveofeveryoneallthetimeorIcan’tbehappy.”//
“Healthyrelationshipsneverstruggle.”
5. EmotionalPerfectionism
• “Ican’tbehappyandcontentandfeelnegativeemotions.”//“Negativefeelings
areasignofweaknessandlossofcontrol.”
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C. StressfulLifeEvent
1. Roletransitions
2. RelationshipConflict
3. UnresolvedGrief
4. Loneliness
• TypeI
• TypeII
D. TheDepressiveTriad
1. NegativeBias
• Self
• Other
• Future
2. Chronicmooddysregulation
3. Confirmationbias
E. BehaviorDisturbance
1. BehavioralShutdown
2. Stop:MasteryBehavior—lossofmeaningandpurpose
3. Stop:PleasureBehavior—lossofenjoyment
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4. RelationalWithdraw—Loneliness
5. Procrastination—Criticism
II. ChronicDepression
A. Characteristics
1. Long-standinghistoryofDysthymicDisorder,nowPersistentDepressiveDisorder
withmultiple,superimposedMajorDepressiveEpisodes
2. MultipleMajorDepressiveepisodes,eachlastingseveralyears
• Someneverfullyrecoverandremaininpartialremission
3. Manyhavecomorbiddisorders,includinganxietyandpersonalitydisorders
B. TypicalTreatmentHistory
1. Longperiodsofuntreateddepressionbeforeseekingfirsttreatment
2. Previouslymisdiagnosed
3. Antidepressantonlyatinadequatedosesand/orlengthoftreatment
4. Thosereceivingtherapyderivedlittletonobenefit
5. Fewwillhavereceivedcombinedmedicationandpsychotherapy
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C. CharacteristicsofChronic,TreatmentResistantDepression
1. Highlytreatmentresistanttonearlyalltreatmentmodes
2. Medication
3. Psychotherapy
• CBT
• IPT
• STDP
D. PsychosocialProfile
1. Historyofearly—sometimescomplex—relationshiptrauma//attachmenttrauma
2. RelationshipTrauma"continuousseriesof“low-grade”trauma:
• Psychologicalinsults,putdowns,interpersonalrejection/punishment
• Combinedwithoneormore“high-grade”traumas:physical/sexualabuse,actual
parentalabandonment,emotional/physicalneglect
3. Neurocognitivedeficits"Pre-operationalthinking"apre-causalviewofworld
4. Learnedhelplessness(Lowinternallocusofcontrol)
5. Chronicmooddysregulation"doesnotrespondtoinformation/disputation/
insight/cognitiverestructuring
6. Behavioralshut-down
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7. Ineffective,self-defeatingpatternsofsocialbehavior
8. SubmissiveIPStyle—pullstherapistintodominantrole-"recapitulatesprevious
relationships"helplessness
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TRD103:
ChronicDepressionandInterpersonalNeurobiology
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
Neurobiology plays a significant role in the understanding and treatment of depression. The
brain is complicated—to fully comprehend chronic depression, counselors must also have a
foundational knowledge of interpersonal neurobiology. In this presentation, Drs. Sibcy and
Vance introduce the conceptof interpersonalneurobiologyandwalkparticipants through the
brainanditsfunctions.
LearningObjectives
1. Participants will evaluate Siegel’s Triangle of Well-being and how it relates to the
treatmentofchronicdepression.
2. Participantswillidentifytherolesoftheleftandrighthemispheresofthebrain.
3. Participantswilllistanddefinetheninefunctionsofthemiddleprefrontalcortex.
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I. InterpersonalNeurobiology
A. Siegel’sTriangleofWell-being
1. Mind
2. Brain
3. Relationships
B. TheTwoHemispheresoftheBrain(HorizontalIntegration)
1. Righthemisphere
• Firsttodevelop
• Imagery,emotional,holisticthinking,nonverballanguage,autobiographical
memory
2. Lefthemisphere
• Developslater
• Logic,verbal,linear
3. Horizontalintegration
C. FromHeadtoGut(VerticalIntegration)
1. Nervoussystemascendsfrombottom(ourbodiesandgut)totop(brainstem,limbic
system,prefrontalcortex)
2. Verticalintegrationisaboutlinkingthesedifferentareastogether,bringingbodily
sensationupintoawareness
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D. BrainStem
1. AutonomicNervousSystem–PolyvagalTheory
• TwoBranches
• Sympathetic—Gaspedal
o Fight
o Flight
• Parasympathetic—Brake
o Freeze
2. TheLadder
• Toprung:Ventralactivation(safety)
• Middlerung:Sympatheticactivation(defensesactivated)
• Lowerrung:Dorsalactivation(dissociation)
E. LimbicSystem
1. Emotionalcontrolcenterinbrain
2. Encodesemotionallychargedexperiences
3. Formingofkeymentalmodels/schemasabout
• Self
• Others
• World
4. ConditionedEmotionalResponses
5. Associativelearning
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F. PrefrontalCortex
1. Themiddleprefrontalcortex
• Anteriorcingulate
• Orbitalprefrontalcortex
• Themedialprefrontal
• Ventrallateral
2. Allworktogetherasateam
G. NineFunctionsoftheMiddlePrefrontalCortex
1. Bodyregulation
2. Attunedcommunication
3. Emotionalbalance
4. ResponseFlexibility
5. Insight
6. Empathy
• Theoryofmind
• Mindsight–mentalization
7. Fearmodulation
8. Accessingintuition
9. Morality
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TRD104:
Attachment,InternalWorkingModels,andDepression
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
Thispresentationcoversthebasicstructureofthesecurebasesystem,whichinvolveshowthe
brainandone’ssenseofselfdevelopwithinthecontextofattachmentrelationships.Thislecture
alsodiscussesmodelsofattachmentandinternalworkingmodelsastheyrelatetodepression.
LearningObjectives
1. Participantswillidentifythesecurebasecycleofattachment.
2. Participantswilldefineandexplorethefourtypesofattachmentstyles.
3. Participants will evaluate how attachment wounds impact chronic depression and its
treatment.
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I. TheEssenceofAttachment
A. UniversalCoreEmotionalNeeds
1. Safety
2. Security
3. Nurturance
4. Acceptance
5. Autonomy
6. Livingwithinrealisticlimits"self-control
7. Competence
8. Senseofidentity
9. Freedomtoexpressfeelingsandneeds
B. SecureBase
1. Feltsecurity
2. Self-confidence/exploration
3. Perceivedthreat
4. Attachmentsystem
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5. Signaling
• Caregiver’ssignaldetectionandinterpretation
6. Proximityseeking
7. Safehaven
C. ExpectationsaboutSelfandOthers
1. SenseofSelf
• Autonomy
• Competence
• Identity
• Creativity/spontaneity
• Realisticlimits/Self-control
2. SenseofOthers
• Safety
• Nurturance
• Acceptance
D. StylesofAttachment
1. Secure
2. Avoidant
3. Preoccupied
4. Disorganized
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E. CoreBeliefs/RelationshipRules
1. Self
• AmIworthy?
• AmIcapable?
• AmIwilling?
2. Other
• Areyoutrustworthy?
• Areyouaccessible?
• Areyoucapable?
• Areyouwilling?
F. InternalWorkingModels:RelationshipRules
1. SecureAttachment
• Self-dimension
o I’mworthyoflove
o I’mcapableofgettingtheloveIneed
• OtherDimensions
o Othersarewillingandabletoloveme
o Icancountonyoutobethereforme
2. AvoidantAttachment
• Self-dimension
o I’mworthyoflove(falsepride)
o I’mcapableofgettingloveIwantandneed(falsesenseofmastery)
• OtherDimension
o Othersareincompetent
o Othersareuntrustworthy
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3. AmbivalentAttachment
• Self-dimension
o I’mnotworthyoflove(Ifeelflawed)
o I’mnotabletogetloveIneedwithoutbeingangryorclingy
• OtherDimension
o Capablebutunwilling(becauseofmyflaws)
o Mayabandonme(becauseofmyflaws)
4. Fearful-AvoidantAttachment
• Self-dimension
o I’mnotworthyoflove
o I’munabletogettheloveIneed
• OtherDimension
o Othersareunwilling
o Othersareunable
o Othersareabusive,Ideserveit
G. LearningHistory
1. Self
• Needs
• Wants
• Feelings
• Opinions
2. Others
• Rejection
• Criticism
• Betrayal
• Abuse
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3. Fearedoutcome
• Anxiety
• Shame
• Guilt
4. Avoidance/stufffeelings
• Worthlessness
• Helplessness
5. Helplessness
• Signalsbrainintoashutdownofenergy,motivation,andpleasure
• Signalsbrainintosurvivalmodewithfight/flight,on-edge,irritability/anger,and
hypervigilance
H. EmotionDysregulation
1. Avoidancebehavior
• Stopmasterybehavior
• Stoppleasure
• Signalsbraintostopproducingneurochemistry
• Reinforceshelplessness/worthlessness
• Lossofenergy,motivation,andpleasure
2. Dissociation/PerceptualDisengagement
3. TensionReductionBehaviors
• Self-mutilation
• Sexualactingout
• Addictivebehavior
• Suicidefantasy
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I. PsychosocialProfile
1. MoodDisorderlearnedandmaintainedbychronicandpervasivepatternof
interpersonalavoidance.
2. Avoidanceisfueledbyattachment-basedfear(i.e.,fearbasedonhistoryof
interpersonallearningincontextofattachmentrelationships)whereexpressionof
self/attachment(wants,needs,emotions,andintentions)isrepeatedassociatedwith
attachmentinjuriesandpsychologicalinsultsdeliveredbyattachmentfiguresinthe
formofrejection,criticism,andblame.
3. Consequently,thepersoncomestoassociatetheexpressionofself(includingall
attachmentneeds)withanxiety,shame,andguilt.Anaturalresponsetothese
feelingsisavoidancebehavior(stuffingoffeelings).
4. Thisresultsinchronicfeelingsofworthlessness(“Myfeelingsdon’tmatter”)and
helplessness(“NothingIdoworks,sowhytry?”).Thebiologicalconsequenceofthese
perceptionsisthedeactivationofmotivation,energy,andpleasure(thebrainis
primarilyandconservatorofenergy,thuswhentheperceptionisthatnothingwill
workorchangeinturnsoffactivationrelatedneurotransmitters).Itmayalsoactivate
thebrainssurvivalmode,whichresultsinchronicover-activationofthesympathetic
nervoussystem,resultinginfeelingsofanxiety,tension,andirritability.
J. NeurocognitiveConsequences
1. Theneurobiologicalconsequenceofchronicemotiondysregulationisthe
disintegrationofdendriticconnectionsbetweenPFCandvarioussubcorticalsystems
inlimbicsystem,includinghippocampus.
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2. Degenerationofmiddlefrontalareasofthebrainandhippocampus"impaired
abilitytoattendtoandcontextualizingrelationshipevents
• Consequently,personrelatesinmindlessfashion,repeatingsameoldpatternsof
relationshipexperiences—”InterpersonalSameness”
• Confirmsfeelingsofhopelessnessandhelplessness
3. Thisinterfereswiththebrainsabilitytoformautobiographicalmemoryandother
neurocognitivedeficits
K. NeurocognitiveDeficits
1. Theseneurocognitivedeficitsaresimilartodeficitsdescribedinotherresearch,
includingTheoryofMind,Mindsight,andMentalization
2. AlsosimilartoPiagetianconceptofpreoperationalfunctioning:childlikeegocentric
patternofthinkingwheretheindividualisnotinfluencedbyexternalenvironment….
3. FailureofPerceptualEngagement—visuallydisengagedfromsocialenvironment,
usingpastexperiencetointerpretpresentmoment,thuscreatingthepastinthe
present:continuous,interpersonalsameness.
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TRD105:
Relationship,Healing,andTransformation:AnOverviewofCBASPandChristian
Integration
GarySibcy,Ph.D.,andToddVance,Ph.D.
TreatmentResistantDepression
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Summary
Treatingdepressionrequiresanin-depthunderstandingofhowrelationshipsimpacthealingand
transformation.ThispresentationtouchesonKiesler’sInterpersonalCircumplexModelandalso
provides viewers with a thorough overview of the Cognitive Behavioral Analysis System of
Psychotherapy and its components. Christian integration and accommodation are significant
parts of therapy for many clinicians—this lecture touches on ways Christian caregivers can
effectivelyintegrateCBASPprinciplesintotheirtreatmentmodels.
LearningObjectives
1. Participantswill analyze theKiesler InterpersonalCircumplexModel and its relevance to
treatingpatientswithchronicdepression.
2. ParticipantswillidentifythetheoreticalunderpinningsofCBASP.
3. ParticipantswilldefineandanalyzethetreatmentcomponentsofCBASP.
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I. UnderstandingCBASP
A. TheKieslerInterpersonalCircumplexModel
1. Dominance
• Dominanthostility
• Dominantfriendly
2. Passivity
• Passivehostility
• Passivefriendly
3. Friendly
• Dominantfriendly
• Passivefriendly
4. Hostility
• Dominanthostility
• Passivehostility
B. TheTherapeuticAlliance
1. Empathy,understanding,andsafetyarepartofthetherapeuticalliance.
2. Agreed-upongoalsandmethodsarealsopartofthetherapeuticalliance.
C. WhatisCBASP?
1. CognitiveBehavioralAnalysisSystemofPsychotherapy
• NotBeck’sCognitiveTherapy
• Consideredathird-wavecognitivetherapy
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2. Analytical
3. Exposure-based(avoidanceisactivelydiscouragedandconsequencesofbehaviorare
madeunavoidable)
4. Explicitlyfocusedonlearning–“teachingisarrangingcontingenciessopeoplelearn”
(Skinner,1968)
5. Practicalandactive,notabstract(thepre-operational,chronicpatientcannot
abstract)
6. Interpersonal
7. Focusedatthe“molecular”level(slowpaceandverybasic)
D. TheoreticalUnderpinnings
1. Developmentaltheory(Piaget)
2. Learnedhelplessness(Seligman)
3. Learningtheory(Skinner,Pavlov,Bandura)
4. Perceivedfunctionality(McCullough)
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II. CBASPTreatmentComponents
A. TheSignificantOtherHistory
1. TransferenceHypothesis
2. Identificationof“HotSpot”
B. SituationAnalysis
1. Breakingdowninterpersonalproblematicsituationsinaspecific,structuredwayto
helpthepatientbegintoseewhathappened.
2. Identifyhowthepersonisreadingthesituation.
3. Trainclientstobecometheobserveroftheirownfeelingsandactions.
4. Evaluatetheactualoutcome.
5. Evaluatethedesiredoutcome.
6. Didtheactualoutcomematchthedesiredoutcome?
7. Why?
C. DisciplinedPersonalInvolvement
1. Designedtopenetratepatientsinterpersonalsamenessthroughperceptual
engagement
2. Confrontinginterpersonalbehavior
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3. IncreasingMentalization,understandinghowbehavioraffectsothers
4. Notusingpasttointerpretthepresent
5. Usuallywillactivate“TransferenceHotSpot”
D. InterpersonalDiscriminationExercises
1. Hotspotactivated
2. Drawattentiontoit
3. Askhowotherswouldreacttoit
4. Askhow“you”reactedtoitwiththeminsession
5. Compareandcontrasttopast/others
6. Askaboutimplicationfortherapy
7. Askaboutgeneralizationtofuture
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TRD106:
CBASPToolsandTechniques:SignificantOtherHistory
GarySibcy,Ph.D.,andToddVance,Ph.D.
TreatmentResistantDepression
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Summary
In this presentation, Drs. Sibcy and Vance continue the discussion of CBASP tools and
techniques,focusingspecificallyontheroleandpurposeoftheSignificantOtherHistory.They
discussthefunctionofSignificantOtherHistory inthetherapeuticsettingandunpackthefive
stepsofconductingaSignificantOtherHistory.Additionally, this lecturepresentsacasestudy
illustratingthe importanceofthistechnique inhelpingthetherapistunderstandandbesthelp
theclient.
LearningObjectives
1. Participantswillexploretheroleandpurposeofthesignificantotherhistory.
2. Participantswillwalkthroughthefivestepsofconductingasignificantotherhistory.
3. Participantswillanalyzeacasestudytodeterminethevalueofasignificantotherhistory.
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I. SignificantOtherHistory
A. Introduction
1. TheSignificantOtherHistorypresupposesthatyouhavealreadydoneagood
diagnosticinterview
2. Beopenandhonestwiththeclientaboutthediagnosis
3. Focusonrelievingtheburdenofdepressionbeforeaddressingotherissuesintheir
lives
4. CBASPisarelationaltherapy
5. CBASPmirrorstherelationalaspectsoftheChristianfaith
B. UnderstandingtheSignificantOtherHistory
1. Conductedinfirsttreatmentsessionwithpatient(afterproperdiagnosis)
2. Patientisinstructedtolistnomorethan6personswhohavehadasignificantimpact
onpatient’slife,forbetterorforworse
3. Incontrasttoatraditionalclinicalinterview,theSignificantOtherHistoryisa
structuredmeansofallowingthepatienttoeducatethetherapistaboutthepatient’s
worldastheyseeit
4. Patientbeginstomakeexplicitcausalinferences(movingfrompreoperational
functioningtoformaloperationsthinking)
5. ProvidesbasisforTransferenceHypotheses
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6. LaysgroundworkforInterpersonalDiscriminationExerciseswiththegoalofhaving
thetherapistbecomeasafetysignalforthepatient
• Untilandunlessthishappens,learningcannotoccur
II. TheFiveSteps
A. Step1
1. Requestalistofupto6SignificantOtherswhohaveplayedamajorroleandhada
significantinfluenceonthedirectionthepatient’slifehastaken,orwhohasshaped
thepatienttobewhotheyaretoday.
2. TheinfluencesoftheSignificantOtherscanbepositiveornegative.
B. Step2
1. GothroughthelistofSignificantOthersintheorderthepatientlistedthem.
2. Makesureyouhavethekeyplayers.
C. Step3
1. Beginwiththisquestion:Whatwasitlikegrowinguporbeingaroundthisperson?
Letthepatientrecallseveralmemories,situations,orstories.
2. Then,gotooneofthefollowingpromptsandsay:
• Tellmehowthispersoninfluencedyoutobethekindofpersonyouaretoday
• Howhasgrowinguparoundthispersoninfluencedthedirectionyourlifehad
taken–whatisthatdirection?
• Whatkindofpersonareyouasaresultoflivingaroundthisperson?
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D. Step4
1. GoalistohavethepatientformulateoneCausalTheoryConclusionforeach
SignificantOther.
2. Theconclusionshouldrepresentthe“stamp”orlegacythepatientbelievesthe
SignificantOtherhasleftonthepatient.
3. HowhastheSignificantOtherinfluencedthepatienttobewhohe/sheisrightnow
today?
E. Step5
1. Reviewthe“stamp/legacy”conclusionsofthe6SignificantOthers.Incooperation
withthepatient,trytoidentifyaconsistentthemethatcharacterizestherelationship
thepatienthadwithhis/herSignificantOthers.
2. Then,withthepatient,constructoneTransferenceHypothesisthatexpressesthe
prominenttheme.
• “Ifthissituationhappens,thenthatconsequencewilloccur”
3. Thetransferencehypothesisshouldbepositionedinoneofthefourdomainslisted
below:
• Intimacy/closeness(“IfIgettooclosetoDr.Vance,then…theexpectedoutcome
basedonthecausaltheoryconclusions”)
• Disclosedemotionalneedsorpersonalissues(“IfIneedanythingemotionallyor
disclosepersonalissuestoDr.Vance,then…”)
• Makingmistakes(“IfImakeamistakearoundDr.Vance,then…”)
• Expressednegativeemotionstowardthetherapist(“IfIexpressnegativefeelings
towardDr.Vance,then…”)
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III. CaseStudies:Jane
A. Jane’sBackground
1. 25-year-oldfemale
2. Depressionsinceadolescence
3. Earlyenvironmentcharacterizedbyharshdiscipline,caretakerresponsibilitiesfora
drug-addictedparent,emotionalneglect
B. SignificantOthers
1. Father
2. Mother
3. Oldersister
4. Son
5. Currentboyfriend
C. Summaries
1. Father:Strictdiscipline,morals,butdidnotlivethemhimself(drugaddict),patient
actedasherfather’scaregiver.“DoasIsay,notasIdo.”
2. Mother:Angry,isolated.“Easiertoexpressangerthanotheremotions,‘anti-social.’”
3. Oldersister:Manipulative,dishonest.“Betheoppositeofher.”
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4. Son:Helpedhergrowup.“Patience,letmyguarddown.”
5. Currentboyfriend:Considerateofherfeelings.“Betterabletoexpressloveandsofter
emotions.”
D. AdditionalInformation
1. DuringconstructionofTransferenceHypothesis,fatherofpatient’sson(nother
currentboyfriend)wasmentionedbythepatient
2. ThisS.O.wasaddedtolist,withemergingthemeof“Mencannotbetrusted”
3. ResultingTransferenceHypothesis:“IfItrustDr.Vance,hewillbetrayme.”(a
variationontheintimacydomain)
E. TheRoleoftheTherapist
1. Thetherapistthenrelatesthetransferencehypothesistothetherapist/patient
relationship
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TRD107:
CBASPToolsandTechniques:SituationalAnalysisPartI
GarySibcy,Ph.D.,andToddVance,Ph.D.
TreatmentResistantDepression
LightUniversity54
Summary
In this presentation, Drs. Sibcy and Vance continue the discussion of CBASP tools and
techniques,focusingspecificallyontheroleandpurposeofSituationalAnalysis.Drs.Sibcyand
VanceunpackthesevenstepsofSituationalAnalysis.Viewerswillalsoexploreandunderstand
techniquessuchastheElicitationPhaseandtheRemediationPhase.
LearningObjectives
1. Participantswillexplorethesevenstepsofsituationalanalysis.
2. Participantswillidentifythegoalsoftheelicitationphase.
3. Participantswillanalyzeacasestudyofworkingthroughsituationalanalysis.
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I. CBASPToolsandTechniques
A. SituationalAnalysis
1. UsesCopingSurveyQuestionnaire
2. Twophases
• Elicitation–SAusedasaninterpersonal,cognitivebehavioraldiagnostictool
• Remediation–Problematicbehaviorsaretargetedforchangeandreviseduntil
newbehaviorsbringadesirableconclusion
3. Confrontsavoidanceanddirectsthepatient’sattentiontotheinterpersonal
environment
B. CopingSurveyQuestionnaire
1. DateofSituationalEventandDateofTherapySessionnoted
2. Instructions:Selectoneinterpersonalproblematiceventthathashappenedtoyou
duringthepastweekanddescribeitusingtheformatbelow.Pleasetrytofilloutall
partsofthequestionnaire.YourtherapistwillassistyouinSituationalAnalysisduring
yournexttherapysession.
3. SituationalArea:
___Spouse/Partner
___Children
___ExtendedFamily
___Work/School
___Social
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C. TheSevenSteps
1. Step1:Describewhathappened.(Abrief“sliceoftime”withabeginning,anend,
andashortstoryin-between.)
2. Step2:Howdidyouinterpretwhathappened(howdidyou“read”thesituation?).(A
descriptionoftheprocessofthesituation.)
• 1.
• 2.
• 3.
3. Step3:Describewhatyoudidduringthesituation(whatyousaid/howyousaidit).
(Whatsomeoneelsewouldhaveobservediftheyhadbeenabletoseeyouduring
thissituation.)
4. Step4:Describehowtheeventcameoutforyou(actualoutcome).(Goesbacktothe
endofthesituationinStep1)
5. Step5:Describehowyouwantedtheeventtocomeoutforyou(desiredoutcome).
(Lookingattheendpointofthissituation,whatisthebestyoucoulddoatthat
point?Remember,goalsmustberealisticandattainable.)
6. Step6:Wasthedesiredoutcomeachieved?YES___NO____
7. (Step7:WhyorWhyNot?)
II. TheElicitationStage
A. Step1
1. Steps1-6comprisetheElicitationStageofSituationalAnalysis.
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2. Aninitialgoalissimplytogetthechronicallydepressedpatienttopayattentionto
his/herinterpersonalinteractions.
3. ThiscanmakeStep1verychallenging.
4. Thetherapist’sjobistodirectthepatient’sattentiontoabriefsliceoftimewitha
beginning,anend,andashortstoryin-between.
B. Step2
1. Thetherapistwillalsoassistthepatientinidentifyinghis/herinterpretations
(“reads”)inStep2.
2. Initialreadsareoften“editorial”innature(asisthenarrativeinStep1),giving
reasons,background,ascribingother’smotivations,etc.
3. Thegoalistodirectthepatient’sattentiontowardreadsthatareaccurate(not
guesses)andrelevant(movehim/hertowardthedesiredoutcomeand/orare
groundedintheflowofeventsinthesituation).
C. Step3
1. Thetherapisthelpsthepatientdescribewhathe/shesaidanddidduringthe
problematicsituationintermsthatareobservableandbehavioral.
2. Mostofteninearlysessionsthepatientwilldescribefeelingstates(“Iwasangry”).
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D. Step4
1. Thedisciplineforthetherapistinthisstepistohelpthepatientidentifyan
“endpoint”tothesituation(theActualOutcome)thatcanbedescribedin
observable,behavioralterms.
2. Feelings/emotionscanbenoted,butshouldnotbethemainfocusofdescribingthe
ActualOutcome.
E. Step5
1. Asthepatientbeginstopayattentiontohis/herinterpersonalsituations,the
therapistwillthenbegintoshiftthepatient’sattentiontowardhis/herDesired
Outcome(goal)inthesituation.
2. ThechronicallydepressedpatientisusuallyNOTusedtothinkingintermsofwhat
he/shewantsinasituation(pre-operationalstageofdevelopment).
3. AswiththeActualOutcome,theDesiredOutcomemustbeexpressedinobservable,
behavioralterms.
4. Oftenbesttofocusonwhatthepatientcandirectlysayordoinearlystagesto
teachingSituationalAnalysis.
5. ADesiredOutcomethatmeetscriteriaisthekeyelementofaSituationalAnalysis
thatcanbesuccessfullyremediatedorofasituationwithasuccessfuloutcome.
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III. CaseExample:Mary
A. Step1
Iwasfeedingmysonlunch.Thedoorbellrang.Istoppedfeedingmysonandlefthimin
hischair.Myneighborwantedtoborrowacupofsugar.Itoldherthiswasnotagood
time.Sheinsisted.Iaskedhertocomeback.Shemumbledsomethingabouthowthis
won’ttakelongandaskedwherethesugarwas.Iopenedthedoorandshecamein.She
wentintothekitchenandgotacupofsugar.Thensheleft.Iwasfrustrated,mad,and
thengotdepressedandthought,“I’vebeenscrewedagain.”
B. Step2
1. “Iliketoanswerthedoorbellwhenitrings”
2. “Peopleareinsensitivetomyneeds”
3. “Icannotcontrolmylife”
4. Revisedreads(accurate,relevant):
• “Idon’twanttointerruptfeedingmyson”
• “Ihavetellmyneighborshemustcomebacklater”
• Actionread–“Speakup!”
C. Step3
1. Iansweredthedoorbellandtoldmyneighborthatthisisnotagoodtime.Iaskedher
tocomeback.Iopenedthedoorandletherin.Ipointedhertothesugarbin,then
wentbacktofeedingmyson.
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2. Inremediation,assertivebehaviorwouldbeaddedtomatchDesiredOutcome(Tell
theneighbor“No,comeback”ratherthanlettingherin).
D. Step4
1. ActualOutcome–“myson’slunchwasinterruptedwhenmyneighborcamein.”
E. Step5
1. DesiredOutcome–“Iwantedmyneighbortocomebackatamoreconvenienttime.”
2. TomovetowardthisDesiredOutcome,thepatientneedstosaytotheneighbor,“I’m
feedingmysonnow,canyoucomebacklater?”
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TRD108:
CBASPToolsandTechniques:SituationalAnalysisPartII
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary:
In this presentation, Drs. Vance and Sibcy continue to unpack situational analysis and its use
withchronicallydepressedpatients.Unlikemanyoftheothertoolsandtechniques,situational
analysisisatoolthatwillbeutilizedinnearlyeverycounselingsession.Dr.Vancewalksviewers
throughthestep-by-stepprocessofconductingasituationalanalysiswithclientsandprovides
anin-depthcasestudy.
LearningObjectives
1. Participantswillwalkthrougheachstepofsituationalanalysisin-depth.
2. Participantswillbeabletoconducttheirownsituationalanalyseswithclients.
3. Participantswillexploreacasestudyillustratingasuccessfulsituationalanalysis.
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I. SituationalAnalysisCaseStudyContinued
A. Situation
“MyhusbandandIwereeatingdinner.Hegotup,wenttothedoorandsaid,‘I’mgoing
downstairstoplayvideogames.’Ilookedathimandnoddedmyhead.”
B. Interpretation
1. “Herewegoagain”
2. “What’sthepoint?”
• Feelinghurtandlonely
3. “Nothingworksforme.”
• Speakupandtellhimwhatyouwant
C. Behavior
“Ijustnoddedmyhead.”
D. ActualOutcome
“Ilookedathimandnoddedmyhead.”
E. DesiredOutcome:
1. “WatchTVwithme.”
2. “Iwouldhaveasked,‘WouldyouwatchTVwithmemaybesometimelater?’”
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F. Didyougetit?
“No”
II. FurtherUnderstandingofSituationalAnalysis
A. Step1
1. AftertheElicitationphase,thepatient’sattentionisdirectedtoward“fixing”the
situationintheRemediationphase.
2. AgoodRemediationrequiresagoodDesiredOutcome(realisticandattainable).
3. Therefore,itisoftenbestintheearlystagestohelpthepatientfinddesired
outcomesthatinvolvewhathe/shecandirectlydoorsay.
B. Step2
1. AfterthetherapistandpatienthavereviewedtheCopingSurveyQuestionnaireand
determinedthatthepatient’sDesiredOutcomewasnotobtained,thepatient’s
interpretations(“reads”)inStep2arerevisited.
2. Eachreadisfirstexaminedusingtwocriteria:
• 1)Isthereadaccurate?(i.e.,notaguess,notmindreading,notassuming,etc.)
• 2)Isthereadrelevant–relevanttogettingyourDesiredOutcomeorgroundedin
theflowofthesituation?(i.e.,Doesthereadinsomewaymoveyoutowardwhat
youwantinthesituation?Isthereadgroundedinwhatisactuallyhappening
duringthesituation?)
3. Eachreadisreviewedandevaluatedbyeachcriterion(accurateandrelevant).
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4. Thetherapistthenhelpsthepatientidentifymoreaccuratereadsandreadsthatare
relevanttoachievingtheDesiredOutcome.
5. Thisisusuallydifficultforthepatient.
6. Thetherapistmustbedisciplinedtonotdotheworkforthepatient!
7. Itcanhelptogroundthepatienttemporallyinthe“sliceoftime”inStep1(i.e.,
“Okay,aswelookatthisread,atwhatpointinthesliceoftimedidyouhavethis
read?”Gosentence-by-sentenceifneeded.)
8. Usingawhiteboardorflipchartisveryhelpfulandrecommended.Lookingatthe
problemtogethergivesthepatientadifferent,therapeuticinterpersonalexperience.
9. ThetherapistmayneedtorevisitStep1togetthestory
• VeryoftentheinitialslicesoftimeinStep1aretoolong,“editorial”(mixingreads
andassumptionsintothestory),andnotverbatim
• Thetherapist’sjobistohelpthepatient“draintheswamp”ofemotionand
extraneousinformationinStep1andfocusonJUSTTHEFACTS
• Getaperson-by-personverbatimaccountofthestory
10. Thegoalistoeventuallyarriveatreadsthatmeetbothcriteria(thereadsare
accurateandrelevant)
11. Usuallyactioninterpretations(alsocalled“actionreads”)areneeded
12. Actionreadsareshortinternalpromptsthatmovethepatienttowardactiontaking
• “Speakup”
• “Staycalm”
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C. Step3
1. Step3isrevisitedintheRemediationphase.
2. ThetherapistasksifthepatientseesanythinginStep3thatmayhaveinfluencedthe
outcomeofthesituation.
3. Thegoalistohelpthepatientbecomeabetterobserverofhimself/herself–body
language,toneofvoice,attention,eyecontact,gestures,etc.
• Thishelpsthepatientbegintoseeandunderstandreciprocalrelationships(PxE)
D. PersonbyEnvironmentInteraction
1. Forthechronicallydepressed,theenvironmentdoesnotinformbehavior.
2. OneoftheoverarchinggoalsofCBASPistoteachthepatienthowtointeractin
reciprocalrelationshipsinwhichtheenvironment(otherpeople,context)informs
behaviorandhe/shecancommunicateinwaythattheiseffectiveinthe
environment.
E. FinalSteps
1. AttheendoftheRemediationPhase,thetherapistasks,“Ifyouhadsaid/donethe
thingsyouhavenowidentified,woulditmoveyouclosertoyourDesiredOutcome?
Wouldyougetclosertowhatyouwantedinthatsituation?”
2. Thetherapistthenhelpsthepatientgeneralizethelearningtoother,similar
situations(therearealmostalwaysrecurringthemes).
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3. Thetherapistasks,“Canyouthinkofatleastonemoresituationinwhichyou
behavedinasimilarway?”
4. Finally,thetherapistasks,“If,moreoftenthannot,youhandledsimilarsituationsin
thisnewway,whatwouldyourlifebelike?”
III. CaseStudy
A. Ralph’sStory
RalphforgetshisappointmenttimewithDr.Vanceiswhenheissupposedtobehometo
gethischildrenoffthebusafterschool.
B. Step1
“ItoldmywifeIhadanappointmentwithyouatthesametimeIwassupposedtogetthe
kids.Shegotangry.IsaidIwouldnotchangetheappointmentbutIwouldmakeother
arrangementsforthekids.Shecalledmeafailure.IfeltguiltybutsaidIwouldgetasitter
andIdid.”
C. Step2
1. “Iforgotaboutourappointmentandmyagreementwithmywifetopickupthe
kids.”
2. “Iwon’tbreakmyappointmentwithDr.Vance.”
3. “MywifethinksI’mafailure.”
4. “I’vegottoscheduleasittertogetthekidsby3:30(actioninterpretation/read).”
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D. Step3
“Ilistenedtomywife.ItoldherIwassorrybutwouldn’tchangemyappointment.I
listenedtohersayIwasafailureanddidn’tcarrymyshareoftheloadinthefamily.Ina
matter-of-factway,IsaidIwouldgetasitter.Idid.”
E. Step4
ActualOutcome–“Igotasitterandkeptmyappointment.”
F. Step5
DesiredOutcome–“Iwantedtogetasitterandseeyou.”
G. Step6
1. WastheDesiredOutcomeachieved?YES!
2. Why?“BecauseIstayedfocusedonwhatIwantedandIfoundawaytomakethat
happen,ratherthanfallingintothetrapofthinking‘nothingIdomatters.’”
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TRD109:
CBASPToolsandTechniques:DisciplinedPersonalInvolvement
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
In this presentation, Drs. Sibcy and Vance explore and explain the role and purpose of
Disciplined Personal Involvement. Techniques, such as Interpersonal Discrimination Exercises
and Contingent Personal Reactivity, are discussed. Throughout this lecture, participants will
overview and realize a deeper understanding of the core steps of Disciplined Personal
Involvement and discover how it can be used to help clients work through their emotional
issues.
LearningObjectives
1. Participantswilldiscuss the theorybehindCBASPandunderstandhow it ties in toother
theoreticalmodels.
2. Participantswillexplorethetechniquesusedindisciplinedpersonalinvolvementandhow
theycanbenefitclientsstrugglingwithdepression.
3. Participantswillanalyzehowthetherapistcanutilizedisciplinedpersonal involvementto
establishconnectionswithclients.
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I. DisciplinedPersonalInvolvement
A. Theory
1. CBASPisanempiricallysupportedtherapywithmanualizedaspects.
2. DisciplinePersonalInvolvementisoneofthedistinctivesofCBASP
• TreatingChronicDepressionwithDisciplinedPersonalInvolvement:Cognitive
BehavioralAnalysisSystemofPsychotherapy(2006)
B. PerceivedFunctionality
1. CBASP’sbasicmotifistoconnectthepatientperceptuallytotheenvironment.
2. Perceivedfunctionality,aprimarygoaloftreatment,meansthatthepatientisable
toidentifyandusetheconsequencesofhis/herbehaviorinwaysthatleadtoDesired
Outcomes.
3. UsingDisciplinedPersonalInvolvementisgroundedinthePersonxEnvironment
behavioralmodel:
• B=f(PxE)
4. ThisisderivedfromtheworkofAlbertBandura(1977:SocialLearningTheory).
5. InCBASPtheequationissimplifiedinthatthetherapistisfunctioningasanEforthe
patientandthepatientisintheroleofthePintheequation.
6. Thetherapistisaffectedbythepatientandthepatientisaffectedbythetherapist.
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7. Withthepre-operational,chronicallydepressedpatient,theenvironmentdoesnot
informhis/herbehavior.
8. OneofthegoalsofCBASPistohelpthepatientacquiretheskillstohaveeffective,
reciprocalrelationshipswithhis/herenvironment.
9. Thepatient’sbehaviorisinformedbyhis/herenvironmentANDthepatienthasthe
skillsandabilitiestohavetheenvironmentreceiveinformationfromthepatient.
C. Discipline
1. The“disciplined”componentmeansthatthetherapistisawareoftheimpactsthe
patientishavingonhim/herandisNOTreactinginthewaymostpeoplereacttothe
patientoutsideoftherapy.
2. Instead,he/shechoreographshis/herreactionsinawaythatteachesthepatientthat
he/sheisconnectedwiththepatient(“Iaffectandyouaffectme,likeitornot!”).
3. Asthepatientachievesincreasinglevelsofperceivedfunctionality,thenatureofthe
relationshipchangesandbecomesmuchmorereciprocal.
II. TypesofDisciplinedPersonalInvolvement
A. Overview
1. InterpersonalDiscriminationExercise
2. ContingentPersonalReactivity
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B. InterpersonalDiscrimination
1. Thetherapistmustbecomea“safetysignal”forthepatient
2. Patientscomefromearlytraumaticenvironmentswhereothersareexperiencedas
toxic
3. Pavlovianlearningmustbeaddressed
4. Therapistmustlookforopportunitiestoallowpatienttoexperienceinterpersonal
discrimination,becomeasafetysignal
5. IDErequiresthetherapisttobeawareofthepatient’stransferencehotspots,then
useopportunitiestocompareandcontrastthetherapist’sinteractionwiththe
patienttothoseoftoxicSignificantOthers
6. Thegoalisforthetherapisttoarrangethecontingenciesintheenvironmentsothat
thepatienthasadifferent,therapeuticinterpersonalexperience
7. Thetherapistisdiscriminatinghimself/herselffromthepatient’stoxicSignificant
Others
C. InterpersonalDiscriminationExercise
1. Thetherapistlooksforopportunitiestocompareandcontrasthis/herbehaviorto
thatoftoxicSignificantOthers
2. CaseExample:Lori,a35-year-oldfemale,getsthedateandtimeofhernext
appointmentconfusedandarrivesattheofficeexpectingtoseeDr.Vance
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3. Dr.VanceremembersoneofLori’stransferencehotspotsis,“IfImakeamistake,I’ll
bepunished.”
4. Dr.VancespeakswithLori,worksoutthesituation,andcomparesandcontrastshis
behaviortospecificSignificantOthers(“Lori,I’mwondering,howwouldyourfather
havehandledthissamesituationyouandIjustdealtwith?”)
5. ThenDr.VancehelpsLorigeneralizethelearningtoothersituations(“IfyouandIcan
workthisout,whatdoesthatmeanforyououtsideofthisoffice?”)
6. DONOTdotheworkforthepatientatthispoint!
D. ContingentPersonalReactivity
1. Incertaintherapeuticsituations,thetherapistbecomesaninterpersonalproblemfor
thepatienttodealwith.
2. Thistypicallyinvolvesproblematicbehaviorbythepatient(e.g.,beinghabituallylate
forappointments,noshows,suicidalthreats,discountingthetherapist’smotivations,
etc.).
3. Butcanalsobeusedtoreinforcedesiredbehaviors(e.g.,asuccessfulSA,inquiring
aboutthetherapist’swell-being,etc.)–reactBIGinthesesituations.
4. Thetherapistnoticesthebehaviorandasksthepatienttoconsiderhowthatbehavior
affectsthetherapist.
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5. Thetherapist“consequates”thebehaviorofthepatientbydisclosingpersonal
responsesandfeelingsproducedintherapistbythebehaviorofthepatient.
6. SeveralthingsmusthappenwhenthisformofDPIisused:
• Thetherapist’spersonalreactionmustbestatedopenly(“I’mgettingpessimistic
aboutourworkjustlisteningtoyoutellmethatyouarewastingyourtimehere.”)
• Thepatient’sbehaviorthatpulledforthereactionmustbeidentified(“Your
continualattemptstopersuademethatnothingcanhelpyou.”)
• Thepatientmustbeshownexplicitlythattheeffectonthetherapistderivesfrom
thePxEconnection(“DidyourealizethatwhatyoudoaffectshowIfeel,whatI
think,andmyreactionstoyoumoment-by-moment?)
7. Goals:
• TeachthePxEconnectiontothepatient
• Modifybehaviorsthatarehurtfulandlimitthepatient/therapistrelationship
• Transferthenewlylearnedinterpersonalskillstorelationshipsoutsideoftherapy
• ThetherapistservesasanENVIRONMENTALCONSEQUENCEforin-sessionpatient
behavior
E. AdditionalInformation
1. DisciplinedPersonalInvolvementisapowerfultoolthatmustalwaysbeused
therapeutically,forthebenefitofthepatient.
2. DPIisusedbythetherapist:
• Tomodifypatientbehaviorbydisclosingpersonalresponsesandfeelingsthe
patienthaspulledfromthetherapist
• TohealearlytraumaperpetratedbytoxicSignificantOthers
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TRD110:
MeasuringProgressandChangeThroughoutTherapy
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
Togetanaccuratereadontheefficacyoftreatmentwithclients,itisessentialtomeasure
progressandchangethroughoutthecourseoftherapy.Drs.SibcyandVancedescribethe
importanceandbenefitsofmeasurementinCBASPtherapyforbothcounselorsandclients.The
presentersdiscussseveralcasestudiesandillustratehowmeasurementcanshedlightonthe
treatmentforallinvolved.
LearningObjectives
1. Participantswillevaluatetheimportanceofaccurateandthoroughmeasurementin
therapy.
2. ParticipantswillanalyzethetypesofmeasurementusedinCBASPtherapysessions.
3. Participantswillexplorecasestudiesanddiscoverthepracticalapplicationof
measurementintherapy.
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I. MeasuringProgressandChangethroughoutTherapy
A. TheImportanceofMeasurement
1. Whilemuchismadeof“empiricallysupportedtherapies”theessenceofthe
empiricalapproachissimple
2. Thetherapistmeasuresthepatient’sprogressatbaselineandthroughouttherapy
3. Thesedataareusedtoinformthepatientandtherapistofthepatient’sprogress
B. TypesofMeasurement
1. Targetedthoughtsandbehaviorsaremadeexplicittothepatientandmeasured
• Distressatbaseline(BDI-II,PHQ-9,HAM-D,etc.)
• TransferenceDomains:CBASPInterpersonalQuestionnaire(CIQ)
• SituationalAnalysis:PatientPerformanceRatingForm(PPRF)
• GeneralizedTreatmentEffects(BDI-II,PHQ-9,HAM-D,etc.)
C. BaselineMeasurement
1. Takenatthetimeofintake/diagnosticinterview
2. Multiplemeasurescanbeused,ifdesired
3. Inmanycases,thechronicallydepressedpatient’sresultswithbeatornear
maximumseveritylevels
4. Onemacroassessmentoftreatmentsuccessiswhenthepatientdoesnotreactto
normal,dailystresswithdepression
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D. EarlyPhaseMeasurement
1. CBASPInterpersonalQuestionnaire(CIQ)isadministeredatthetimeofthe
SignificantOtherHistory(firstsessionafterintakeanddiagnosis).
2. TheCIQmeasurefourtransferencehypothesisdomainstodeterminewhicharemost
presentforthepatient.
3. FourDomains:
• Intimacy
• EmotionalNeeds/PersonalDisclosure
• MakingMistakes
• ExpressingNegativeAffect
E. MeasurementDuringTherapy
1. Atregularintervals(ideallyeverytwoweeks),askthepatienttotakeonemeasure
(PHQ-9orBDI-IIaregood)beforeyoursessionbegins
2. Thereareprosandconstoeachmeasure
3. Useoneconsistently
4. Trackthisovertimeanddiscussitwithyourpatient
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II. CaseStudies
A. Jill
1. Co-morbidPTSDandDepression
2. MedsandPsychotherapy
3. 20therapysessionswithabreakofmorethansixweeksattheendoftherapy
4. Depressionsymptomswithinnormallimitsatsession14
5. DepressionsymptomsremainedWNLaftersix-weekbreak
051015202530354045
1 2 3 4 5 6 7 8 9 10
Scor
e
Bi-Weekly Measurement
BDI-II Scores
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B. Mary
1. 50-year-oldfemale
2. Historyofsexualtrauma,ChronicDepression,PTSD
3. Depressivesymptomsinthesevererangeatbaseline
4. Declinedmedications,thereforeCBASPonly
5. Triggeredbytraumareminderduringtherapy,referredfortrauma-specifictherapy
Depression Symptom Severity
0
510
1520
2530
35
1 4 7 10 13 16 19 22 25 28 31 34 37
Tx Sessions
BDI-I
I Sco
res
Series1
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C. Joe
1. 48-year-oldmale
2. ReferredforCBASPafterbeingnon-responsetoout-patientdepressiongroup
III. MeasuringSkillsAcquisition
A. PatientPerformanceRatingForm
1. Usedtomeasurepatient’sabilitytocompleteSituationalAnalysishimself/herself
withoutthetherapist’sassistanceduringthesession.
2. PatientmustbeabletocompletebothElicitationandRemediationphasesatalevel
of5ona0-5ratingscale.
BDI-II Scores
0
10
20
30
40
50
60
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Sessions
BDI-I
I Sco
res
Series1
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B. FiveRatedSteps
1. Step1–describingthesituation
2. Step2–interpretations/readsmustbeaccurateandrelevant(groundedinsituation
beinganalyzed)
3. Step3–patient’sbehaviorwasinserviceoftheDO(presupposesagoodDO)
4. Step4–actualoutcomedescribedinbehaviorallanguagethatisobservable
5. Step5–agood(meetscriteria)DOspecifiedinbehaviorallanguage(donotrate
feelings/emotions)
C. MeasuringGeneralizedTreatmentEffects
1. Overtime,thegoalisforthepatient’sdepressivesymptomstoremit.
2. TheBDI-II,PHQ-9,andothermeasuresshowevidenceofgeneralizedtreatment
effects.
3. Theidealisforthepatienttonotreacttonormalstresswithdepressionandfor
treatmenteffectstobedurableovertime.
4. Ifpossible,scheduleathree-monthfollow-upaftertreatmentiscompleted.
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TRD111:
ChristianIntegrationandAccommodation
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
CBASPisaversatiletreatmentthatcanbeeasilyintegratedwiththeChristianfaith.Inthis
presentation,Drs.SibcyandVancewalkthroughwayscounselorscanincorporateChristian
principlesandtechniquesintoCBASPtherapyifworkingwithclientsoffaith.Viewerslearnhow
tointegrateChristianprinciplesonboththetherapistandclientlevelinawaythatisbeneficial
toclients.
LearningObjectives
1. Participantswillidentifythefouraspectsofdepression.
2. Participantswillexaminetheimportanceofrelationshipinchronicdepression.
3. ParticipantswillanalyzethetwoplanesofChristianintegrationwithCBASPpatients.
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I. ChristianIntegrationandAccommodation
A. UnderstandingDepression
1. Biological
2. Psychological
3. Social
4. Spiritual
5. CBASP–chronicdepressionisarelationalproblem
B. ChristianFaithisInherentlyRelational
1. Genesis2:18–Itisnotgoodformantobealone
2. Relationshipisabiologicalimperative(Porges,2011)
II. TwoPlanesofIntegration
A. TheTherapistLevel
1. Implicit/explicitpractice
2. Linkingyourpracticeofcounselingandpsychotherapytorelationshipimperative
3. Justasyoucarryoutyourplansandintentionsthroughyourbody,soChrist/God
carriesoutHisthroughHisbody,theChurch.
4. 1Peter2:5–livingstones
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5. ICorinthians12:12ff–thediversityandunityofthebody
6. WeareinhabitedbytheHolySpirit,whoprompts,direct,supportsyouasyougo
throughthisprocess
7. John7:37-38–RiverofLifeMetaphor
B. TheClientLevel
1. Differenttypesofpatients:
• AretheyseekingChristiancounseling?
• AretheyChristian’sseekingcounseling?
• Aretheyexplicitlywantingyoutoaddresstheirfaithinthecourse?
2. Keythemes:
• “I’mspiritualbutnotreligious”Christians
• Explorehowchurchhaspossiblydamagedthem
• Considerthesefactorsintransferencehypothesis
• TheroleDPI
C. OvercomingInterpersonalFear
1. OutofEgypt
2. Leavingthewilderness
• CrossingtheJordanRiver
• Enteringthepromisedland
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TRD112:
Role-play:ClinicalDiagnosisofPersistentDepression
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
How do you diagnose chronic depression? Should you always use CBASP or are there times
when it would be better to use other treatments? Drs. Sibcy and Vance demonstrate this
throughrole-play.Viewerswillwitnessrole-playsthatrevealwhatquestionstoaskintheinitial
diagnosticinterview,howtointroduceCBASPtoaclient,andhowtosetthestageforCBASP.
LearningObjectives
1. Participants will explore how to conduct a diagnostic interview and the types of
informationthatshouldbegathered.
2. Participantswillcompilealistofhelpfuldiagnosticquestions.
3. Participantswillpinpointthetypeofdepressionexhibitedbythepatientintherole-play.
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I. TheDiagnosticInterview
A. GatheringInformation
1. Generaloverview
• Age
• Reasonfortreatment
2. Backgroundinformation
• Placeoforigin
• Familysituation
• Relationshiptoparents
• Childhoodexperiences
3. Currentsituation
• Maritalstatus
• Children
• Homelife
4. Historyofabuse
5. Religiousbeliefs
6. Previoustreatment
• Medications
• Counseling
7. Familyoforigin
• Mentalillness
• Physicalproblems
8. Employment
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B. DiagnosticQuestions
1. Inthepasttwoweeks,wouldyousayyouhavefeltdown,sad,anddepressedmore
daysthannot?
2. Haveyoufoundyourselflessinterestedinthingsyouusuallyenjoyorlessmotivated
thanyouwouldliketobe?
3. Inthepasttwoweekshaveyounoticedanychangeinappetite?
4. Inthepasttwoweeks,haveyounoticedanychangeinyoursleeppattern?
5. Wouldpeoplearoundyounoticeyoubeingsluggish,lethargic,ortheopposite;keyed
uporedgy?
6. Howhasyourenergylevelbeen?
7. Haveyoufoundyourselfbeingparticularlyhardonyourselfinthelasttwoweeks?
8. Hasitbeenharderthanusualtoconcentrate?
9. Haveyouhadanythoughtsofsuicide?
C. PinpointingtheTypeofDepression
1. Ifyouwentbacktwoyears,wouldyousayyouhavebeendepressedmoredaysthan
notforthepasttwoyears?
2. Doyougenerallyhavepoorappetiteortendtoovereat?
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3. Howdoyoufeelaboutyourself?
4. Howdoyoudowithdecisionmaking?
5. Doyoueverwrestlewithfeelingsofhopelessness?
6. Haveyoueverhadadistinctperiodoftimethatotherswouldnoticewhereitwasthe
completeoppositeofdepression?
7. Haveyouhadanytraumaticexperiencesthatcontinuetohauntyou?
D. GivingFeedback
1. Diagnosis
2. TreatmentPlan
II. Observations
A. AskingSpecificQuestions
B. FurtherPointstoConsider
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TRD113:
Role-play:SignificantOtherHistory
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
How do you conduct a Situational Analysis? Drawing from the information presented in the
previouslectures,Drs.SibcyandVancerole-playasessionwherethecounselorandclientwork
throughcreatingaSituationalAnalysis.Viewerswillbeabletowatchasthepresentersportraya
scenarioinwhichaclientishelpedtounderstandwhatneedstotakeplaceforhimtoreceivehis
desiredoutcome.
LearningObjectives
1. Participantswilldiscovertechniquesusefulforhelpingapatientidentifysignificantothers.
2. Participantswillexplorewaystoanalyzethemesandrelationshippatternswiththeclient.
3. Participantswilldiscoverhowtobalancetherapeuticinsightandallowingclientstocome
totheirownrealizations.
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I. ConductingaSignificantOtherHistory
A. TheFourSignificantOthers
1. Mother
• Controlling
• Negative
• Unpleasant
2. Father
• Pleasant
• Rarelyaround
• Goodrelationship
3. John
• Friend’sfather
• Treatedlikeason
4. Sandy
• Wife
• Controlling
• Complainer
B. GoingDeeper
1. Whatmarkhavetheyleftonyou?
• Mother
• Father
• John
• Sandy
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C. IdentifyingThemes
1. Avoidance
2. “IfIaskforwhatIneed,___________________.”
II. Observations
A. TypicalSignificantOtherHistoryPatterns
B. UnresolvedLoss
C. Chronicsvs.Non-chronics
D. LetthePatientConnecttheDots
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TRD114:
Role-play:SituationalAnalysis
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
How do you conduct a Situational Analysis? Drawing from the information presented in the
previouslectures,Drs.SibcyandVancerole-playasessionwherethecounselorandclientwork
throughcreatingaSituationalAnalysis.Viewerswillbeabletowatchasthepresentersportraya
scenarioinwhichaclientishelpedtounderstandwhatneedstotakeplaceforhimtoreceivehis
desiredoutcome.
LearningObjectives
1. Participantswill identifypractical tools and techniquesuseful in conductinga situational
analysiswithaCBASPclient.
2. Participantswillobservethetherapistwalkthroughthesevenstepswiththeclient.
3. Participantswillanalyzetheefficacyofthesituationalanalysiswiththeclient.
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I. ConductingaSituationalAnalysis
A. TheSituationalArea
1. Spouseorpartner
2. Children
3. Extendedfamily
4. Workorschool
5. Social
B. TheSevenSteps
1. Step1:Describewhathappened
2. Step2:Describeyourinterpretationofwhathappened
3. Step3:Describewhatanobserverwouldhaveseen
4. Step4:Describehowtheeventturnedout
5. Step5:Describehowyouwantedtoeventtoturnout
6. Step6:Describewhetheryouachievethedesiredoutcome
7. Step7:Describewhyorwhynot
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II. WalkingThroughaSituationalAnalysis
A. Situation
Fredwalksintothegrocerystore.Hiswifecallsandaskswhatheisdoing.Fredreplies
thatheisgoingtothestoretopickupsomethings.Hiswifeaskswhyheisdoingthat
sinceshejustwentyesterdayandtheydon’tneedanything,it’snotgoodforhim,and
it’llmakehimfat.Fredreplies,“Whatever,”hangsup,andwalksoutofthestorewithout
purchasinganything.
B. TheElicitationPhase
1. Walkthroughthestepswiththeclient
2. Writedownresponses
C. TheRemediationPhase
1. Evaluateeachreadbyrelevance
2. Evaluateeachreadbyaccuracy
III. Observations
A. CommentsontheSituationalAnalysis
B. AdditionalAdvice
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TRD115:
Role-play:DisciplinedPersonalInvolvement
GarySibcy,Ph.D.,andToddVance,Ph.D.
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Summary
In this final segment of the CBASP role-play, Drs. Sibcy and Vance role-play how to use
Disciplined Personal Involvement to demonstrate to clients that their actions impact those
around them. Particular emphasis is placed on working through issues in counseling in a
therapeuticway.Withcareandintentionality,therapistscanhelpclientsdiscoverhowtowork
throughconflictinahealthymanner.
LearningObjectives
1. Participantswillexplorewaystoefficientlyandeffectivelyutilizedisciplinedpersonal
involvementwithCBASPclients.
2. Participantswilldiscoverhowtobalancebetweenencouragingtheclienttotakethings
seriouslyandrefrainingfromemotionallyoverwhelmingtheclient.
3. Participantswilldiscoverhowtouseatherapysatisfactionscaleasateachingtoolin
therapy.
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I. Role-play:DisciplinedPersonalInvolvement
A. AddressingtheIssues
1. Howdoesano-showaffectthecounselor?
2. Whatcanbedonetofixtheproblem?
B. DifferencesinTherapist’sResponsevs.Client’sExpectations
1. WhathappenedwhenFredaskedforwhatheneeded?
2. HowwouldFred’smotherhavehandledthesituation?
3. Howwouldothershandlethesituation?
II. Observations
A. TheArtofCBASP
1. Findingthefinelinebetweenencouragingtheclienttotakethecounselorseriously
ratherthanoverwhelmingthememotionally.
2. Generalizethelearning(“Hasanybodyeverreactedthisway?”)
3. Makeyourselfaproblemforthepatientinatherapeuticway
B. TheAttachmentSystem
1. Thefearfulavoidanceismaintainedbyescapinganxiety.
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2. Earlyon,thereistypicallyverylittlereciprocity.
3. Itisverycommonforpatientstofearexpressingnegativeemotion.
III. Role-play:TherapySatisfactionScale
A. TheClient’sPerspective
B. TheTherapist’sResponse
C. WorkingthroughtheIssuesTherapeutically
1. Howdidthetherapistrespond?
2. Howwouldpeopleintheclient’spasthaveresponded?
3. Howwillothersrespond?
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