Class Log 421, Summer 2023
this page is under prepetual construction
7-13-23: 15th class: last class "time for you to go out to the places you will be from" (Closing Time, Semisonic)
Greeting Exercise
Begin with breath
Visualzie the person behind the door, suffering human being, once a child, has hopes and) dreams, vulnerable and afraid, believing you can help
Now open the door and say "hello." (Ronald D. Siegel, workshop, 2019)
7-11-23 14th class: systems cont.
This is the secret of the teaching: It may be so, but it is not always so. Without being caught by words or rules, without many preconceived ideas, we actually do something, and doing something, we apply our teaching. (Suzuki, 2002, p. 93)
Ivan
discussion of test: AB et al., pp 103-176 led by Shania
review: course, textbooks
Macon, token economies, generalization (transfer & maintenance)
Show & Tell: Friedberg & McClure (2002); Lee (2014); Stott et al. (2010)
Assignment: turn in your journal Thursday
books that aren't about therapy but might make you a better therapis:L Gina Rippon (2019). Gender and Our Brains: How new neuroscience explodes the myths of male and female minds. NY: Pantheon Books. [I actually disagree with her overall conclusion that there are no biologically based differences in male and female brains but agree with most of her particular points and aguements. Just because you think someone is wrong doesn't mean that they don't have ideas worth thinking about.]
7-6-23 13th class: systems
As the Buddhist Nun Thubten Chodren has asserted in a recent book title, both Buddhist psychology and CBT suggest, "Don't believe everything you think" (2012). As such, healthy speech involves our understanding that the words we use with ourselves, as well as with others, carry strong influences upon our behavior and emotions. By bring mindfulness, acceptance, and compassion to our speech, we are following the Eightfold Path, and moving towards liberation of suffering in both Buddhist psychology and CBT terms.(Tirch, Siberstein, & Kolts, 2016, p. 53)
video: Donald Meichenbaum "Cognitive Behavioral Therapy"
discussion of Beck et al.(2021) ch.s 1-6 lead by Joshua
Ivan
Ivan assignment: in your journal, develop an initial home behavioral program for the Rumples
a) at least one positive goal: working to increase desirable behavior
b) identify a clear behavioral target (objective, countable)
c) lay out their program for the week (what the parents are to do)
d) make some attempt to evaluate results of 1st week
handouts: Ivan the Terrible
show & tell: Miller (1975); Patterson (1968, 1975); Tharp & Wetzel (1969)
books that aren't about therapy but might make you a better therapist: Atul Gawande (2010). The Checklist Manifesto: How to get things right. NY: Picador.
6-29-23 12th class CBT
"Frieda Fromm-Reichmann . . . was inspired in childhood by the writings of the great sixteenth-century rabbi Isaac Luria on tikkun, the collective task of rescuing the sparks of the divine that were shattered at creation . . . Luria taught that to help another human being was inherently redemptive. According to the principle of tikkun, 'To redeem one person is to redeem the world.'" (Williams, 2004, p. 283).
video: J.S. Beck (2006), Cognitive Therapy. APA Systems of Psychotherapy, series 1
discussion of JB ch. 11-16 led by Aleena
practice: working with thoughts
What matters: Beck pleasure and mastery
Kahneman: happiness and satisfaction
Self-Determination Theory (Deci & Ryan): "autonomy, competence, and relatednesss are organismic psychological needs" (Reeve, 2018, p. 125)
natural regulators of mood: exercise, social engagement, satisfying activities
6-27-23 11th class CBT cont.
Feelings are the very revelation to each indivudal mind of the status of life within the respective organism, a status expressed along a range that runs from positive to negative. . . . Feelings are the subjective experience of the state of life--that is, of homeostatis--in all creatures endowed with a mind and a conscious point of view. We can think of feelings as mental deputies of homeostatis. (Damasio 2018, p. 25)
discussion of text led by Jenna: ch. 17-22
assignment: ACT treatment of offensive word, record results (no word or words) in journal
Think of a word that really bothers you. That you dislike hearing aloud. Find a private place. Speak the word aloud, repeatedly, rapidly for s few minutes. What is your experience? What happens to the word, its meaning, emotional valence, evocative characteristics as you say it alound, over and over, for a period of time? I don't need to know the word or words you used but, in your journal/log write down how this experience was for you. Would it ever be useful to prescribe this activity for a client? How would/could it be helpful (or not) for a client?
books that aren't about therapy but might make you a better therapist: Marcus Aurelius, Meditations
6-21-23 10th class CBT cont.
"Here's a quote that has been attributed tp several sources that sumes this up nicely: What your thoughts. They become words. Watch your words. They become actions. What your actions. They become habits. What your habits. They become character. Whatch your character. It becomes your destiny." Judson Brewer, J. (2021). Unwinding Anxiety: New science shows how to break the cycles of worry and fear to heal your mind. NY: Avery.
Open, Questions, Agenda
Journals, Role Plays, Reading (J. Beck ch. 6 & 7 by House), A. Beck video, ?, Plan, Summary, Close
discussion: views on PMR and meditation
handouts: BDI, PHQ-9, GAD-7
show & tell: Thich Nhat Hanh (1976); Kornfield (1993); Kabat-Zinn (1994); McCown, Reibel, & Micozzi (2010)
books that aren't about therapy but might make you a better therapist: Panksepp, J. & Biven, L. (2012). The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions. New York: W.W. Norton.
6-19-23 9th class: Cognitive Behavior Therapy
Men are disturbed not by things, but by the view which they take of them. Epictetus (55 — 135 AD)
role plays, conclude
text: JB ch.s 1-5, led by Heileigh
case videofeedback of role plays and social skill training
cognitive therapy, cognitive behavior therapy, CBT
Ellis, Beck, main stream
turn in journals
show & tell: Ledley, D.R., Marx, B.P., & Heimberg, R.G. (2018). Making Cognitive-Behavioral Therapy Work: Clinical process for new practitioners, 3rd ed. NY: Guilford; Schuyler (1991). A Practical Guide to Cognitive Therapy. NY: Norton; D. Greenberger & C.A. Padesky (2016). Mind Over Mood: Change how you feel by changing the way you think, 2nd ed. NY: Guilford; C.A. Padesky (2020). The Clinician's Guide to CBT Using Mind Over Mood, 2nd ed. NY: Guilford; Beck, Rush, Shaw, Emery (1979), Cognitive Therapy of Depression, NY: Guilford; Ellis, A. (1971), Reason and Emotion in Psychotherapy. NY: Lyle Stuart.
6-15-23 8th class: social skill training/behavioral activation cont.
A typical human heart beats between sixty and a hundred times a minute. In the modern world, where we are the beneficiaries of advanced medicine and nutrition, humans live on average for about as twice as long as West's scaling laws would predict. Call it 3 billion heart beats. Three billion isn't such a big number. What are you going to do with your heart beats?" (Carroll, 2016, p. 389)
set agenda
questions, issues? discussion of practice discussion of reading MDH-D pp. 122-189 (ch.s 7-10) led by Michelle work show & tell: Marra (2005); Campbell (2018); Resick et al. (2017); Kanter, et al., 2009).books that aren't about therapy but might make you a better therapist: Howard Rachlin (2014). The Escape of the Mind. Oxford: Oxford University Press.
6-13-23 7th class: BA, Soc Skill Training
"In the Nichomachean Ethics, Aristotle draws a helpful distinction between the clever man and the wise man. the clever person is one who knows the best means to any given end; the wise individual is the one who knows which ends are worth seeking." (Hinman, 2000, p. 423)
set agenda
questions, issues? discussion of practice discussion of reading MDH-D pp 62-121 led by Joey workLiberman's view of social skills Actualization Through Assertion: A Behavioral Approach to Personal Effectiveness
show & tell: Alberti & Emmons (1974); Dawley & Wenrich (1976); Liberman, DeRisi, & Mueser (1989); Meichenbaum (2012)
handouts: Liberman notes
books that aren't about therapy but might make you a better therapist: Joseph LeDoux (2019). The Deep History of Ourselves: The four-billion-year story of how we got conscious brains. NY: Viking.
6-8-23 6th class: behavior activation,: social skill training
Good therapy thus involves helping the client to make sense of how the world really works; this means both the person's internal and external worlds, and represents a substantial chnage from the inflexible set of negative beliefs that characterize emotional disorders. (Stott, Mansell, Salkovskis, Lavender, & Cartwright-Hatton, 2010, p. 38)
set agenda
discussion of reading MDH-D pp 1-60 led by Raquel video: McMain & Wiebe (2013). Dialectical Behavior Therapy for Emotional Regulation. N.Y.: W.W. Norton. books that aren't about therapy but might make you a better therapist: Joshua Green (2013), Moral Tribes: Emotiona, Reason, and the gap between us and them. NY: Penguin. [I'm not sure about his solution (read this book while watching the remake of Brave New World on TV) but he lays out the problem, and the neurobiology, quite well.]
6-6-23 5th classs: DBT
You are perfect just the way you are, and you could use a few improvements. (Suzuki, 2006)
DBTindividual sessions (validation & change, chain analysis, exposure)
telephone coaching
skill training (mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness)
team meeting (maintaining treatment fidelity)
handouts: Mascaro et al. (2015); Miller (2018), DBT Flowchart; DBT for Emotional Regulation
show & tell: Koermer (2012; Linahan
5-26-23 4th class: addressing issues of arousal, emotional regulation, fears,
"Likewise, modern clinical practitioners are advised to be careful not to make mindfulness itself an end goal, or to make it some kind of sacred thing, or to become a 'militant for mindfulness.' The history of psychology is already too full of pompeting cult-like schools of thought. After we cross a river using a raft, we don't need to carry the raft around on our backs all the time, and we don't need to preach to other why they too should all carry rafts on their backs. There is no need to become attached to the concept of mindfulness--it is simply a concept that describes a natural human process.
Mindfulness is a tool we can use for ourselves and for our clients to wake up to the present moment. When you put this book down, ask yourself, 'What am I experiencing right now?' When you meet with a client, ask, 'How may I help you?'" (Sears, Tirch, Denton, 2011, p. 162)
set agenda
questions, issues, confusion? discussion of practice discussion of reading, DHELN by Estrella. work Systematic Desensitization emotive imagery handout: example of desensitization record case: treatment of complex case--OCD, fears, poor self-esteem, nonassertiveness treatment of OCD Assignments 5 and 6 practice: selecting a target behavior/problem for next week: Assignment 10show and tell: Thich Nhat Hanh (2008); O'Mara (2019); Salmon (2020); Williams et al. (2015)
handout: systematic desensitization record
alternative arousal management techniques
cue conditioned relaxation, differential relaxation systematic desensitization & flooding/response prevention/prolonged exposure AWARE (Beck, 1995) imagery relaxing images: swimming pool, mountain scene, personally relaxing image containment: putting issues away ego strengthing: challange/overcoming images clearing imagery: thought stopping, SCT (distress tolerance vs. emotional regulation skills) breathing (interesting discussion) James Nestor (2020). Breath: The new science of a lost art. NY: Riverhead Books. diaphragmatic breathing heart rate variability box breathing counting demo: child relaxation Raggerty Ann/Andy questions summary close
books that aren't about therapy but might make you a better therapist: Panksepp, J. & Biven, L. (2012). The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions. New York: W.W. Norton.
5-30-23: 3rd class: hierarchies, & successive approximations; desensitization
The easiest way to eat the elephant in your path is in many little pieces. African proverb
set agenda
questions, issues, confusion? discussion of practice discussion of reading, DHELN led by Garett work hierarchy buildingdemonstration: hierarchy construction
practice
Assignment: for the next three weeks, trying sitting (meditation) daily for 10 minutes, record experience in journal
turn in journals a week from today
discussion of text on Thursday, lead by Estrella.
you will need an interpersonal problem for the next two weeks: something involving a situation you would like to turn out better, something real, something possible (you will need to practice in real life as well)
show & tell: Feldman ^ Kuyken (2019); Carrington (1977); Pollak, Pedulla, & Siegel (2014); Smalley & Winston (2010).
books that aren't about therapy but might make you a better therapist: Robert M. Sapolsky (2017). Behave: The biology of humans at our best and worst. NY: Penguin Press.
5-25-23: 2nd class: arousal management cont.: variations on PMR; imagery and suggestion; meditation
"It is not necessary to do the practice and make it work; it is only necessary to do the practice and trust that you are planting seeds that in time will take root." Morgan & Morgan, 2005, p. 90
set agenda
questions, issue, confusion? discussion of practice and assignments discussion of reading, House: DHELN ch 1-4 work demo and practice: PMR/focus and release only sensory focus imagery/suggestion review questions closeAssignments:
Journal assignment 3 (construct a personally relaxing image)
for Tuesday: practice passive (relax only) PMR on your own, record efforts in journal
find someone to practice practice passive (relax only) PMR with, record efforts in journal
You need a fear for next week, something that bothers you more than you think it should; most of us have 5 to 7 irrational fears. Pick one you wouldn't mind having discussed in class (potentially) and worked with. Something real and meaningful to you will be more interesting. Simple fears (snakes, spiders, small spaces, heights) work well; as do social anxieties (speaking up in class, disagreeing with your professor) and blood/injury worries (dental work, injections); find something you can work with.
Garett leads discussion of reading on Tuesday, D. et al., pp 65-157 (sessions 1-4)
show & tell: Wolpe & Lazarus (1966; Cautela & Groden (1978);Roemer & Orsillo, (2009); Smalley & Winston (2010); Wilson (1085); Benson (1975)
handouts: Physically Passive Neuromuscular Relaxation; Selecting Your Mantra; Stress Management Techniques; Coping Self-Statements; AWARE; Sensory Relaxation Training; 40 Words
books that aren't about therapy but might make you a better therapist: Kahneman, D. (2011). Thinking, Fast and Slow. New York: Farrar, Straus, & Giroux.
5-23 1st class: orientation and anxiety (arousal) management
In the beginner's mind there are many possibilities, but in the expert's there are few. Shunryu Suzuki (1970), Zen Mind, Beginner's Mind
open
set agenda
your goals for class figure 1.1 my goals for class work of class your work for next time review questions close demonstration: traditional PMR ("tension-release"; "discrimination training")practice: PMR
handouts:syllabus 2023, Wolpe's PMR; PMR training sheets; Relaxation Protocol (191); Appendix (Lazarus, 1977); Push-Release Technique (1989); Morris & Kratochwill (1998) Relaxation Protocol
assignments:
begin Journal Assignment #1 (self-monitor SUD's until Thursday's class)
discussion of text assignment next Thursday, lead by House; discussion of text assignment next Tues., lead by:
for Thursday: 1) find someone to practice PMR with:
a) collect SUD's rating from them before and after
b) note any difficulties you have or unusual aspects of experience
c) record results in your journal and bring to class Thursday2) practice doing PMR yourself once this evening and tomorrow
a) collect SUD's rating from them before and after
b) note any difficulties you have or unusual aspects of experience
c) record results in your journal and bring to class Thursdayshow & tell: ); Bernstein & Borkovec (1973);Wolpe (1990); Lazarus (1977); Goldfried & Davison (1994)
Aftab: Any words of advice for psychiatry trainees and young psychiatrists?
Harrington: My answer might surprise you, but it is an answer that you might expect from an historian rather than a clinician! It is to try sometimes to read the literature, including textbooks, against the grain. That is to say, do not just read to absorb the information being offered, but look also for possible gaps, contradictions, or incidental references to factors or issues that are not pursued, and then ask why not. This comes back to the point I made earlier: with every new chapter in the field, there is a risk that we don’t just become smarter, but also more ignorant. Reading against the grain can be a very effective way for every field—not just psychiatry—to better recognize its implicit biases and blind spots. (an interview with Dr. Anne Harrington, June 27, 2019 )