Spring 2016, Mondays 1:00PM – 4:50PM, 1030D
Instructors: Bob Chernoff Shannon Couture
Email:
Office:
Cell: rchernof@usc.edu
SGM 931, (213) 740-4742
(323) 497-6876 scouture@usc.edu
SGM 1030A, (213) 740-6620
(720) 206-6462
Course Overview
This semester we will learn about other widely used, evidence based psychotherapies with adults that approach treatment in a different fashion than traditional cognitive-behavioral therapy
(CBT). Some of these, like DBT and ACT, are part of the so-called “third wave” of (CBT) and have their own body of treatment outcome studies showing their efficacy and effectiveness.
Others, like IPT, are based on somewhat different foundational principles but are also quite effective as demonstrated in treatment outcome studies. We will review the theory, concepts, and principles that underlie these treatment approaches, but we will focus most of our attention on the pragmatic “nuts and bolts” of how to develop case formulations and treatment plans using these approaches, and how to use specific therapy techniques characteristic of these approaches.
There will be opportunities to develop competencies through demonstrations, video samples, and role-play practice. We will address the ways in which law, ethics, and cultural diversity play a role in these treatment approaches. Students will prepare one written case report and oral case presentation by the end of the semester.
We will also address the subject of clinical supervision, including such topics as what makes good supervision, alliance in supervisory relationships, ruptures and rifts in supervision, and diversity in supervision. Students will have the opportunity to provide ongoing peer supervision throughout the semester, as well as to provide feedback to one peer for one recorded therapy session.
Learning Objectives
(1) Students will learn about the theory and practice of alternative evidence-based psychotherapies (i.e., DBT, ACT, IPT, & mindfulness-based therapies). Students will also have the opportunity to practice techniques from these approaches through role plays.
(2) Students will learn about the theory and practice of clinical supervision, and will have the opportunity to provide ongoing peer supervision during the diprac, as well as participate in one peer feedback exercise.
Clinical Requirements
We will continue with the requirement this semester that you carry at least 4 hours per week of direct clinical service. At least half of your clinical hours should be related to this di-prac, and
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we suggest that you maintain at least 3 cases in the di-prac to obtain the best training experience.
Any more than 2 cases outside the di-prac should be approved by the instructors.
During this semester, please continue to enter all hours you accumulate into Time2Track. We will be monitoring this on an ongoing basis. It is also expected that you adhere to all clinic procedures.
During the group supervision portion of the di-prac (usually the first 2 hours), we will discuss any new cases available at the PSC that might be good training cases. If you take on a new case, you will be expected to contact the assigned case shortly after it is assigned to you, and to follow up appropriately (e.g., contacting the client and setting up an appointment prior to the next class meeting if possible).
Class Structure
During the first 2 hours of the di-prac, we will continue to have group supervision and discuss the individual adult cases you are seeing. We ask that, prior to group supervision, you review at least one of your recordings and present a segment or clip from your session that the group can discuss. The clip you choose can be: (1) a part of the session that you are not sure how to handle, and you would like feedback from the group on what to do; (2) a segment that you believe did not go well and you want feedback from the group about how to do it better or differently for the next session; or (3) a segment that you feel went well and you want to share this success with the group.
Please come to group supervision prepared to present your cases. This will include a brief synopsis of the history of presenting illness, relevant background information, diagnostics, hypotheses, case formulations, and treatment plans. Please be prepared to discuss what issues you need help with, what has gone well and/or wrong with the case, what is your plan for upcoming sessions, etc. Group supervision will continue to be supplemented with individual supervision as needed.
The second 2 hours of the di-prac will be a combination of didactics, interactive group discussion, demonstrations, and role plays. During this section, we will discuss the readings for the week. We may also demonstrate or view DVDs about how to conduct a particular treatment
(e.g., DBT, ACT). We will also conduct role plays so that you can practice some of the skills that we present during the di-prac. Our hope is that this portion of the di-prac is participatory and interactive.
With regard to the readings, we will continue the practice of posting discussion points on
Blackboard. Please post at least 2 or more key issues to discuss. The discussion points should be posted on Blackboard by 5:00PM on Sunday evenings before the class date.
Please put your discussion points in the appropriate section (labeled by class date). You must post them even if you are going to miss the class. Please log on and take a moment to read the discussion points prior to class.
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Your questions and discussion points should be thought-provoking and go beyond the material presented. You can raise issues, present a different perspective to the readings, etc. The idea is to use the readings to generate ideas of your own.
As we did last semester, we will ask each of you to be the discussion leader for one diprac. You will have the opportunity to sign up for a particular date on which to do this.
Video Recording and Viewing
Please record all of your sessions, and check that the equipment is in proper working order. You should review your sessions and bring segments of about 5-10 minutes in length for feedback and fostering discussion.
You should review at least one of your therapy sessions (by watching the video) at least once per week, preferably one which will correspond with the discussion you are having with your individual case supervisor.
Progress Notes and Intakes
You should continue to complete progress notes for your therapy sessions in a timely fashion
(i.e., within 24-48 hours). If there is any instance of risk assessment or mandatory reporting, these notes are required to be completed immediately (i.e., minutes after you see the client), and you should contact your supervisors in these instances. You should also document all contacts with the client, including any messages, emails, or letters. As part of quality clinical care, you should continue to complete periodic follow-up assessments with your clients, and these should be documented in your progress notes.
Role Plays
Everyone will be asked to participate in role plays over the course of the semester, as we discuss how to apply the ideas in the readings to our clients. Everyone will have opportunities to play the role of therapist and client, and everyone will be asked to provide constructive feedback to the students playing the therapist role.
Case Write-Up and Presentation
You will be asked to complete one case write-up during this semester that follows a format that will be distributed later in the semester. In the case write-up, you will be asked to explain how you would conceptualize the case using traditional CBT, and how you would conceptualize the case using at least one of the treatment approaches discussed this semester. You will make comparisons and contrasts between how these two approaches would inform your treatment plan.
You will also be asked to present this case in an oral case presentation format. The case presentation should be about 20 minutes in length, and will also follow a format that will be distributed later in the semester.
Peer Feedback
In furtherance of the goal of teaching principles of clinical supervision, you will have the opportunity to provide specific feedback to one fellow student. The instructors will pair you up with a specific student. You will select one video recording of a therapy session which you will
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watch and complete a self-assessment form. Your peer will watch the same video and complete the same assessment form. You will meet in person to discuss the feedback, and then repeat this process with your partner. The intent of this exercise is to give you the opportunity to both selfassess and to provide feedback to a peer in a mutually supportive and respectful atmosphere.
(The assessment form will be provided later in the semester.)
Classroom Etiquette
Please make every effort to attend every class and be on time. If there is any reason you will be late or absent, please notify us by email as soon as you have this information. Please silence your phone during class and only monitor your phone if you are expecting an emergency call. Because peer group supervision is an essential aspect of this diprac, it is imperative that every student listen and pay attention to their fellow students as they present and discuss cases. Therefore, as a matter of courtesy and respect to your fellow students, we ask that you kindly refrain from using your laptops or other devices during diprac to check email, text, surf the web, instant message, etc.
Course Readings
January 11 Introduction to Dialectical Behavior Therapy (DBT), Part 1
Class plan:
Review of borderline personality; theoretical rationale for DBT; targets of treatment; acceptance and change strategies.
Introduction to validation strategies.
Reading:
Koerner (2012), Doing dialectical behavior therapy.
Chapter 1, Tools for tough circumstances.
Handouts:
Six levels of validation
Martin Luther King, Jr. Holiday – No Class January 18
January 25 DBT Treatment Strategies, Part 2
Class plan:
DBT case formulation & treatment planning; validation strategies; introduction to change strategies – self-monitoring (diary card); behavioral chain analysis.
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February 1
February 8
Readings:
Linehan (1993), Cognitive-behavioral treatment of borderline personality disorder. Chapter 2, Dialectical and biosocial underpinnings of treatment.
Koerner (2012), Doing dialectical behavior therapy.
Chapter 2,
Navigating to a case formulation and treatment plan.
Koerner (2012), Doing dialectical behavior therapy.
Chapter 4, Validation principles and strategies.
DBT Treatment Strategies, Part 3
Class plan:
More DBT change strategies
DBT dialectical strategies
Special treatment strategies - e.g., crisis, suicidal behavior
How to avoid treatment failure
Readings:
Koerner (2012), Doing dialectical behavior therapy.
Chapter 3, Change strategies.
Koerner (2012), Doing dialectical behavior therapy.
Chapter 5,
Dialectical strategies.
Linehan (1993), Cognitive-behavioral treatment of borderline personality disorder. Chapter 15: Special treatment strategies.
Handouts:
DBT diary card and instructions;
Guidelines for chain analysis.
DBT Skills Training, Part 4
Class plan:
Introduction to skills training - concepts & principles
Core mindfulness skills
Distress tolerance skills
Readings:
Linehan (2015), DBT Skills Training Manual (2d. ed.). Chapter 5,
Application of fundamental DBT strategies in behavioral skills training.
Linehan (2015), DBT Skills Training Manual (2d. ed.). Chapter 7,
Mindfulness skills.
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Linehan (2015), DBT Skills Training Manual (2d. ed.). Chapter 10,
Distress tolerance skills.
February 15
February 22
Handouts:
Linehan (2015), DBT Skills Training Handouts and Worksheets :
Mindfulness handouts.
Linehan (2015), DBT Skills Training Handouts and Worksheets : Distress tolerance handouts; Handouts for reality acceptance skills.
Presidents’ Day – No Class
DBT Skills Training, Part 5
Class plan:
Interpersonal effectiveness skills
Emotion regulation skills
Teaching skills in individual therapy vs. group
Readings:
Linehan (2015), DBT Skills Training Manual (2d. ed.), chapter 8,
Interpersonal effectiveness.
Linehan (2015), DBT Skills Training Manual (2d. ed.), chapter 9, Emotion regulation.
Rizvi, S.L. (2011). Treatment failure in dialectical behavior therapy.
Cognitive and Behavioral Practice, 18, 403-412.
Handouts:
Linehan (2015), DBT Skills Training Handouts and Worksheets :
Interpersonal effectiveness handouts.
Linehan (2015), DBT Skills Training Handouts and Worksheets : Emotion regulation handouts.
February 29 Acceptance and Commitment Therapy (ACT), Part 1
(Leap Year Day!)
Class plan:
Theory & rationale - concepts & principles
Six core processes of ACT
How ACT is different from CBT
How to begin ACT - Creative hopelessness
Experiential avoidance
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March 7
March 14 – 18
March 21
Readings:
Luoma, Hayes, & Walser (2007). Learning ACT . Chapter 1: The six core processes of ACT and their common target.
Zettle (2007). ACT for depression . Chapter 1: What is ACT for depression and what makes it unique?
Walser & Westrup (2007). Acceptance & Commitment Therapy for the
Treatment of PTSD & Trauma-Related Problems . Chapters 3-5.
ACT, Part 2
Class plan:
Written case report assignment distributed
Cognitive defusion
Mindfulness in ACT
Willingness & acceptance
Readings:
Harris (2009). ACT made simple . Chapter 7: Watch your thinking.
Hayes, (2005). Get out of your mind & into your life . Chapter 8:
Mindfulness.
Hayes, (2005). Get out of your mind & into your life . Chapters 9-10:
Willingness.
Eifert & Forsyth (2011). The application of acceptance and commitment therapy to problem anger. Cognitive and Behavioral Practice, 18, 241-
250.
Handouts:
TBD
Spring Recess – No Class
ACT, Part 3
Class plan:
Peer feedback exercise distributed
Self-as-context
Values
Commitment to action
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March 28
April 4
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Readings:
Walser & Westrup (2007). Acceptance & Commitment Therapy for the
Treatment of PTSD & Trauma-Related Problems . Chapter 7: Self-ascontext.
Hayes, (2005). Get out of your mind & into your life . Chapters 11-12:
Values; Chapter 13: Committing to doing it.
Eifert, Forsyth, et al. (2009). Acceptance and commitment therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol. Cognitive and Behavioral Practice, 16, 368-385.
Handouts:
TBD
Clinical Supervision, Part 1
Class plan:
What are the qualities of good vs. not so good supervision?
Countertransference & self-disclosure
Alliance & ruptures
Readings:
Falender & Shafranske (2004). Clinical supervision: A competency-based approach. Chapters 2: What makes for good supervision?
Falender & Shafranske (2004). Clinical supervision: A competency-based approach. Chapters 4: Addressing personal factors in supervision
Falender & Shafranske (2004). Clinical supervision: A competency-based approach. Chapters 5: Alliance in therapeutic and supervisory relationships.
Clinical Supervision, Part 2;
Interpersonal Psychotherapy (IPT), Part 1
Class plan:
Discuss supervision vignettes
Theory & rationale - concepts & principles of IPT
How IPT differs from CBT
Goals & tasks of IPT
Interpersonal Inventory
Grief

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April 25
Segal, Williams, & Teasdale (2002). Mindfulness-based cognitive therapy for depression.
Selected chapters.
Thict Nhat Hanh (1975, 1976). The miracle of mindfulness: An introduction to the practice of meditation. Selected excerpts.
Handouts:
TBD
Case Presentations; Wrap-Up
Class plan:
Written case report due
Oral case presentations
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References
Koerner, K. (2012). Doing dialectical behavior therapy: A practical guide. New York: Guilford
Press.
Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline disorder. New York:
Guilford Press.
Linehan, M.M. (2015). DBT skills training manual (2d ed.). New York: Guilford Press.
Linehan, M.M. (2015). DBT skills training handouts and worksheets (2d ed.). New York:
Guilford Press.
Rizvi, S.L. (2011). Treatment failure in dialectical behavior therapy. Cognitive and Behavioral
Practice, 18, 403-412.
Luoma, J.B., Hayes, S.C., & Walser, R.D. (2007). Learning ACT: An acceptance & commitment therapy skills-training manual for therapists. Oakland, CA: New Harbinger Publications.
Zettle, R.D. (2007). ACT for depression: A clinician’s guide to using acceptance & commitment therapy in treatment depression. Oakland, CA: New Harbinger Publications.
Walser, R.D., & Westrup, D. (2007). Acceptance & commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner’s guide to using mindfulness and acceptance strategies. Oakland, CA: New Harbinger Publications.
Harris, R. (2009). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. Oakland, CA: New Harbinger Publications.
Hayes, S.C. (2005). Get out of your mind & into your life: The new acceptance & commitment therapy. Oakland, CA: New Harbinger Publications.
Eifert, G.H., & Forsyth, J.P. (2011). The application of acceptance and commitment therapy to problem anger. Cognitive and Behavioral Practice, 18, 241-250.
Eifert, G.H., Forsyth, J.P. et al. (2009). Acceptance and commitment therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol. Cognitive and
Behavioral Practice, 16, 368-385.
Falender, C.A., & Shafranske, E.P. (2004). Clinical supervision: A competency-based approach.
Washington, DC: American Psychological Association.
Klerman, G.L., Weissman, M.M., Rounsaville, B.J., & Chevron, E.S. (1984, 2004).
Interpersonal psychotherapy of depression. Lanham, MD: Rowman & Littlefield Publishers.
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Weissman, M.M., Markowitz, J.C., & Klerman, G.L. (2007).
Clinician’s quick guide to interpersonal psychotherapy. New York: Oxford University Press.
Weissman, M.M., Markowitz, J.C., & Klerman, G.L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books.
Stuart, S. (2006). Interpersonal psychotherapy: A guide to the basics. Psychiatric Annals, 36,
542-549.
Frank, E., Swartz, H.A., & Kupfer, D.J. (2000). Interpersonal and social rhythm therapy:
Managing the chaos of bipolar disorder. Biological Psychiatry, 48, 593-604.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life.
New York: Hachette Books.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Random House.
Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.
Hanh, T.N. (1975, 1987). The miracle of mindfulness: A manual on meditation. Boston: Beacon
Press.
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