ADVANCED TREATMENT TECHNIQUES
(APPL.616.185)
Spring, 2013
AC214
Wednesdays, 5:30-8 p.m.
Instructor: Elaine Johnson, Ph.D.
Office: AC213A
Phone: (410) 837-6683
Fax: (410) 837-4059
e-mail: eljohnson@ubalt.edu
Office Hours: Wednesdays, 3-5 p.m.,
or by appointment
Welcome to Advanced Treatment Techniques! This course examines the application of theoretically and
empirically based change strategies in mental health counseling. Several theoretical approaches to a variety of
clinical problems are surveyed, with emphasis on cognitive and behavioral treatments for behavioral and
anxiety disorders. Applications to both children and adults are included. This course meets the State of
Maryland LCPC licensure requirement for a course in Psychotherapy and Treatment of Mental Disorders. It is
geared toward the student of professional counseling, and has APPL 605 (Advanced Theories of Personality)
and 606 (Basic Counseling Techniques) or their equivalents as prerequisites. In addition, it is assumed that you
have had graduate courses in psychopathology and diagnosis, and learning theory. If you have deficits in these
areas, you should speak with me. Additionally, this course involves significant out-of-class preparation and
work. If this is not a semester in which you can devote 10-12 hours per week to this course, you are advised to
consider scheduling it for another time.
Course Objectives
By the end of this course, students will be able to:
1. Describe the essential structural components of psychotherapy from initial session to termination.
2. Conceptualize client concerns and treatment from a preferred theoretical orientation.
3. Conduct a comprehensive intake/assessment of a client.
4. Describe the application a variety of theoretical models to various disorders, including existential,
person-centered, cognitive, CBT, psychodynamic, and integrative models.
5. Discuss the status of empirically supported treatments (ESTs) in general in psychotherapy; and for
depression and behavioral, anxiety, and personality disorders, in particular.
6. Complete a treatment of systematic desensitization for a client with an anxiety disorder.
7. Discuss and apply a variety of cognitive-behavioral techniques to the treatment of stress and anxiety,
behavioral disorders, and depression.
Required Texts
A graduate-level text on personality AND counseling theory. Needed for first writing theory-based papers.
Cormier, Nurius, P. S., & Osborn, C.J. (2009). Interviewing and Change Strategies for Helpers
(6th ed.). Pacific Grove, CA: Brooks/Cole-Thomson Learning
Wedding, D. & Corsini, R.J.(Eds). (2008). Case Studies in Psychotherapy. (5th Ed.). Belmont, CA: Thomson
Brooks/Cole.
OR
Wedding, D. & Corsini, R.J.(Eds). (2012). Case Studies in Psychotherapy. (6th Ed.). Belmont,
CA: Thomson Brooks/Cole.
Yalom, I.D. (1989). Love’s Executioner. New York, NY: HarperCollins.
Zucker, B. (2009). Anxiety-free kids. Waco, TX: Prufrock Press, Inc.
Other Required Reading
Selected readings posted on Sakai (e-reserves from Langsdale Library), including:
Capuzzi, C. (2007). Bringing the war home. Psychotherapy Networker. January/February, 28: 37-49.
Cormier, S., & Nurius, P.S. (2003). Interviewing and change strategies for helpers (5th Ed,). Pacific Grove,
CA: Brooks-Cole-Thomson Learning. Chapter 17, “Desensitization Strategies.”
Comas-Diaz, L. “Alma.” Chapter 14 of Case Studies in Psychotherapy, 6e. Ed. Wedding, D. & R. J. Corsini.
Brooks/Cole-Thomson Learning, 2011. Pages 192-195.
Cowan, E.W. (2005). Ariadne's Thread: Case Studies in the Therapeutic Relationship. Boston:
Lahaska Press. Selections.
Crenshaw, D. 2008). The healing power of play. Psychotherapy Networker, 32(5), 61-65.
Fraiberg, S., E. Adelson & V. Shapiro. "Psychoanalysis." Chapter 1 of Case Studies in Psychotherapy, 5e. Ed.
Wedding, D. & R. J. Corsini. Belmont, CA: Thomson Brooks/Cole, 2008. Pages 3-11.
Knight, T. A. "Earlene." Chapter 4 of Case Studies in Psychotherapy, 6e. Ed. Wedding, D. & R. J. Corsini.
Brooks/Cole-Thomson Learning, 2011. Pages 45-50.
Lazarus, A. A. "Multimodal Therapy." Chapter 10 of Case Studies in Psychotherapy, 5e. Ed. Wedding, D. & R.
J. Corsini. Belmont, CA: Thomson Brooks/Cole, 2008. Pages 147-158.
McHugh, L. (2004). A feminist approach to agoraphobia. In J. Chrisler, C. Golden, & P Rozee.
(Eds.), Lectures on the psychology of women. New York: McGraw-Hill
Mendelowitz, E. "Existential Psychotherapy." Chapter 8 of Case Studies in Psychotherapy, 5e. Ed. Wedding, D.
& R. J. Corsini. Belmont, CA: Thomson Brooks/Cole, 2008. Pages 113-121.
Prochaska, J.O. & Norcross, J.C. (2010). Systems of Psychotherapy: A Transtheoretical Anlysis (7th ed).
Pacific Grove, CA: Brooks Cole. (Chapter 16, Comparative Conclusions).
Rappoport, J. L. "The Auto Accident that Never Was (Told by Dr. S.)." Chapter 1 of The boy who couldn't stop
washing. New York: Penguin Books, 1989. Pages 20-42.
Schramski, T.T., & Giovando, K. (1993). Sexual orientation, social interest, and exemplary
practice. Individual Psychology, 49(2), 199-204.
Seligman, L. & Reichenberg, L.W. (2007). Selecting effective treatments (3rd Ed). San Francisco, CA:
John Wiley & Sons. Selections.
Recommended Resources
Georgetown University Honor Council (1999). What is Plagiarism? Retrieved January 19, 2003 from
http://www.georgetown.edu/honor/plagiarism..html.
Georgetown University Honor Council (1993). Acknowledging the Work of Others. Retrieved January 19,
2003 from http://www.georgetown.edu/honor/main.html.
Course Method
This classroom component of the course will follow a seminar/workshop format, and will largely center on
discussion of readings for that week. Come to every class prepared to discuss the assigned readings and any
writing assignments done for that day. The first part of every class will be lecture/discussion format, and the
second half will focus on demonstrations and practice of skills. Students will prepare recorded therapy
demonstrations, which will constitute part of the skills portions of class.
Your knowledge of assessment, conceptualization and treatment models will be advanced via your reading,
class presentations and discussions, and critical thinking for written assignments. In this course, you will read
many different therapy cases. Irvin Yalom's cases will allow you to see how one therapist (Yalom), applies one
theoretical approach (Existential) across a variety of client diagnoses and problems. Other cases will expose
you to the use of other theoretical models with various clinical problems. Although a variety of therapy models
will be explored, the emphasis in the course is on cognitive-behavioral approaches.
The development of your own theoretical orientation will occur through reading, class discussions, and
written assignments. You will apply your preferred theoretical orientation to several different cases throughout
the semester, and will discuss these conceptualizations in class. Discussions will allow you to see how different
theoretical frameworks may be used with each case.
Skill development will be addressed by therapy demonstrations and out-of-class assignments. You will be
asked to present, individually or in a team of two, an in-class demonstration of a therapy technique. Out of
class, you will conduct a series of sessions involving systematic desensitization with a volunteer "client."
Your understanding of assessment, conceptualization, treatment techniques and psychotherapy research will be
assessed via a mid-term exam and a final exam.
Course Requirements
Specific Requirements
Chloe Theory Paper
Penny/Elva Theory Paper
Analysis Papers(4)
Presentation/ Demonstration
Desensitization Project
Exam 1
Exam 2
Participation
Total Points
Total Percent
Points
20
30
40
40
100
100
100
30
460
100
A
A-
B+
B
B-
C+
C
C-
428 414
93 90
400
87
382
83
368
80
354
77
339
73
322
70
Requirements Explained
Papers

Chloe Theory. For this paper, you will write a conceptualization of Chloe’s problems and treatment
from your preferred theoretical orientation. Clearly articulate the etiology AND treatment approaches
that follow from a single (specified) theoretical orientation. You should draw on a counseling theories
text for this paper, employing theoretical constructs to explain both etiology and treatment from that
approach. Use APA style and properly cite and reference the text that you use as resource.
Approximately 2 pages.

Penny/Elva Theory. This paper is similar to your Chloe paper, but should go a little more in depth.
Describe how the problems of either Penny or Elva would be conceptualized from a theoretical
framework other than Yalom’s existential approach. Again, clearly articulate, making full use of
theoretical constructs (aim for 3 etiological constructs and 3 treatment constructs) to describe the way
both the problem(s) and the treatment would be formulated from your preferred theoretical orientation.
Again, write from the perspective of one, single theory. Again, cite appropriately and provide the
reference for your resource text. Approximately 3 pages.

Analysis Papers. Choose any four cases that intrigue you from those assigned (but not one you wrote
about in the first two papers), and write a 2-page paper on each (10 points each). In each paper, cite at
least two ways in which the approach taken by the therapist illustrates that author’s theoretical
orientation. Then compare or contrast the author’s approach with how you would conceptualize and
treat this client’s problems, given your own evolving theoretical orientation. Your work should reflect
an accurate understanding of the author’s theoretical approach (based on information given by the
author) and of your own theoretical approach. Your purposed in writing these papers is to refine your
understanding of theory – both yours and theirs – and explore how you might borrow from various
approaches to integrate them into your own. Therefore, if you find yourself thinking “integratively,”
please tell me about that! These papers may be handed in anytime that you complete them. Reference
any resource text that you use outside of those assigned for this class.

Desensitization Project (DP). (100 points) This paper will actually be "written" throughout the
semester, as you conduct a major project in this course. For this project, you will conduct 7- 8 sessions
with a volunteer "client" in which you treat the client using systematic desensitization. Your client may
be a classmate, a family member, or anyone else who admits to anxiety about a specific thing (exams,
spiders, driving over bridges, etc.) and will be a cooperative and willing subject! For success, the client
must also be willing to fully participate and practice relaxation and desensitization outside of your
sessions. Follow the guide points on the syllabus for conducting the stages of your treatment. In a
report, to be completed by May 7, please hand in a report of your treatment, including:

Notes on your intake sessions. Assess your client on all 11 of areas for a comprehensive
assessment from CNO, Chapter 8. Include notes on each dimension. One “affective” dimension
of the client problem will be anxiety, but there may be other affective components, as well.
Include and label the somatic, behavioral, cognitive, contextual and relationship aspects of the
anxiety, and note at least two possible antecedents and two consequences that maintain the
anxiety.

A clear statement of your client's goals using the criteria for good goals in CNO, Chapter 9
(positive form, advantages/disadvantages, etc). Also, note your client's stage of change and any
strategies from motivational interviewing or solution-focused therapy that you use.

Notes on each session with your client, describing the components (rationale, instruction,
modeling, rehearsal, and practice) of both the relaxation and the desensitization phases. Do not
provide anything close to a verbatim account of what was said in the sessions (!) but do describe
the content of each. Be especially careful to provide sufficient detail that I can see exactly how
you taught the relaxation, and how you used a hierarchy to desensitize the client. Report the
criterion that you set before moving to the next item on the hierarchy and how many trials were
needed to reach the criterion for each item.

The hierarchy you constructed with your client, and record of SUDS ratings throughout the
treatment, and any modifications that you made to the hierarchy as treatment progressed.

An evaluation of the effectiveness of your treatment

Notes on your termination

Conclude your report with 1-2 pages describing your experience with using these techniques.
What parts did you like best and least? Tell me what you learned in this assignment, and
whether, and with what issues, you are likely to use the techniques in your counseling practice.
More specific instruction on each of the components of this project will be provided in class. This report will
probably not be less than 20 pages.
All papers must be submitted on Sakai AND ALSO via hard copy, at 5:30, in class, on the due date. Late
papers will be accepted, but points will be reduced by 10% for each day the paper is late.
Presentation/demonstrations (Demos) will require you, either individually (with your DP client) or in teams
of two, to demonstrate (via a video of your work, recorded in the CTC) one of the cognitive-behavioral
strategies that you will learn about in this course. For those working in teams, one of you will be the counselor,
and the other will play the "client" to demonstrate the technique(s). Your demonstration should be polished,
professional and look like a real, live therapy session. Both members of the team are equally responsible for
the quality of the demonstration. Both should be equally involved in preparing both a believable "client" role
and an accurate and complete demonstration of the assigned technique. Please prepare a presentation that
includes a) information about your "case," including relevant cultural/demographic factors, and what aspects of
the problem you will address, b) the demonstration itself, which should run 5-7 minutes, and c) what you
learned, by practicing this intervention, including some of the details that are important for its effectiveness .
You must follow the evidence-based protocol given in CNO in excruciating detail in these demonstrations. Do
NOT add to or embellish this EVT protocol! I will be available for consultation to help you design and tape
your presentation during the week PRIOR to your demo (no last-minute consultations, please!). The complete
presentations should take about 20 minutes, including some time for discussion.
Attendance and Participation are required and extremely important for this class. Attendance will be
recorded for each class. You may miss two classes without penalty. Two late arrivals beyond 15 minutes or
leaving class 15 minutes prior to the end of class constitute an absence. After two absences, your final grade
will be reduced ½ letter grade for each missed class. Participation points will be based on the quality of your
participation and your contribution to creating an intellectually stimulating, respectful and mutually supportive
classroom atmosphere. You should plan to be an active discussant in every class.
Exams 1 and 2 will consist of short answer essay questions. The mid-term will be take-home; the final may
include portions that are take-home and will be partly comprehensive. Missed exams can be made up only for
emergency situations. You must notify me, personally, by phone or e-mail BEFORE the exam, and you must
supply documentation (doctor’s note, tow truck receipt, etc.) supporting your emergency’s status.
Academic Integrity. Each student is responsible for personal academic integrity, and thus avoidance of such
misconduct as cheating, plagiarism, falsification or attempts of these acts. Any violation of the University of
Baltimore Academic Integrity Policy will result in a minimum sanction of failure on the assignment, with no
chance to resubmit the assignment. Other sanctions are possible for even one infraction, including failure in the
course and referral to Academic Affairs, with a maximum being expulsion from the University.
Accommodations/Academic Adjustment
Anyone who requires special accommodations because of a disability registered with the Center for Educational
Access must present the appropriate form from that Office to me as soon as possible.
Course Outline
Class
1
Date
1/23
Topic and Activity
Introduction to the Course
Assigned
Reading & Projects
Syllabus
Elements of Psychotherapy:
Exploration, Insight, Action, etc! OR
Skills, Theory, Structure, and Science/
Empirical Support
2
1/30
Skills: The Case of Chloe – Part 1
------------------------------------------------------------------DP Demo: Progressive Muscle Relaxation – Rationale &
Instruction (EJ)
Paper 1 Due – Theoretical Analysis of Chloe
Cowan, Ch. 4, pp. 110-122*
STRUCTURE: Assessment & relationship-building
CNO, Ch. 8
Theory: Cases: Chloe, Part 2
Penny; Elva (Existential)
3
4
2/6
Theory text
Cowan, Ch. 4, pp 122-132*
Yalom, Prologue; Ch. 4, 5
DP Demo: Progressive Muscle Relaxation, Rehearsal (EJ)
Paper 2 Due – Theoretical Analysis of Penny or Elva
DP: Secure the client
STRUCTURE: Assessing Client Readiness to Change
CNO, Ch. 18
STRUCTURE: Goal- Setting
CNO, Ch. 9, 229-241
Chloe, Part 3
------------------------------------------------------------------DP Demo: Assessment__________________________
Cowan, Ch. 4, pp. 132-133*
STRUCTURE: Treatment Planning Basics
CNO, Ch.10, 271-278
DP: Assess Client
2/13
Theory: Chloe, Conclusion (?What theory)
BEHAVIORAL PROBLEMS: Overview and Research
Theory: Behavioral Treatments
Behavioral Assessment/Functional Analysis
Token Economies
DP Demo: Assessment__________________________
DP Demo: Goal-Setting ________________________
5
DP: Search for a client
2/20
Case: Rev X
Paraphelias, Overview and Research
Guest speaker
Cowan, Ch. 4, pp. 133-148*
Seligman, Ch. 6, pp. 290296*
CNO, Chapter 7
Ghezzi, et al*
DP: Assess Client
W&C,Ch. 6
Seligman, Ch. 6, 345-359*
DP: Assess/set goals
6
2/27
Eating Disorders, Overview and Research
Theory: Case: Rachel (Family Therapy)
STRUCTURE: Treatment Planning: Treatment
Selection
Theory: Mr. F.H. (Integrative)
7
3/6
W&C, Ch. 13
DP Demo: Assmt/Goal-setting __________________
Treatment of ANXIETY DISORDERS: Overview
DP: Assess/Set Goals
Zucker, Ch. 1& 1
Seligman, Ch 5, pp. 233-246*
Phobias: Overview
Seligman Ch. 5, pp. 247-265*
Cowan, Ch.8*
W&C, 2; Schramski &
Giovando*
McHugh
Relaxation Training
CNO, Ch. 15, p. 463-474
Demo/Discussion: Relaxation Training – EJ
DP: Rationale & Instruction
for Relaxation
Acute Anxiety and Stress
Theory: Saul (Existential)
Theory: CBT Approaches
Diaphragmatic Breathing
Meditation
Case: James (Meditation)
Desensitization
3/20
CNO, Ch. 10, 278-286
CNO, Ch. 10, 286-297
Auntie (Feminist Therapy)
3/13
W&C, Ch.11
STRUCTURE: Treatment Planning, Cultural
Considerations
Case: Nayana
Theory: Roger (Adlerian Therapy)
8
Seligman, Ch. 6, pp. 333-345
------------------------------------------------------------------Demos: (2 students each)
Diaphragmatic Breathing _______________________
Meditation ___________________________________
Hand in DP for ungraded review.
No Class – Spring Break!
Yalom, Ch. 8
CNO, 14, pp. 416-427
Zucker, Ch 3 & 3
CNO, Ch. 15,454-463
W&C, Ch. 12
C&N, Ch 17*
Zucker, Ch 2&2
Zucker, Ch,6&6, 7&7
DP: Train client in
relaxation; Client practice
Client Practice!
9
10
11
12
3/27
Exam I (Take home) due
Desensitization Techniques, Continued
OCD: Overview
Case:
Dr. S & Jeffrey
PTSD: Overview
C&N, Ch. 17* (continued)
Seligman, Ch. 5, pp. 265270*
Rappoport, 21-42*
Selgiman, Ch 5, pp. 270-278*
Cases: Bobby;
Jesus
DP Demos:
Rehearsal for Relaxation ________________________
Rationale for Desensitization ____________________
Hierarchy Construction_________________________
Desensitization as a variant of exposure
Crenshaw*
Capuzzi*
GAD: Overview
Seligman, Ch. 5, 278-285
CNO,
Ch. 11, 317-323
Ch. 12, 346-351
Seligman, Ch. 5, 285-289*
4/10
Theory: CBT Techniques
Guided Imagery
Reframing
Research: Anxiety and Stress Disorders
------------------------------------------------------------------?
Theory: Cognitive Restructuring
W&C, Ch. 5 and Ch. 7
4/17
Cases: Martha
Graduate Student
DEPRESSION: Overview and Research
-----------------------------------------------------------------Demos (2 students each):
Guided Imagery___________________________
Reframing_______________________________
PERSONALITY DISORDERS: Overview
4/3
DP: Client
Practice/Rationale for
Desensitization
CNO, Ch. 16, 486-512
DP: Construct Hierarchy
Zucker, Ch. 4&4, 5&5
CNO, Ch. 13
Seligman, Ch. 4, pp. 180-195;
? pp. 195-203
DP: Desensitize
Seligman, Ch. 8, pp. 418-428
CNO, Ch. 4
Theory: Psychoanalytic and Humanistic
Cases:
Ron (Existential)
Mrs. March (Psychoanalytic)
Earline (Person-Centered)
Marge (Existential)
----------------------------------------------------------------Demos (2 students each):
Desensitizing a la C&N________________________
Desensitizing a la CNO________________________
Mendelowitz*
Fraiberg, et al *
Knight*
Yalom, Ch. 9
DP: Desensitize/Client
practice
13
4/24
Research: BPD and OCPD
Seligman, Ch. 8, pp . 447454; pp. 476-480
Theory: Integration of Technique, Culture, &
Spirituality
Case: Alma
W&C, Ch. 14
DP: Desensitize/Client
practice/Wrap up
14
5/1
Theory: Integration
Multimodal Therapy Case: Ben
Transtheoretical Model
Lazarus*
P&N Ch. 16*
Desensitization Report Due
DP: Terminate
5/8 Final Exam
* Indicates this source is on Electronic Reserve and posted on Sakai; (some not posted as of 1/23) Refer to
reference list, p. 2 for the reference and location of an article.
DP = Desensitization Project; C&N = Cormier & Nurius; CNO = Cormier, Nurius & Osborn; P&N = Prochska
& Norcross; W& C = Wedding and Corsini, both 5th and 6th editions.
To Access Sakai: On your MyUB portal, click “UBOnlineSakai” and log in using your net ID. Tab to
this course. You will have access to announcements, the syllabus, and other postings. You will also
submit all of your papers on this site by the due date and time. They are automatically scanned by
Turnitin
The instructor reserves the right to modify this syllabus at any point in the semester.
SIGNING UP FOR THE CTC
(USING WEJOININ)
SIGNING UP FOR A TIMESLOT

Go to http://www.wejoinin.com/sheets/iucvm

Find the date/time that you would like to sign up for the CTC.
(NOTE: Only ONE person may sign up for each timeslot. For those of you who have not yet utilized
the CTC, there are two rooms. If someone has already signed up for room 1 during the date and time
that you would like, feel free to sign up for room 2 if it is available.)

Click “Join” then add your name and email address in the area provided.
(Your email address will only be visible to Emily and will be used to send a confirmation email for your
sign up date and time.)
HOW TO CANCEL A TIMESLOT

When you click “Join” to sign up for a timeslot, you will be provided with a cancellation code. Copy it
and save it.
(There is an area in the top right-hand corner that says “cancel your sign up, enter your cancel code
here.)
OR

There are instructions on how to cancel a timeslot in the confirmation email, which is sent when you
sign up for a timeslot.
IF ALL ELSE FAILS

Email Emily Curran at Emily.Curran@ubalt.edu and ask her to cancel it for you.
ADDITIONAL QUESTIONS??
Contact:
Emily Curran
AC 210
Emily.Curran@ubalt.edu
Office: (410) 837-5115
Cell: (443) 904-5472