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Class Log – Summer 2024

7-11-23: 15th class: “time for you to go out to the places you will be from” (Closing Time, Semisonic)

  • Beck, et al., section 3, CT-R for solo practice
  • review: texts, class
  • questions
  • discussion of Practice Assingment 18
  • the ethics of behavior change

Every new beginning comes from some other beginning’s end 

(Seneca; also Semisonic)

7-9-24: 14th class: CT-R and family interventions

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)
  • Beck, et al., section 2: negative symptoms, delusions, hallucinations, communication, trauma
  • children I have known
  • Macon, token economies, generalization (transfer & maintenance)
  • Ivan the Terrible: who hurts?
  • treating trauma
  • show and tell: Lee (2014); Orsillo & Roemer (2011)
  • books that aren’t about therapy but might make you a better therapist: Weinberger, J. & Stoycheva, V. (2020). The Unconscious: Theory, research, and clnical implicaitons. New York” Guilford Press.

7-2-24: 13th class: CT-R

  • Beck et. al., (2021), section 1
  • video: Fefergrad & Zaretsky Cognitive Behavioral Therapy for Depression
  • reinforcement
  • extinction
  • punishment
  • show & tell: Barkley (2013); Greene & Ablon (2006); Barlow et. al., (2011); Miller (1975); McEvoy, Saulsman, & Rapee (2018).

6-27-24: 12th class: CBT cont.

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)
  • discussion of assignment, discussion of final chapters in J. Beck led by Lilla
  • video: Donald Meichenbaum Cognitive-Behavioral Therapy
  • show and tell: Greenberger & Padesky (2016); Padesky & Greenberger (2020); Zylowska & Mitchell (2021); Safren, Sprich, Perlman, & Otto (2017)
  • books that aren’t about therapy but might make you a better therapist: 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.]

6-25-24: 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 Sharitah: ch. 11-16
  • 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
  • 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 a 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

6-20-24: 10th class: CBT

“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?, assignment, Reading (J. Beck ch. 6 & 7 by Lilla), Beck video, class, summary, Close
  • Values, Aspirations, Goals
  • Rational Emotive Therapy (RET) (Ellis); Cognitive Therapy (Beck); Schema Therapy (Young)
  • show and tell: Walen, DiGiuseppe, & Wessler (1980); Rafaeli, Bernstein & Young (2011); Torneke 2017; Stott, Mansell, Sakovskis, Lavender, & Cartwright-Hatton (20100
  • 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.

6-18-24: 9th class: Cognitive Behavior Therapy

Men are disturbed not by things, but by the view which they take of them.

Epictetus (55 — 135 AD)
  • text: JB ch.s 1-5, led by Trinity
  • Ravitz & Maunder (2013) Cognitive Behavioral Therapy for Anxiety, conclude
  • cognitive therapy, cognitive behavior therapy, CBT
  • Ellis, Beck, Meichenbaum, main stream
  • Assignment 14: monitor thoughts
  • turn in journals Thursday
  • 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; Nezu, Nezu, & Lombardo (2004), Cognitive-Behavioral Case Formulation and Treatment Design: A problem-solving approach.NY, NY: Springer Publishing Co.; Friedberg & McClure (2002). Clinical Practice of Cognitive Therapy with Children and Adolescents. NY: NY: Guilford.
  • books that aren’t about therapy but might make you a better therapis: 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 (and data) worth thinking about.]

Our course is over half over now. What will you gain from the remaining classes?

6-13-24: 8th class: BA, Soc Skill Training

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 Sanjana
  • work
  • case with videotaped feedback
  • Ravitz & Maunder (2013) Cognitive Behavioral Therapy for Anxiety
  • show & tell: Pederson (2012); Resick et al. (2017); Marra (2005; van der Kolk (2014)
  • 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.

6-11-24: 7th class: BA, Social 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 Peyton
  • Video: McMain & Wiebe (2013). Dialectical Behavior Therapy for Emotional Regulation. N.Y.: W.W. Norton. conclude work
  • Davidson, Persons, & Tompkins Cognitive-Behavioral Therapy for Depression: Structure of the Therapy Session
  • Liberman’s View of Social skills
  • Show & tell: Alberti & Emmons (1974); Liberman, DeRisi, & Mueser (1989); Meichenbaum (2012); Grandin & Barron (2005)
  • 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.

6-6-24: 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 Karina
  • Video: McMain & Wiebe (2013). Dialectical Behavior Therapy for Emotional Regulation. N.Y.: W.W. Norton.
  • Liberman’s view of social skills Actualization Through Assertion: A Behavioral Approach to Personal Effectiveness
  • Show & tell: Koermer (2012); Campbell (2018); Thompson, et al., (2023); Linehan (1993); Swales & Heard (2009)
  • Smoking cessation treatment, treatment of OCD
  • 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.]

6-4-24: 5th class: From Feeling to Actions: Conclusion of First Section, Behavioral Activation, Social Skill Training, DBT

“You are perfect just the way you are, and you could use a few improvements.“

(Suzuki, 2006)

Set Agenda

  • Open, questions, set agenda
  • Questions: Our course is 1/4 over. Are you learning anything useful for serving your clients? What would make the course more helpful? What could we do more or less of to improve your experience?
  • Discuss assignments: self desensitization, sitting, interpersonal goal to work on
  • Discussion of final chapters in Deckersbach led by Fawzia
  • DBT
  • Introduction to social skill training
    • selling magazines, assertivenss training, role play studies of diatic behavior, Personal Effectiveness, Interpersonal Effectiveness
  • Handouts: Miller (2018), DBT Flowchart
  • Liberman, Actualization Through Assertion: A behaviroral approach to Personal Effectiveness
  • individual sessions (dialectics, validation & change, chain analysis, exposure)
  • telephone coaching
  • skill training (mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness)
  • team meeting (maintaining treatment fidelity)

5-30-24: 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 work
  • Work
    • Systematic Desensitization
    • emotive imagery
  • Handout: example of desensitization record, smoking cessation treatment, Guest House
  • Case: treatment of complex case–OCD, fears, poor self-esteem, nonassertiveness practice: S.D.
  • Assignment: for the next three weeks, trying sitting (meditation) daily for 10 minutes, record experience in journal
    • Assignments: 5 and 6
    • Assignment: selecting a target behavior/problem for next week: Assignment 10
  • Discussion: What does acceptance mean? (Different things to different authors)
    • One basic dialectic: change vs. acceptance (The answer is: both)
  • alternative arousal management techniques
  • 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
  • show and tell: Sears etal. (2011); Wilson (2008); Goldfried & Davison (1976); Williams et al. (2015); Spiegel & Spiegel (1978)
  • questions: Our course is 1/4 over today. Are you learning anything useful for serving your clients? What would make the course more helpful? What could we do more or less of to improve your experience?
  • summary
  • close

5-28-24: 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 Eric
  • work
  • Cautella’s Self-Control Triad
  • Hierarchy building (successive approximations of behavior, stimulus fading)
    • demonstration: hierarchy construction
      • practice
  • Assingment: activity 4
    • Turn in journals a week from today
    • Discussion of text on Thursday, lead by Kibra
    • You will need an interpersonal/social problem for the next week: something involving a situation you would like to have turned out better, something real, something possible (you will need to practice in real life as well). Give it some thought and we will discuss tentative goals next class.
  • Show & tell: Feldman & Kuyken (2019); Carrington (1977); Pollak, Pedulla, & Siegel (2014); Kabat-Zinn (1994)
  • 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.

5-23-24: 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
    • close
  • Meditation
  • Assignments:
    • 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 working 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.
      • discussion of reading on Tuesday, D. et al., pp 65-157 (sessions 1-4)
  • Show & tell: 6; Cautela & Groden (1978);Roemer & Orsillo, (2009); Smalley & Winston (2010); Wilson (1085); Benson (1975)
  • Handouts: Selecting Your Mantra; AWARE; Sensory Relaxation Training
  • 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. 

5-21-24 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

Set Agenda

  • Open
  • Your goals for class
  • 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, Wolpe’s PMR; PMR training sheets; Relaxation Protocol (191); Appendix (Lazarus, 1977); Push-Release Technique (1989);
    • relaxation training notes
  • 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: Eric
    • for Thursday:
      • 1) find someone to practice PMR with:
        • collect SUD’s rating from them before and after
        • note any difficulties you have or unusual aspects of experience
        • record results in your journal and bring to class Thursday
      • 2) practice doing PMR yourself once this evening and tomorrow
        • collect SUD’s rating from them before and after
        • note any difficulties you have or unusual aspects of experience
        • record results in your journal and bring to class Thursday
  • Show & tell: ); Bernstein & Borkovec (1973);Wolpe & Lazarus (1966); Lazarus (1977)

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 )

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