Therapy on the Cutting Edge

In this episode, Terry discusses starting off his career working in residential treatment programs for kids and becoming interested in the idea of probability, and how in making behavior goals, he could increase the probability for the child’s success. In grad school he focused on instructional strategies for kids with challenging behaviors, and finding effective ways to intervene. He discussed how many people think that positive and negative feedback are equal, but positive reinforcement has more of an effect. He discussed focusing on creating opportunities for success, including being intentional about how you want to be (e.g., body posture, tone) with children. He talks about the research on the optimal ratio of positive to negative interactions, which is somewhere between five to one and three to one, but how this is very difficult for teachers, parents and others to do. He explained that in elementary school, teachers make positive statements once every 6-7 minutes, in middle school every 13 minutes and in high school every 23 minutes. He discussed his interest in why it is so difficult for adults to increase their positive statements, whether it may be related to culture or human nature or other factors. He explained that there is not a great deal of variance between teachers and that the research has found teachers tend to overestimate the number of positive statements they make, including himself when he steps in to teach a class. He said that his research has found that you can predict behavioral disruptions in classrooms by by looking at whether there is active engagement with the children and a higher ratio of the number of opportunities to respond positively and the positive responses, which may even be just a thumbs up or nod. He explained that kids with problem behaviors often need more in the range of 14 to 1 ratio of positive to negative because they have often had a lifetime of 1 to 1 million positive to negative. He discussed how teachers are able to give instruction when it comes to correcting academic mistakes, but very little instruction is given when correcting behavioral mistakes, with corrective statements being so low that in their research it was only observed once per nine schools. Terry talked about how many times teachers might say that they’ve already told the child before or after getting a consequence like being sent to the principal’s office that child has not been punished enough, asking how they are supposed to treat them like nothing happened? He explained that although teachers know that repetition is fundamental to learning academically, they struggle applying that to behavioral learning and often don’t persist in how often, how intense and how long they change their approach, since they may not see results immediately. He discussed his next research project which looks at the physiological responses of children in classrooms, similar to a study done on the physiological reactions teachers have when viewing video of misbehavior, and possibly looking at the interaction effects of the child’s physiology and the teacher’s physiology and their interaction effect with a focus on emotional regulation. Terrance M. Scott, Ph.D. is a professor, distinguished scholar and director of the Center for Instructional and behavioral Research in Schools in the Department of Special Education, Early Childhood and Prevention Science at the University of Louisville. Dr. Scott spent 24 years as a professor and researcher in special education and was the senior principal education researcher at the Stanford Research Institute (SRI). He began his career as a counselor in residential treatment and has worked with students with challenging behaviors across a variety of settings. Since receiving his PhD in Special Education at the University of Oregon in 1994, Dr. Scott has written over 100 publications, has conducted well more than 1,000 presentations and training activities throughout the United States and across the world, and has successfully competed for more than $24 million in external grant funding. In 2004 he received the Distinguished Early Career Award from the Research Division of the International Council for Exceptional Children, and in 2012 he received the Outstanding National Leadership Award from the Council for Children with Behavior Disorders. He was elected president of this organization in 2013 and served as a two term editor of the journal, Beyond Behavior. His research interests focus on schoolwide prevention systems, the role of instructional variables in managing student behavior, functional behavior assessment/intervention, video-based training for school personnel, and scientific research in education.

In this episode, I speak with Laco about his work and research in the area of Emotion Focused Therapy (EFT). Laco discusses how he originally was trained in Client Centered Therapy and was drawn to Les Greenberg’s, Emotion-Focused Therapy as it was an extension of Carl Rogers’ work, with Les Greenberg being a student of one of Rogers’ students. We discussed Emotion-Focused Therapy and how Les Greenberg and others were studying the change moments in therapy, and were conducting process research on Gestalt interventions using empty chair work and two-chair dialogues with self-criticism. He explained that in EFT, the therapist is trying to access the core of the pain and the unmet needs. He discussed how emotions are seen as either being at the symptom level, or are the underlying emotions, and the therapists is identifying those underlying emotions and emotion schemes, which are the target of intervention. He discussed his work on identifying transdianostic features of Emotion-Focused Therapy and discussed how most of these pivotal painful moments had to do with either the emotions of feeling sad/lonely, shame, or fear. He explained that through the imaginary chair dialogues, the client is able to have a corrective experience, where compassion is elicited, like speaking to their younger self who was hurt, or healthy boundary setting anger for protection. These processes help the person’s emotion schemes become more flexible, moving them from sad/lonely to feeling connected, from shame to validation and acceptance, and from fear to safety or protection. We discuss how EFT conducts extensive process research, and discussed Laco’s work in research and writing, recently publishing the Transdiangosic Emotion-Focused Therapy: A Clinical Guide for Transforming Emotional Pain book with Daragh Keogh, Ph.D., and also creating a workbook for clients to be able to continue the work outside of therapy. He also discussed his work in making resources available online and possibly creating more online programs for clients to continue their work. ​Ladislav Timulak, PhD is Professor in Counselling Psychology at Trinity College Dublin. He is Course Director of the Doctorate in Counselling Psychology. Ladislav (or short Laco; read Latso) is involved in the training of counselling psychologists. His main research interest is psychotherapy research, particularly the development of emotion focused therapy as well as online mental health interventions. He has written (or co-written) 10 books, over 100 peer reviewed papers and chapters in both his native language, Slovak, and in English. His most recent books include Transforming Emotional Pain in Psychotherapy: An Emotion‐Focused Approach (Routledge, 2015) and Transforming Generalized Anxiety: An Emotion-Focused Approach (Routledge, 2017)(with James McElvaney; 2018), and Essentials of Descriptive-Interpretive Qualitative Research: (with co-author Robert Elliott) and Transdiagnostic Emotion-Focused Therapy (with co-author Daragh Keogh) published by the American Psychological Association (2021). His latest books include Essentials of Qualitative Meta-Analysis (with Mary Creaner; American Psychological Association) and Transforming Emotional Pain: An Emotion-Focused Workbook (with several co-authors; Routledge). He provides trainings for clinicians using the approach presented in his books internationally. He directs Emotion-Focused Therapy Research Group and co-directs an E-Mental Health Research group.He previously co-edited Counselling Psychology Quarterly. He serves on various editorial boards and provides expert reviews of academic papers and research grants internationally.

In this episode, I speak with Dave about his journey to becoming the first podcaster in the field of psychology and his prolific career publishing over a 1,000 interviews. Dave explained that he had learned about podcasting very early on and it fit with his interest in radio, which, as a teenager, he got involved with amateur radio, had taken the FCC exams, and built his own components. This lead him to go to college to study electrical engineering, but he quickly learned that his high school had not prepared him for an engineering major. He said he took a Psychology 101 course, but it was completely focused on behaviorism, which turned him off to the field, and instead got a degree in creative writing. At the end of college, he explained that a friend told him he was studying to become a Rogerian psychologist, which sounded interesting, and Dave had always enjoyed helping people with their problems, so he took an abnormal Psychology class, and then went to graduate school for a doctorate in psychology. Dave discussed how his graduate school was focused on psychoanalytic theory, which he didn’t find to be a good fit for him, so he gravitated more towards Humanistic Psychology. He discussed running encounter groups and we discussed the Human Potential Movement in the 60s and how he and others were seeking alternative perspectives. He explained that he had published articles in the Human Behavior journal and after learning about podcasting, thought that interviewing his fellow professors at Sonoma. State University where he met, which was Humanistically focused, would be a great way to begin his program Shrink Rap Radio and Wise Counsel. We discussed that during the 80s, when personal computers were becoming more popular, he became interested in the tech and business world, and began doing market research focus groups, and used online focus groups in the early days of the internet. He continued this work while he taught, had a psychotherapy practice and all of these skills assisted him in his podcast interviews. He explained that he challenged himself to be open to a wide variety of perspective, interviewing a broad range of clinicians and non-clinicians. Dave lastly discussed his interest in Positive Psychology and how he saw it as an outgrowth of Humanistic psychotherapy, and how Positive Psychology’s coaching aspects have been adopted in the business world. David Van Nuys, Ph.D. is past-chair and professor emeritus in Psychology at Sonoma State University, a department with an international reputation for humanistic, existential, and transpersonal psychology. He also taught at the University of Montana, the University of Michigan, and the University of New Hampshire. In addition, David runs a market research business, e-FocusGroups, which has served a distinguished list of clients, including The New York Times, Apple Computer, IBM, Hewlett Packard, and QuickenLoans, among others. He leads personal growth workshops at various growth centers around the U.S. and abroad. David earned his doctorate in clinical psychology from the University of Michigan and has worked as a licensed psychotherapist in both New Hampshire and California. A frequent public speaker, he has also published in professional journals, popular magazines, and co-authored a book on the infamous Zodiac serial killer. He also produces two popular podcasts: Shrink Rap Radio and Wise Counsel. David is a longtime dreamworker himself and a past IASD presenter and for many years taught a course on Myth, Dream, and Symbol at Sonoma State University. In 2018, he received an award from the American Psychological Association for his pioneering podcast, Shrink Rap Radio. The award was presented at Harvard University by the APA president before a crowd of several hundred educational podcasters. Since 2005, he has conducted around one thousand interviews with movers and shakers around the broad world of psychology (including dreamworkers , dream researchers, and Jungian analysts).

In this interview, I speak with Diane about her expertise in sex therapy, and her American Association of Sexual Educators, Counselors, and Therapists (AASECT) certification. She discusses sex therapy, couples therapy with sex issues, and she discusses the PLISSIT model, which describes various levels of intervention, which include Permission, Limited Information, Specific Suggestions and Intensive Therapy. She discusses her eclectic approach, which is grounded in a Humanistic perspective, helping clients accept themselves and address shame. She explains that sexual relationships are complex involving how each partner feels about each other, the challenges people experience in their life, and their different stages in their relationships. She discusses her blog article, “To the Wife Upset About Her Husband’s Porn Viewing: An Open Letter From a Sex Therapist”, and how she addresses how porn is symbolic and is a “fantasy” and what we can learn from this about our partner. She explains how she often sees men who come in by themselves, because they’re partner is upset with them about their pornography use, and how this often suggests an Identified Patient perspective, and missing the couple dynamics and how the couple can heal and improve their relationship together. We also discuss the conflict between being respectful of women, but then also, for heterosexual men particularly, to also be enjoying pornography and objectification of women. She discussed perpetrator fear and how it become more pronounced after the #MeToo movement, and how a number of clients came to work with her to discuss their past sexual encounters. She discusses consent and what that means and looks like in sexual encounters and relational sexual relationships. Diane Gleim, LMFT is a Licensed Marriage and Family Therapist and AASECT Certified Sex Therapist and Supervisor practicing online throughout California and in-person in Santa Rosa, California. As the first Certified Sex Therapist in Sonoma County, Diane treats the many diverse issues related to sexual identity, sexual expression, sexual behavior, and sexual relationships. Her clients include everyone with a sexual concern: individuals and couples ages 18-85, and the LGBTQ+, kinky, and poly populations. In addition to her private practice, Diane’s work also includes providing trainings and consultations on sex therapy; writing the blog "Underneath the Sheets" on Psychology Today’s website; and supervising sex-therapists-in-training. She has been quoted in various press and a guest on podcasts. Diane has been voted Sonoma County’s Best Sex Therapist by the readers of the North Bay Bohemian five times.

In this workshop, Karin discussed her career where she trained in Argentina, then came to Palo Alto to learn at the Mental Research Institute forty years ago. She discussed the place the MRI has in the history of developing family and systemic therapy. She worked with Paul Watzlawick, Dick Fisch, and John Weakland, and eventually became the Director of the Brief Therapy Center, a title she still holds. In 1966, the group was interested in seeing what type of changes they could help create within 10 sessions (hence the term brief), which was very different from the prevailing psychoanalytic approach during the time. She discussed how the approach based in systems theory, but is a minimalistic family therapy/systems therapy way of promoting change, where they don’t need the whole system to be present in the office for change to occur. Interactions are always in the clinician’s mind, understanding who is this effecting, how is someone reacting to this, which allows you to intervene with the person who is the most motivated for change in the system. She explained that they’re not necessarily trying to achieve perfection, but instead help the person in pain and asking for help at the time to get out of a hole. She shared the quote by John Weakland that “when you have a problem, life is the same damn thing over and over again, and when you no longer have a problem, life is one damn thing after another”. Karin discussed identifying whom to focus on in the therapy by identifying who is most in pain and therefore is most motivated to work with the therapist to promote a positive change. If working with a family, the therapist might not put all of their energy into the child since they have the least power in the system, and the most motivated one in the family might be the parent, so they will be the one you need to engage to make change. She also pointed out that they go straight into the problem that brought clients in, and stay in the here and now, and try not to “open doors” to the past, which is what allows the work to be so brief. We discussed how the approach postulates that the attempted solution is what has become the problem, keeping the system stuck, so instead, having the individual, couple or family do the 180 degree opposite of that, even if it goes against common sense, then observing what happens and discussing in the following session. As opposed to many other models of systemic and family therapy, the Brief Therapy Center works with fewer people and change happens outside of the session. She pointed out that they were able to make significant change in a matter of ten sessions, with the average amount of sessions being six. Karin explained that there have been many different models and techniques developed over the years, although the simplicity of the Brief Therapy approach still stands as an effective treatment and could be the key to reduce the mental health crisis in the U.S. currently. Karin Schlanger, LMFT was the Director of the Brief Therapy Center in MRI since 2008 until the sale of the building in 2019. She continues to be the director of the BTC currently. She has worked as a psychologist, supervisor in the Brief Therapy Model and professor at several universities internationally. She studied Psychology in the Universidad of Buenos Aires – Argentina and graduated in 1982. She arrived at the MRI in 1983 having heard of the work of John Weakland, Dick Fisch and Paul Wazlawick and worked with them until the end of their days. In 1990, she opened the Centro Latino de Terapia Breve to do research on how this pure American model of Problem solving can be applied in other cultures. This project continues today, working with low income Spanish-speaking families, who are at the worse end of society’s inequality. In 2012, she founded a NGO, Room to Talk, to offer psychological services to students, families and school staff at the school. She was the Executive Director. She has been a professor in several local Universities — University of San Francisco, Stanford University, School of Psychiatry and Behavioral Sciences, College of Notre Dame de Namur, and other Universities of Spain — Valencia International University, Universidad de Abat Oliva, Institute Systemic de Barcelona. She is a supervisor in the Hospital of San Pau, in Barcelona. Karin is the author of a book that has been translated to 5 languages, and the author of many articles and chapters of lots of books throughout the years. Also, in 2012, she has started the Grupo Palo Alto Internacional, which was officially launched in Mexico, January – 2016. Currently, Karin trains and supervises therapists internationally as well as locally through county mental health programming. She provides trainings through the https://www.brieftherapycenter.org/

In this episode, I interview Carolyn and Phil about their decades of research on couples and the changes they experience after the birth of the first child. They discussed how Carolyn had been an elementary school teacher and was pregnant with their second child when they moved to Berkeley where Phil was starting his new job at the University of California, Berkeley. They discussed how their own life experiences led them to be interested in the effect of having children on the couple’s relationship, and created a study where couples joined a group during their third trimester of a first pregnancy, and worked together until their child was four months old. In comparison to the control group, who were not offered the couples group intervention, the couples in the groups maintained their relationship satisfaction, while the couples in the control couples with no intervention experienced a significant decrease in satisfaction, which was also reflected in studies by others that followed. The Cowans then worked with another group of couples from when their first child was making the transition to school, and followed them until the children entered high school at 14-15 years old. They discussed the exercises they used during these inventions, and how it was so significant for these couples to talk with their partners in a safe setting about the key issues in their lives and to hear others’ experiences and discover that they were not alone during these difficult times. The first two studies were with nonclinical couples in the community. Later, they received a grant to work with low-income couples who had few resources for support, which was designed to increase fathers' engagement with the mothers and their children. Once again, they found positive results in terms of the quality of the couples' relationships as partners and parents, of parenting that was less harsh, of the children having fewer troubling behaviors, and in many cases, increases in income. Phil and Carolyn explained that the majority of current grant funding is siloed, with separate funding for children, for mothers, and for fathers, and and almost no programs taking a family systems view. They feel that the lack of a systemic perspective misses opportunities to take a broader perspective on family development and to work with parents, non parental caregivers, children, and fathers, which can lead to improved outcomes for parents and children, and be more efficient and cost effective. They referenced a study they are overseeing now that has also included employment support, since this is so integral in family functioning for low-income families. Their intervention work has been replicated in the U.K., Germany, Malta, and most recently in Israel. Philip A. Cowan, Ph.D. and Carolyn Pape Cowan, Ph.D. are clinical psychologists and professors Emeriti at University of California, Berkeley who have conducted three significant longitudinal research studies on couples relationships after the birth of the first child. They have received grants from the National Institute of Mental Health and the California Office of Child Abuse Prevention. Their three projects, the Becoming a Family Project, the Schoolchildren and Families Project, and the Supporting Father Involvement Project, which is an ongoing collaboration with Marsha Kline Pruett, Ph.D., M.S.L. ABPP at Smith College and Yale University, have studied the effects of interventions on the couples relationship, father involvement, child wellbeing and a number of other factors. Their group model for couples is being conducted throughout California, in Connecticut, Alberta Canada, England, and Malta. Carolyn and Phil Cowan received the the Distinguished Contribution to Family Systems Research award from the American Family Therapy Academy (AFTA) and the Best Research Article award, along with Marsha and Kyle Pruett, Ph.D., M.S.L. ABPP and Jessie Wong, Ph.D., from the Men in Families Focus Group of the National Council on Family Relations (NCFR). They are the authors of When Partners Become Parents: The Big Life Change for Couples, and there are “training the trainer” trainings in their Supporting Father Involvement program through Brazelton Touchpoints Center, which is part of the Division of Developmental Medicine at Boston Children's Hospital, a teaching hospital of Harvard Medical School.

In this episode, Carol discusses how early in her career she was hired to be the assistant director of training for a child and family guidance clinic, and became very intrigued in the processes of clinical supervision. After a decade, she became Director of Training at another American Psychological Association accredited program and developed the site visit documentation, which led her to collaborate with her future coauthor, Ed Shafranske, Ph.D., to develop a model of supervision. She explained how their model is transtheoretical, providing a framework for supervisors to provide supervision systematically and intentionally. She said that most clinicians provide supervision the way they were supervised, through osmosis, or internalizing practices done unto them, rather than using a particular model or being guided by research and evidence. She pointed out that increasingly, high rates of inadequate and even harmful supervision are being reported by supervisees, and how the process of becoming a supervisor varies dramatically. Some supervisors simply begin, utilizing practices that were done unto them during their training trajectory; others have taken a workshop, and some have a longer training period with a substantial sequence of courseswork, experiential training, video review, and targeted feedback to develop their skills as a supervisor. She explained that in their model focus is on a process that includes development of the supervisory alliance, monitoring that alliance over time attentive to the perspectives of cultural humility with respect to the clients, supervisees, and supervisor. Additionally it includes focus on reacivity or countertransference, supervisee self-care, legal and ethical issues, attending to a communitarian constellation, an environment of caring, respect, and support. We discussed having strong boundaries around supporting the supervisee in instances of reactivity in regards to client, while at the same time, never crossing the boundary to provide psychotherapy to the supervisee. In talking about supporting supervisees, she discussed trauma informed supervision and helping supervisees to have an understanding how their nervous system is affected, as well as helping them have tools for regulating their activation. She pointed out that the ultimate job of the supervisor is to protect clients, and gatekeeping, ensuring that unsuitable supervisees do not enter the profession. Carol discussed cultural humility and power in the supervisory relationship and how she and her co-author encourage supervisors to be open about their various identities and privilege from the outset of the supervisory relationship and throughout. She encourages giving feedback regularly throughout supervision, and being honest and transparent about the supervisee’s development and scaffolding their strengths to improve the areas that are in development, rather than avoiding giving corrective feedback until review time. She discusses how monitoring client outcomes and feedback is critical and often left out in supervision, as well as encouraging supervisee self-assessment and not being fearful of give needed feedback to the supervisee. Carol Falender, Ph.D. is co-author of multiple books on clinical supervision including Clinical Supervision: A Competency-based Approach (2004; second edition, 2021), Getting the Most Out of Clinical Training and Supervision: A Guide for Practicum Students and Interns (2012) The Essentials of Competency-based Clinical Supervision (2017), co-editor of Casebook for Competency-based Clinical Supervision and all with Edward Shafranske; Multiculturalism and Diversity in Clinical Supervision: A Competency-based Approach (2014) edited with Edward Shafranske and Celia Falicov. She edited one book on consultation, Consultation in Psychology: A Competency-based Approach (2020) with Edward Shafranske. She has written numerous articles and conducted workshops and symposia internationally. She directed APA approved training programs for over 20 years and was a member of the Supervision Guidelines Group of the Association of State and Provincial Psychology Boards (ASPPB) and Chair of the Supervision Guidelines Task Force of the Board of Educational Affairs of APA. Dr. Falender is a Fellow of American Psychological Association (APA; Divisions 37. 29 and 43). She is an Adjunct Professor at Pepperdine University, Clinical Professor in the UCLA Department of Psychology. She was the recipient of a Presidential Citation from the American Psychological Association for innovative contributions to the theory and practice of clinical supervision, nationally and internationally, and in 2018 received the Distinguished Career Contributions to Education and Training in Psychology Award from the American Psychological Association. In 2023, she received The Chuck Faltz Lifetime Achievement Award from the California Psychological Association and the Distinguished Award for the International Advancement of Psychotherapy by APA's Division 29.

In this episode, Angelique discusses her career as a sleep consultant for parents of newborns. She explained that she started off as a midwife, then a birth doula, and a post partum doula, and spent a great deal of time helping babies sleep through the night, and new families navigate the transition to parenthood. She explained that she saw sleep as a portal into multiple areas such as post partum depression, parent-infant bonding, and other aspects of the transition to parenthood. She found that there was not a great deal of research on the subject, only research focused on extinction or “cry it out” method of helping infants with sleep issues when she started in the field. She went to conferences, obtained a doctorate in psychology, and used her field work to develop an approach to helping children sleep, which she named the MIllette Method, which takes into account development, temperament, attachment, culture, and numerous other factors that play in to sleep and separation between caregiver and child. She talked about assessing the proximity of the parent to the child, range of crying, parental responsiveness, and charting these factors in order to develop a plan for the family. She discussed the “rinse and repeat” method where the parent will notice sleep signs, put the baby down, soothe them, step away, and then come back again after a little bit to continue soothing, then stepping away again. She explained that sleep is also a process of developing self regulation and the different self regulating behaviors that babies aquire as they develop. Angelique pointed out that the research is mixed on cosleeping or having the child sleep in another room, so it really depends on the family’s preferences, although early on, the rate of Sudden Infant Death Syndrome (SIDS) is lower when the baby is sleeping in the room with the parents for the first six months. She discussed the interval method of sleep training, which allows for more crying, where there may be more crying, but isn’t used until the infant has a number of self soothing abilities. Lastly, she described her approach to helping toddlers and children falling asleep, using two phases. The first is based on her child psychology background, and using play activities to help parents and children practice separation, since separation is the key element of sleeping alone. Sometimes, that in itself leads to better sleep, but if not, she institutes the second phase where the parent sleeps in the child’s room for a few nights, and slowly moves out of the room after consecutive nights. She explained that the key element of separation that is inherent in helping infants and children sleep. ​ Angelique Millette, PhD, CLE, CD/PCD is a parent-child coach, pediatric sleep consultant, and family sleep researcher. Angelique’s diverse background includes training in child play, art, and nature therapies, child development and sleep, and work as a child psychologist. Her commitment to children and parents spans twenty-five years and she continues to develop programs to meet families “where they are at.” Her approach allows her to work with diverse communities both nationally and internationally. Angelique has developed The Millette Method™ a multi-disciplinary approach to family sleep and child behavior. The Millette Method™ does not follow one specific sleep or behavioral method, but rather uses a “tool-box” of different methods and approaches and takes into account various factors including child temperament and history, culture, family social support, access to nature/play, parental overwhelm, history of trauma, and parent/child mental health and wellness. Angelique has worked with more than 15,000 families, and presents professional workshops to non-profits, government agencies, Fortune 500 companies, universities, and parents groups across the country and internationally. She also consults with juvenile products manufacturers in their development of innovative sleep and child development designs.

In this episode, Bob discussed how originally substance misuse was not an area that he worked with, but after it kept showing up with his clients he decided he needed and pursued more training. He discussed how he was part of the Family Recovery Project at the Mental Research Institute with Drs. Stephanie Brown and Virginia Lewis, a study aimed at what happens in couple and family systems after beginning recovery. Bob’s research, a qualitative study on long-term couple recovery, led to him creating a model called the “Couple Recovery Development Approach (CRDA), a theory for explaining how couples can successfully navigate the challenges found in the transition from active addiction to active recovery. Bob talked about the impact of the trauma of addiction, and the trauma of recovery relating that the first year in recovery was challenging, and that relapse rates are high in that first year. He explained how with couples he externalizes addiction and explores how it has invaded their relationship, in a way so that they can both talk about the impact of this unwanted intruder. He discussed how clinicians often believe it’s important not to work on the couple relationship in the beginning of recovery, because each partner is supposed to focus on their individual recovery, but he pointed out that couples impacted by addiction have the highest divorce rate of any other comorbidities, and there actually isn’t any empirical studies to support that approach; in fact research does support the concept that healthy relationships are found to be the biggest predictor of long-term sobriety. It turns out that couples work is one of the most effective ways to identify addiction and move people into recovery. Rather than the common belief that addiction is contraindicated for couples therapy, We addressed the issues of codependency. While it can be helpful in defining issues for the non-using partner, it’s limited. Bob said he feels it is important to add the concept of secondhand harm, and post-traumatic-stress-disorder to normalize partner’s experiences and not pathologize them with the singular term “codependency”. He described his intervention called H.E.A.R.T. (Healing Emotions from Addiction Recovery and Trauma), which helps partners to process the trauma from addiction, without blame or defensiveness. Robert Navarra, Psy.D, LMFT, MAC is a Licensed Marriage and Family Therapist, Certified Gottman Therapist and Master Trainer, and holds National Certification as a Master Addiction Counselor. He has trained counselors and therapists nationally and internationally. Dr. Navarra has co-authored several book chapters with Drs. John and Julie Gottman, and co-authored articles on Gottman Therapy for The Encyclopedia of Couple and Family Therapy with Dr. John Gottman. Based on his research at Mental Research Institute in Palo Alto California, Bob created “Roadmap for the Journey: A Path for Couple Recovery”, a two-day workshop for couples in recovery from an addictive disorder. “Roadmap for the Journey” has been a featured workshop at Hazelden Betty Ford and has been given at treatment programs as well as in small, semi-private workshop settings. Bob and John Gottman are currently researching the impact of Roadmap for the Journey in helping couples integrate recovery into their relationship, a missing element in most treatment programs. In collaboration with the Gottman Institute, Bob has also created a one-day training workshop for counselors and therapists, called “Couples and Addiction Recovery.” He also teaches graduate classes on addictive disorders at Santa Clara University. You can learn more about Bob at www.drrobertnavarra.com.

In this episode, I speak with Sheila about her lifelong work of working with clients with shame. She explained that she got interested in this subject from her experience as a child and being shy, but overcoming it by becoming a children’s magician and performing. She explained how she trained in a number of approaches such as Emotionally Focused Couples Therapy, Drama Therapy, Dialectical Behavior Therapy, Cognitive Behavioral Therapy, AEPD, Accelerated Experiential-Dynamic Psychotherapy, Hakomi and others, but wasn’t finding a particular approach really addressing shame. She discussed how she helps clients to understand that shame has an evolutionary purpose, both in protecting us when we are young, but also helping us to evolve in the present, using it as a signal the client to set boundaries, make changes, and take risks to be more of their authentic self. Sheila talked about how shame is evolutionary by subduing an anger response towards a parent, because it might not be safe, or threaten the connection with parents. She talks about the continuum of shame, which goes from stage fright or imposter syndrome, to never feeling good enough, having a lot of shoulds and perfectionism, and all the way to experiences of humiliation. She discussed how PolyVagal Theory was a great addition to the puzzle, where she was able to have language and a biological explanation for the freeze or shut down that happens for someone when shame comes up. Sheila discussed noticing it in the moment, in the session, when the interpersonal bridge breaks, and helping clients to see the shame, and how it shifts their nervous system. She talked about working with the inner critic, the parent who might have been the critic, using parts work and drama therapy to help clients replay those experiences and becoming the person that could be the hero and protect and save their younger parts. Sheila discussed how helping clients to use mindfulness to notice when the shame comes up, sitting with it, and using compassion for themselves, leads them to be able to be open, rather than shutting down. Sheila Rubin, LMFT, RDT/BCT is a marriage and family therapist and a leading authority on Healing Shame. She developed the Healing Shame Therapy work over the last two decades and is the co-director, with Bret Lyon, of the Center for Healing Shame. in Berkeley, California. Sheila has delivered talks, presentations and workshops across the country and around the world, at conferences from Canada to Romania. She is a Board Certified Trainer through NADTA and past adjunct faculty for the CIIS Drama Therapy Program and JFK University’s Somatic Psychology Department. Sheila's expertise, teaching, and writing contributions have been featured in numerous publications, including seven books. Her writings on shame include the chapter “Women, Food and Feelings: Drama Therapy with Women Who Have Eating Disorders” in the book The Creative Therapies and Eating Disorders, the chapter “Almost Magic: Working with the Shame that Underlies Depression: Using Drama Therapy in the Imaginal Realm” in the book The Use of Creative Therapies in Treating Depression, and the chapter “Unpacking Shame and Healthy Shame: Therapy on the Phone or Internet” in Combining the Creative Therapies with Technology: Using Social Media and Online Counseling to Treat Clients (all books edited by Stephanie L. Brooke). Sheila offers therapy through her private practice in Berkeley and online via Zoom. She also provides consultations to therapists via Skype and leads workshops in Berkeley, internationally, and online. You can learn more about her workshops, writing, and on demand trainings at www.HealingShame.com