Therapy on the Cutting Edge

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

In this episode, I speak with Rebecca, who discusses her career working with children, which led her to focusing on treatment and research of children on the autism spectrum. She discussed being influenced by her training in Philadelphia, which had a strong family systems component, and how working with the parents and children is a foundation for her Regulating Together work. She explains that the children are in a group where they learn affect regulation skills, while the parents are in another group, also learning affect regulation skills, how to coach the kids at home, and prevention and behavioral management skills. The skills the children learn are relaxation skills, identifying triggers and physical reactions, rating emotions, problem solving skills, mindfulness, radical acceptance and cognitive flexibility. She discussed how the caregiver training has a lot of focus on preventing the emotional dysregulation, as well as techniques for managing the dysregulation and behavior problems when they do occur. Additionally, the caregivers are encouraged to use the skills in order to regulate themselves, and how this helps with coregulation with their child. Rebecca discussed using CBT with a child with autism and modifications you might make since many autistic children can struggle with rigidity. She also remarked on how the group leaders have the ability to work with the children in vivo, at the end of the group where the kids earn time to play games. The group facilitators help the children implement the skills they learned if they become triggered during that time socializing. We discuss the research and how they found that the biggest gains were realized between five to ten weeks after the regulating together series was over, which highlights that the benefits of affect regulation and that a shift in behavior may take time to appear. We discussed other applications for the model and future potential research directions and a trial starting using a canine assisted version of the model. Rebecca explains that her and her team will be publishing their manual and are currently training clinicians in the use of this model. Rebecca C. Shaffer, PsyD, is a clinical psychologist and currently serves as an Associate Professor of Pediatrics at Cincinnati Children’s Hospital with an affiliated appointment at the University of Cincinnati. Rebecca is the director of Psychological Services for the Cincinnati Fragile X Center, where she oversees the assessment and treatment of individuals with fragile X syndrome (FXS). Rebecca and her team have created an emotion dysregulation treatment program for children with ASD called Regulating Together. Regulating Together treats emotion dysregulation, especially with reactivity and irritability, in a group setting with concurrent caregiver training. She currently leads several research studies, as well as publications, focused on the development and efficacy of this program. She also serves as the primary investigator of the Simons Foundation Powering Autism Research (SPARK) study at Cincinnati Children’s and other ASD-specific studies. Rebecca has had numerous publications and trains clinicians in Regulating Together throughout the country. To learn more about training in Regulating Together and the research behind it, check out the Shaffer Lab and contact by clicking here.

In this episode, I speak with Susan about how she came to develop Cognitive Behavioral Play Therapy (CBPT). She explained that she was originally trained in psychodynamic play therapy and found it helpful. Talking with and reflecting on a child’s experience was important, but she wanted to find ways to help children gain more adaptive skills to deal with their emotions and difficulties. At the time, it was thought that you could not use CBT with young children, so she used CBT techniques and ideas and incorporated them into play. Finding ways to bring CBT into play involved modeling with puppets, dolls, toys, books and other child-oriented materials. We discussed numerous case studies using CBPT with young children, as well as the research on Cognitive Behavioral Play Interventions (CBPI), currently being used with non-clinical populations. Susan shared case examples of using puppets to model various interventions, such as Systematic Desensitization and Cognitive Change strategies, and using workbook activities, like drawing the Worry Monster/Worry Bully to help anxious and fearful children. We discuss using toys, puppets, books, movies, and art with children. She also talked about her work with parents and assessing whether the presenting problems are better treated by working with just the parents or the child and parents together in different combinations. Susan M. Knell, Ph.D. is a psychologist who received her Ph.D. in Clinical Psychology from Case Western Reserve University and did her internship and NIMH Postdoctoral Fellowship at The Neuropsychiatric Institute (NPI), UCLA, specializing in clinical child psychology and developmental disabilities. She is currently Adjunct Assistant Professor in Psychology at Case Western Reserve University, maintains a private practice, supervises graduate students in training, and is the author of the book, “Cognitive-Behavioral Play Therapy” (Jason Aronson, 1993). Susan was the first to study and write about the application of cognitive-behavioral therapy with young children. In addition to her book, she has published many chapters in edited books on play therapy, with recent chapters on creative applications of CBPT and treating young children with anxiety and phobias. She lectures throughout the country and internationally on Cognitive-Behavioral Play Therapy with preschool and early school-age children. Most recently, Susan has been working with Maria Angela Geraci, Ph.D., Meena Dasari, Ph.D. and colleagues, as part of the Cognitive Behavioral Play Therapy Institute, in Rome, Italy. The Institute will be disseminating relevant research and providing online training in CBPT. Online training is available through the institute website: www.cognitivebehavioralplaytherapy.com.

In this episode, Deb discussed how she was inspired after hearing Stephen Porges, Ph.D. speak about his polyvagal theory, and found ways to use this theory in helping clients to heal. She explained that there are three states of the autonomic nervous system, which are the ventral (feeling regulated, safe, connected), sympathetic (fight or flight, activated), and dorsal (collapse, shut down, disconnected) and that there are cues that trigger these states. We discussed how emotions are the labels that we attach to these states, although the same states may have different labels (anxiety vs. excitement). She pointed out that our nervous system takes in information from three pathways, which are embodied (interoceptive or internal sensations), environmental (external cues), and between nervous systems (how our nervous system is reacting to another’s nervous system). She discussed how the polyvagal theory allows therapists to help clients identify the cues that trigger these states, understand these states, and they also inform the therapist as they help coregulate the client through the therapist being in a ventral state. The polyvagal theory, she pointed out, sees these states in a hierarchy, where when the sympathetic is overwhelmed, then the person moves into the dorsal state of collapse or dissociation, and to move from the dorsal state, one must go back through the sympathetic, fight or flight, state to return to a ventral state. Deb discussed how we learn to move through this system through coregulation and we discuss how this plays out with parents and children and in couple relationships. She explained that survivors of Complex PTSD, who grew up in an unsafe and/or unpredictable environment, weren’t able to get that experience of coregulation to internalize, so they had to regulate themselves, and these solutions may have become maladaptive. This also creates difficulty for the client because their experience is that people are dangerous, so it is dangerous to be in the presence of another, making coregulation very difficult. Part of the therapist's work with trauma survivors is to be able to help coregulate them in a ventral state, while they also access those other states while revisiting the trauma, experiencing the coregulation in the present while engaging with the experience of the past. She discussed techniques she uses with clients such as breathing techniques, connecting to memories of times in ventral state, using objects that cue a time when in a ventral state, and a discernment question where the person is able to reflect on whether the current activation is needed for the current situation, and notice, name, and then turn towards the nervous system experience. Deb Dana, LCSW is a clinician, consultant and author specializing in complex trauma. Her work is focused on using the lens of Polyvagal Theory to understand and resolve the impact of trauma, and creating ways of working that honor the role of the autonomic nervous system. She is a founding member of the Polyvagal Institute, consultant to Khiron Clinics, and advisor to Unyte. Deb is the developer of the signature Rhythm of Regulation Clinical Training Series and is well known for translating Polyvagal Theory into a language and application that is both understandable and accessible for clinicians and curious people alike. Deb’s clinical work published with W.W. Norton includes The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, Polyvagal Exercises for Safety and Connection: 50 Client Centered Practices, the Polyvagal Flip Chart, and the Polyvagal Card Deck. She partners with Sounds True to bring her polyvagal perspective to a general audience through the audio program Befriending Your Nervous System: Looking Through the Lens of Polyvagal Theory and her print book Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Deb can be contacted via her website www.rhythmofregulation.com

In this episode, Scott discusses his beginnings as a family therapist and his struggles with helping families, which lead him to working with Charles Fishman, MD, an expert in Structural Family Therapy, and later Jay Haley. He discussed reviewing videotapes of their work and began to see the patterns in family therapy and got interested in process analysis research. He noticed that there were "key moments of change”, which lead him to create micro steps to help therapists develop their family therapy skills quickly, to be effective in treatment. We discussed his early work with families and teens and all the great, creative, strategic ways of helping parents to manage behavioral issues, and strengthen their relationships. He explained that he was able to do research on the approach about its efficacy and evidence basis, and also included the measures to help organizations to support their staff to utilize the model, and use technology to track progress and intervene when a therapist might be struggling in certain areas. Some years later, as he was reviewing cases where there were treatment “failures”, he described that he found how, when there is trauma involved, the family began to stabilize and become closer, but then not achieve the second order change because the trauma’s effect on the family system would become more apparent. He realized he did not have a model to address trauma, so he did the research trying to find an existing approach, but found there were no family therapy models with the micro steps to address trauma. He went on to write his most recent book, Treating the Traumatized Child, and teach it to clinicians and research its effectiveness, Scott discussed online trainings that he created to help make it available for therapists to gain the skills and utilize the methods in their practice. He shared that his work now is to help make family therapy accessible to organizations and clinics, so their clinicians can learn and use family therapy, without it needing to be a massive financial and time commitment as some of the other evidence based models. His hope is that this will reduce secondary trauma, and help with “the great resignation” of mental health workers that are burnt out, through increasing confidence and competency. Scott P. Sells, PhD, MSW, LCSW, LMFT, is former tenured Professor of Social Work, Savannah State University, Savannah, GA and Associate Professor at UNLV in Las Vegas, NV. He is the author of three best-selling books, Treating the Tough Adolescent: A Family-Based, Step-by-Step Guide (1998), Parenting Your Out-of-Control Teenager: 7 Steps to Reestablish Authority and Reclaim Love (2001), and Treating the Traumatized Child: A Step-by-Step Family Systems Approach (Springer, 2017). Scott is currently the founder and model developer of an evidence based model known as the Parenting with Love and Logic and the Family Systems Trauma Model that are being used by both juvenile justice and child welfare in over 14 states and in Europe. He provides training and resources through the Family Trauma Institute, which can be found at familytrauma.com