Therapy on the Cutting Edge

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

In this episode, Leanne talks about her experience working with Sue Johnson on the Emotionally Focused Couples Therapy (EFCT) efficacy research, and her involvement with EFT and Emotionally Focused Individual Therapy (EFIT). We discuss the EFT and EFIT approaches, and Leanne explains how in both EFT and EFIT, the therapist uses the attachment frame and EFT Tango (macro set of interventions) to help clients tune into and deepen their emotional experience in the context of the ‘safe haven’ alliance created by the therapist. We discuss the use of imaginary conversations between the client and their younger selves or others in their life (Move 3 of the Tango), as well as other moves of the Tango such as processing the encounter (Move 4) – what the client felt, what the reaction is from the other in the imagined encounter, what blocks might emerge and how they are managed. We discuss trauma and how we work with trauma within the couple context, and Leanne shared her work with clients. She talked about a couple in one session where the husband was deferring to his wife, and how trauma, especially longstanding developmental trauma, impacts an evolving sense of self. She reflected the process, deepened the client’s experience, and helped the partner access and share previously disavowed aspects of self and associated vulnerability. We discuss the EFT approach to working with present process, not necessarily focusing on the past relationships of childhood, but at times connecting with the past experiences that are triggered in the couple relationship. She shared a story about a couple where the one partner felt anxious when his wife became dissociated, and through processing this with the couple, his wife was able to share her experience, leading him to realize he was not being rejected, and that she would like him to be with her and help ground her by putting his hand on her leg. Leanne also shares an EFIT example of a client working through trauma and processing unprocessed emotions associated with the imaginal scene of a traumatic event. T. Leanne Campbell, Ph.D., is an international speaker, writer, trainer, and co-developer of EFT-related educational programs and materials. Most recently, she co-authored the first basic EFIT (Emotionally Focused Individual Therapy) text with Dr. Sue Johnson, A Primer for Emotionally Focused Individual Therapy (EFIT): Cultivating Fitness and Growth in Every Client (Routledge, 2021), as well as a workbook for therapists training in EFT (see Furrow et al., Routledge, 2022). Known for her expertise in the areas of loss and trauma, Leanne has provided hundreds of psychological assessment reports for forensic/legal and personal injury matters being considered before various levels of Court, as well as insurance companies and bodies involved in adjudicating personal injury and other loss- and trauma-based claims. In addition to maintaining a full-time private practice, providing individual, couple and family therapy and assessment services, Leanne currently co-manages a multi-site practice comprised of twenty-five clinicians and is a site co-ordinator for an Emotionally Focused Individual Therapy (EFIT) outcome study. You can learn more about Leanne’s work at www.eftvancouverisland.com.

In this episode, I speak with Michelle about her Social Thinking work, and we discussed her career working in an autism spectrum clinic, working with adults with brain injury, working in a high school, and later starting her own clinic. She talked about her enjoyment in working with those on the autism spectrum who have an established expressive and receptive language, as well as others with social learning challenges. She discussed how people tend to have different expectations for those they perceive has having learning differences verses those they perceive to be “bright” or “more able”. This later group tends to be judged far more critically resulting in the public having far less forgiveness for their “social errors”, which further perpetuates social anxiety. She sought to develop a system for helping these brighter individuals learn about the social world, rather on providing behavioral reinforcement. She begins her work with individuals by fostering awareness of social interactions, encouraging them to explore their own and other’s possible social thinking, and how this process involves interpreting each other’s social intentions in context. She discusses how this work is done both one on one, as well as within groups, and how the group participants tend to provide invaluable feedback to each other. She talks about the various factors she considers when working with clients, including social self-awareness, social attention, and ability to interpret (how literal or how abstract). We also discussed the interplay between social interactions, social anxiety and behavioral issues in children and adolescents, and how working on social problem solving helps to decrease anxiety, and fostering use of pro-social behavioral responses. Michelle Garcia Winner, MA, CCC-SLP, is the founder and CEO of Social Thinking and a globally recognized thought leader, author, speaker, and social-cognitive therapist. She is dedicated to helping people of all ages develop social emotional learning, including those with social learning differences. Across her 35-year career she has created numerous evidence-based strategies, treatment frameworks, and curricula to help interventionists develop social competencies in those they support. Michelle's work also teaches how social competencies impact people's broader lives, including their ability to foster relationships and their academic and career performance. She and her team continually update the Social Thinking® Methodology based on the latest research and insights they learn from their clients. She is a prolific writer and has written and/or co-authored more than 40 books and over 100 articles about the Social Thinking Methodology. Michelle maintains a private practice, The Center for Social Thinking, in Santa Clara, California, where she works with clients who continue to teach and inspire her.

In this episode, Janina discusses her career in learning, treating, and teaching about PTSD and Complex PTSD. She discusses being inspired when hearing Judith Herman talk about how that the events in one’s life shape our experiences, as opposed to just being driven by childhood sexual fantasies as was the main viewpoint based on Freud’s work. She explained how the prevailing thought in treating trauma for decades has been that the client needed to tell the story of the trauma, but we have no research that proves that view. Instead, she proposes that the way to treat trauma is to change one’s relationship to the symptoms, rather than re-live the event. She discussed her experience working with Bessel Van Der Kolk, and how he encouraged her to teach about working with PTSD. Additionally, he encouraged all of his clinicians to be trained in a Somatic approach, which lead her to Sensorimotor Psychotherapy training and to EMDR. She discussed her work and how she helps clients to engage their frontal lobes, the thinking brain, and works with clients as fragmented, incorporating Internal Family Systems and working from a Structural Dissociation perspective. We discussed how she treats suicidality in trauma clients as a part trying to protect the client from being overwhelmed by vulnerability. She discussed how her model, Trauma Informed Stabilization Treatment (TIST) is an integrative approach, incorporating parts work, EMDR, somatic, and Structural Dissociation, and she is training others in her model throughout the world. Finally, we discussed the clients’ experience in therapy and working with them where they are, as the client who has experienced trauma may not be able to “trust” the therapist enough to try something new. Janina Fisher, Ph.D. is a licensed clinical psychologist and a former instructor at the Harvard Medical School and former instructor at The Trauma Center, a research and treatment center founded by Bessel van der Kolk. She is known as an expert on the treatment of trauma, and has also been treating individuals, couples and families since 1980. She is past president of the New England Society for the Treatment of Trauma and Dissociation, an EMDR International Association Credit Provider, and Assistant Educational Director of the Sensorimotor Psychotherapy Institute. Janina lectures and teaches nationally and internationally on topics related to the integration of the neurobiological research and newer trauma treatment paradigms into traditional therapeutic modalities. Janina is the author of Healing the Fragmented Selves of Trauma Survivors: Overcoming Self-Alienation (2017), Transforming the Living Legacy of Trauma: a Workbook for Survivors and Therapists (2021), and The Living Legacy Instructional Flip Chart (2022). She is best known for her work on integrating somatic interventions into trauma treatment, and the development of her approach Trauma Informed Stabilization Treatment (TIST), which one can be trained in by going to https://therapywisdom.com/healing-the-fragmented-selves/. You can learn more about Janina at her website, www.janinafisher.com.

In this episode, I speak with Karen about her past as a Child Protective Services caseworker and how she was confused by the therapists who did play therapy, not understanding it fully until she herself got her LCSW and began training in play therapy in Philadelphia. She discussed her experience working with the developers of Filial Therapy, which uses child centered play therapy developed by Virgina Axline and based on Rogerian humanistic theory. In Filial, which in this context means parent-child, parents are taught to hold nondirective, dyadic play sessions with their children, so that the parent becomes the agent of change. Karen discusses learning from numerous experts in play therapy, being trained in Gestalt, and in sand tray therapy. She also discusses how she uses these modalities to help children express their inner experiences, and to help parents learn how to create this space for children and to see the world from their child’s perspective. We discuss areas where parents and therapists get frustrated in their efforts to use play therapeutically, and how the work creates a shift not only in the children, but also in the parents. In addition, we discuss the differences between a Rogerian non-directive play therapy, and a psychodynamic play therapy; in the Rogerian approach, the clinician is reflecting what they see as the child plays, as opposed to interpreting what they see. We also discuss right brain approaches such as play, art therapy, and sand tray, and their application to adults as well as children. Karen Pernet, LSCW, RPT-S, SEP is a Licensed Clinical Social Worker, Registered Play Therapist Supervisor & Somatic Experiencing Practitioner. Karen returned to school to obtain her MSW at Bryn Mawr College of Social Work and Social Research in mid-life after a career in child welfare. She is known for her encouraging and down to earth approach and has been described as knowledgeable, supportive, and playful. Karen’s postgraduate education includes certificates in Gestalt Therapy, Somatic Experiencing, and Filial Therapy. In addition, she has had intensive training in Child Centered Play Therapy, sand tray therapy, Gestalt Play Therapy, trauma treatment, interpersonal neurobiology, and Internal Family Systems. Karen is in private practice in Oakland, CA and provides professional trainings, consultation, and supervision. From 2006 to 2021 she was a certified Filial Therapy trainer with the Family Enhancement and Play Therapy Center and currently a Filial Therapy supervisor with the National Institute for Relationship Enhancement (NIRE).

In this episode, I speak with Louise about her journey from switching careers as a retail buyer, to going to university and getting a degree in psychology, and working as a behavioral therapist. She discussed being introduced to Acceptance Commitment Therapy (ACT) and really liking the model, and applying it in her work with adolescents. She explained that the developmental differences between adolescents and adults lead her to think about many aspects, such as evolutionary science, attachment, and how these natural processes can be tapped into when a teen is stuck by using ACT, to help them enhance their development and thrive. She explained that DNA-V was a framework for ACT that helped with growth and development. The Discoverer is the ablility of us that learns through trial and error and taking risks, the Noticer part is the ability where we are mindful andaware of our embodied self, being present with ourselves and the world around us, the Advisor our ability for self-talk, another way to consider thoughts, and the Values aspect are split between the vitality and values, where the therapist learns about what the teen is passionate about, and derives their values from that. She explained that she will additionally bring in parents and discuss the work and will often access their Advisor, which has lead to her and her colleagues extending this approach to working with adults. The DNA-V model has been helpful in conveying the ACT principals to adolescents, as well as providing a frame for clinicians learning the model. Louise Hayes, Ph.D. is a clinical psychologist, author, and international speaker. She is a Fellow and Past President of the Association for Contextual Behavioral Science. She is a peer-reviewed Acceptance and Commitment Therapy/Training (ACT) trainer, engaged in training professionals all across the world. Together with Joseph Ciarrochi, she developed DNA-v, which is a leading model of acceptance and commitment therapy that has sparked international studies and school curricula. She is the co-author of the best-selling books for young people, Get Out of Your Mind and into your Life for Teenagers; and Your Life Your Way released in 2020. She is the author of the practitioner book, The Thriving Adolescent. In 2022 she will release a new book using DNA-V with adults, What Makes You Stronger. Louise is also an active clinician, working with adults and adolescents. She is a former Senior Fellow with The University of Melbourne and Orygen Youth Mental Health. Louise leads a community of mindfulness practitioners, is a certified Buddhist meditation teacher and takes professionals into the Himalaya to develop their mindfulness skills, raise funds for poor children in remote Nepal and has built a school in remote Nepal. To learn more about Louise, go to www.louisdehayes.com or https://dnav.international

In this episode, Tony discusses being inspired as an early career clinician to track his outcomes with clients, and upon doing so, saw that 50% of his clients were not progressing. He was concerned about this, and reviewed the research, he found that is within the average range of progress that clinicians were having. He explained that psychotherapy is one of the only fields where students and interns don’t practice before they start treating clients. He talked about how he could write a paper on theory and technique, write treatment plans, but when it came out of the abstract and into the real world, there were many nuances to therapy that he was learning. He gave the metaphor of being as if someone said, “I want to play baseball and make it to the major leagues, but I’ll only play in the games and not come to any of the practices”. He discussed his work on Deliberate Practice, and how he and the clinicians he has worked with have created resources for those in training to practice through role play. He explained that they reached out to a number of leading therapy approaches and had them identify the 10 core skills that one would need to practice the particular approach, and came up with role plays to practice these skills and published this through the American Psychological Association. He also explained that he and colleagues have started Sentio University, which will train masters level clinicians using the Deliberate Practice approach, and 50% of each class, and the entire program will consist of practice through role plays. Tony discussed how continuing to practice, and recording sessions and reviewing is so important in developing the skills of the practitioner, since psychotherapy is one of the only fields where what the clinician does is not transparent, with know one seeing exactly what the therapist is doing. He also explained the anxiety that this causes in therapists and training therapists as they may be demonstrating their abilities through role play, video, or one way mirror, and their fear that their performance will not be as good as their ability to talk to others about their performance.