Thursday 20th July - Morning
Unexplained Symptoms: (Chronic Fatigue Syndrome, Irritable Bowel Syndrome,
Somatisation Disorder) A Generic Model and Therapeutic Approaches.
The essential features of medically unexplained symptoms are physical symptoms for which no demonstrable organic findings can be found. The symptoms are not feigned or intentionally produced. Work, social and private functioning are usually impaired and the extent of the disability is usually determined by the degree of belief in the physical nature of the symptoms and/or fearful cognitions about the consequences of them. This mini workshop will provide clinical examples of how to treat different medically unexplained symptoms (syndromes) and will focus on engaging patients in the therapeutic process.
Self-Esteem and Trauma
Traumatic events can suddenly shatter and completely disrupt people’s lives. While in the grip of trauma it is difficult for a person to retain a sense of connection to their previous beliefs of relative safety and of a fairly controllable and manageable world. It is as if the trauma has taken over and now casts its shadow on this person’s entire present and future outlook on life. Part of this trauma shadow are people’s often disabling and distressing Post-Trauma Reactions that can feel totally overwhelming and out of people’s control. Due to the very nature of these reactions people withdraw, cut -off and alienate themselves from others around them and previously enjoyed activities in their life. People’s main priority may become simply one of surviving and getting through their every day life, because their basic sense of safety has been violated by the trauma. People's internal environment feels such that they often find it extremely difficult to experience any sense of self-esteem or power to control or influence others or things in their world around them.
The aims of this workshop are to:
1. Theoretically explore the effect of these disabling Post-Trauma Responses on people’s sense of self-esteem and functioning in life.
2. Introduce clinical techniques and methods that can be practically used to help survivors of trauma re-connect to their previous sense of self-esteem and functioning in life.
To achieve these, the workshop will draw on a combination of theoretical frameworks, clinical case examples and practical techniques and methods. The overall format of the workshop will be of an interactive and participative nature.
Thursday 20th July - Afternoon
Manuals for Empirically Validated Psychological Treatments: Sickle Cell
Disease as an Exemplar
Many psychological treatments have been empirically validated, and the use of manuals for these interventions is becoming extensive. Treatment manuals can be employed as both a standard approaches by which therapists can be trained, and as self-help packages to improve the quality of life of patients. Manuals and computer-assisted programmes have been shown to be effective in cognitive behavioural therapy (CBT).
The management of chronic illness and pain continue to pose a challenge to both clinicians and patients because of unpredictable severity leading to frequent interruptions in treatment programmes. Self-help manuals can be used to assist patients during treatment or when interrupted as a result of change in the course of illness. Self-help materials may also be used in the prevention of relapse.
This workshop will illustrate the identification of the most important CBT components in routine practice relevant to the treatment of patients with chronic illness, and both acute and chronic pain using sickle cell disease as an example. Also, the workshop will demonstrate the use of an innovative CBT Self-Help Manual specifically developed for managing pain and sickle cell disease.
Bloom, B.L. (1992). Computer-assisted psychological intervention: a review and commentary. Clinical Psychology Review, 12, 169-197.
Chambless, D.L. (1995). Training in and dissemination of empirically-validated psychological treatments: Report and recommendations. Clinical Psychologist, 48, 3-23.
Thomas, V.J., Dixon, A.L. and Milligan, P. (1999). Cognitive-behaviour therapy for the management of sickle cell disease pain: an evaluation of a community-based intervention. British Journal of Health Psychology, 4, 209-229.
Clinical Supervision in
CBT: Models and Practice for Trained Therapists
The development of cognitive behavioural theories for a range of common psychological disorders and the more widespread acceptance of CBT in general has led to an increased demand for training. This has many implications for the continuing professional development of CBT therapists or those whose work incorporates the approach. The minimum standards for training courses and therapists registering with the BABCP and UKCP have quite rightly been addresses by the BABCP (January 2000). However, without appropriate and effective supervision subsequent to training, therapists’ skills are unlikely to develop if not diminish. Despite the scanty research on the direct impact of clinical supervision on clinical practice, most practitioners would argue for the benefit of regular supervision and of course this is a requirement for accreditation.
Whether or not therapists are registered with the BABCP or UKCP, there are many issues regarding clinical supervision, both as a supervisor and supervisee. Considerations need to take into account practicalities such as access to appropriate supervision, the training and development of supervisors, the most appropriate mode and method of supervision and the theoretical model of supervision. With the rapid development of cognitive models and training, many practitioners may be more or less orientated to a particular theoretical stance. `Although this may be of issue for some therapists in finding supervisors of a similar orientation, the integration of behavioural and cognitive theories has much to offer the practice of supervision.
This workshop is aimed at qualified cognitive behavioural therapists, and will address issues pertinent to both supervisees and supervisors. It will focus on the range of methods and models appropriate to supervision in CBT. The approaches re directly influenced by CBT theory and practice and are therefore 'therapeutically congruent'. But also incorporate approaches from the general field of clinical supervision and experts in the field.
The central issues addresses will be those at the 'ground level' of practice. For example, what should be the essential components of supervision; how can live supervision be integrated into day to day practice and how can supervisors manage resistance to this. How can we as supervisors be confident in our supervision practice? How can appropriate training, supervision and monitoring of supervision be incorporated? Should we be concerned about the absence of evidence of effectiveness of supervision and could increased standardisation and monitoring lead to more problems than it solves?
References`: Holloway, E. and Carroll, M. (Training Counselling `Supervisors. Sage, London
Rcketts, T. and Donoheo, G. (2000) Clinical Supervision in Cognitive Behavioural Psychotherapy. In Lawton, B. and Feltham, C. (Ed's) Taking Supervision Forward. Sage, London.
Treatment with Difficult Patients
Engaging seriously disordered and historically assaultive patients in treatment for their anger dyscontrol problems present multiple challenges. Such patients are typically avoided by clinicians because of their treatment resistant characteristics and because of the risks faced by the clinician. Advances in cognitive- behavioural anger treatment with such patients, demonstrated in evaluated outcome studies, will be presented with regard to facilitating and maintaining therapeutic engagement. Major issues arising in the recruitment, referral, assessment, and preparation of such patients for treatment will be discussed. Core themes arising in the treatment process, strategies for managing anger episodes, and ways of obtaining leverage for change will be presented. The key ingredients of the cognitive-behavioural approach to severe anger are overviewed, and new methods of assessment will be presented, along with discussion of ongoing work at high security hospitals.
Friday 21st July - Morning
with Children and Parents: Issues of Dependency in Case Formulation,
Treatment Goals and Effective Practice
Studies of CBT for childhood mental health problems have consistently indicated that effective interventions require collaborative engagement with both the parent(s) and the child. In clinical practice this is often difficult to achieve. The aim of this workshop is: -
1. To examine the clinical difficulties posed by the child’s dependent position to the parent in achieving effective collaborative practice with the family as a whole.
2. To develop some clinical strategies in response to these difficulties.
In the main, children are brought to psychological services by parents/carers or at the suggestion of other adult professionals who have concerns about the child’s emotional, cognitive, social or behavioural well-being. The child’s own beliefs about his/her problems may be rather different from their parent as well as having very different understandings about what a ‘problem’ is and what may be helpful to solve it. Key components of CBT such as developing a shared case formulation and treatment model, an explicit treatment plan and a style of practice which supports patient choice and empowerment become much more complex in the context of important cognitive developmental factors and a child’s dependent position in therapy.
This workshop will focus on the challenge of tackling these therapeutic tasks when typically presented with parent constructed child problems. The importance of recognising the child’s dependent position both within the family and within the therapeutic system will be highlighted in this process.
Participants for the workshop should preferably have experience in working with children and/or adolescents and will be encouraged to share case examples or clinical dilemmas relevant to the theme of the workshop. Formal training in CBT is not required and practitioners from other models of practice are particularly welcome. The workshop will be for a maximum of 12 participants.
The workshop will focus more on practitioner than theoretical issues and will be structured as follows:
1. To identify common practitioner problems in CBT work with parents and children.
2. To look briefly at child parent differences in thinking about mental health problems.
3. To briefly review good practice as suggested by manualised CBT treatments for children.
4. To present case material which illustrates therapeutic dilemmas in achieving good and not so good outcomes.
5. To further develop ideas about good practice.
The workshop will be lead by four clinical psychologists working in three different child and adolescent mental health services in Manchester (Chrissie Verduyn, Manchester Children’s Hospital), Dunstable (Miranda Wolpert, Bedfordshire and Luton Community NHS Trust). and London (Peter Fuggle, Vicki Curry, Camden and Islington Community NHS Trust). The aim is to bring together similar but varying clinical practices from a range of different work settings.
forcing change in cognitive behaviour therapy.
Motivational interviewing is widely adopted as an intervention for working with sceptical clients. Based on a stage is of change model, a wide range of interventions aimed at enhancing a clients motivation and and increasing commitment of change has been developed. Motivational interviewing is often trained as a technique to be used before real treatment starts.
In this workshop a brief overview of the stage of change model will be presented. Also, an overview of basic motivational interventions and advanced motivational interventions will be introduced to the participants. The main focus however of this workshop is to focus on the application of motivational techniques while doing cognitive behavioural therapy. The approach to presenter takes the approach that motivational interview can be used at all stages of the treatment. Specific motivational interviewing techniques like selective active listening, positive restructuring, overshooting undershooting, decisional balance sheets, provocations and the Columbo technique are very useful and effective in maintaining motivation during the cognitive behaviour therapy.
Motivational challenges like difficulties with homework, client resistance to completing behavioural experiments and other useful learning experiences can be overcome by using motivational interviewing interventions.
The focus of this workshop will be on integrating the process of the cognitive behaviour therapy with applying motivational interventions when needed.
The workshop consists of brief lectures, demonstrations, practical exercises and video demonstration.
Friday 16th July - Afternoon
In Vivo Exposure in the Treatment of Anxiety Disorders: Some
Guidelines and Suggestions.
Cognitive-behavioural treatment for anxiety disorders is typically centred around exposure to the feared stimulus, whether that is a discrete object or animal (i.e., as in specific phobia), physical sensations or places that evoke physical sensations (i.e., in panic disorder), a thought (i.e., in obsessive-compulsive disorder) or a social situation (i.e., in social phobia). Although the rationale behind exposure is fairly straightforward, exposure exercises can be unsuccessful or even backfire if not conducted according to specific principles. Exposure can also be difficult to sell to clients, and compliance with between-session exposure exercises can be poor. This mini-workshop will offer a review of the principles of exposure and offer suggestions for maximising gains and increasing client acceptance of and compliance with exposure-based interventions for treatment of anxiety problems. Topics covered include identifying subtle and overt avoidance and safety signals, building appropriate exposure hierarchies, guidelines for therapist assisted exposure and between-session exposure, 'selling the model' to clients, and enhancing compliance.
in the Cognitive and Behavioural Psychotherapies
The question of Supervision is though currently much discussed but is poorly defined from a CBP perspective. This is a one-day workshop that considers the rationale and practice of a model of Supervision designed to specifically meet the needs of Cognitive and Behavioural Psychotherapists.
There are a number of writers who have discussed and advocated good practice in the supervision of trainees and students of CBP for example Pedasky 1998, Perris and Blackburn 1993. This workshop however focuses on the supervision needs of qualified and current practitioners.
Since the concept of on going professional non-managerial supervision has been used for many years by other approaches to psychotherapy it seems logical to assume that CBP Supervisors are borrowing and adapting concepts and models of practice from this available source. These may use concepts and models of practice may well be fundamentally at odds with a CBP perspective and formulation of the client and her/his problems, of the most appropriate therapeutic interventions and of the interpersonal processes involved in the therapeutic process.
The workshop will be equally divided between two principle activities:
The consideration of a model of Supervision philosophy and practice that incorporates the requirements of the CBP practitioner.
The development and enhancement of practical skills of supervision.
Ken Lewis is the Programme Leader for the Postgraduate Diploma / M.Sc. in the Cognitive and Behavioural Psychotherapies and Deputy Programme Leader for the Postgraduate Certificate in Cognitive and Behavioural Therapy Supervision at Chester College.
Saturday 21st July - Morning
Mindfulness – What Is It? And How to Use It
Our clients usually come to us fully immersed in the ‘fog’ of yesterday or tomorrow and we are often in something of a fog of our own, - preoccupied with our relationships, careers and stomachs. Two fogs together don’t make for effective therapy. But if one fog can clear, the other may just have a chance!
Mindfulness practice has been developed over thousands of years. What does it consist of? There are numerous ‘routes’. Attention to breathing, heightened awareness of movement, the cultivation of compassion for self and others, and ‘sitting with’ feelings.
The methods are described most fully in the writings of Buddhism and Taoism however Christianity and, to my knowledge, all spiritual traditions, have some way of helping the person to transcend the ‘chattering of the mind’ and bring oneself to a state of peace and openness to the moment.
In the last ten years the practice of mindfulness has become the subject of experimental investigation. Random controlled trials have shown significant benefits for a range of conditions including pain management, anxiety, depression and fibromyalgia. This workshop aims to give the participant first hand experience of the practice of mindfulness. Relevant psychological theory and research will be briefly reviewed. The main emphasis of the workshop however, will be the application of mindfulness both as a self-help technique for clients and as a way of helping us, as therapists, find a way of ‘being’ with our clients which is present, compassionate and awake.
At the end of the workshop participants will be able to:
Describe what is meant by the term ‘mindfulness’.
Discuss some similarities and differences between mindfulness and cognitive therapy.
Explore how psychological models may be useful in understanding the mode of action of mindfulness.
Locate sources of research that show the effectiveness of mindfulness.
Experience the methods of mindfulness of breathing; mindfulness of movement; and cultivation of compassion for self and others.
Experiment with applying these methods in a client-therapist role-play situation.
Explore the role of mindfulness in enhancing non-specific therapist effects.
Nigel Mills is a Clinical Psychologist who has also developed a familiarity with mindfulness over the past 10 years by training in meditation and Tai Chi/Chi Gong. Nigel has applied the principles of mindfulness as a therapeutic intervention for: people with Multiple Sclerosis (Mills, 1999; Mills, Allen & Carey-Morgan, 2000), people with psychosis (Mills & Whiting, 1997; Mills, 2000), people on an acute admissions unit; and for therapists facing burn-out (Mills 2000a).
Mills, N. & Whiting, S. (1997). Being centred and being scattered: a kinaesthetic strategy for people who experience psychotic symptoms. Clinical Psychology Forum, 103, 27-31.
Mills, N. (1999). Encouraging body and mind to work together. International Journal of Alternative and Complementary Medicine, 17, 27-28.
Mills, N. (2000a). Therapist burn-out or therapist glow? Some light from the East. Clinical Psychology Forum, in press.
Mills, N., Allen, J. & Carey-Morgan, S. (2000). Mindfulness of breathing and movement as coping strategies in Multiple Sclerosis. Journal of Bodywork and Movement Therapy, 4(1), 39-48.
Mills, N. (2000). The Experience of Fragmentation in Psychosis. Can Mindfulness Help? In I Clarke (Ed). Psychosis & Spirituality. Whurr.
BABCP ANNUAL CONFERENCE - 20th - 22nd July 2000
MINI WORKSHOP PROGRAMME
Ö (tick) workshops required
Please make cheque payable to EYAS Ltd and send to 5 Cooper Street, Chichester, West Sussex, PO19 1EB and to arrive no later than Friday 14th July. All booking after that date will be processed at the conference. Admission tickets and a receipt for the workshops will be issues with the registration pack at the conference.