PRE CONFERENCE WORKSHOPS - Wednesday 16th July

Details of each workshop are in the next section...

 

 

Workshop 1 Working with Flashbacks Linked to Type I and Type II Trauma
Helen Kennerley, Oxford Cognitive Therapy Centre, UK &
Deborah Lee, University College London & Berkshire Traumatic Stress Service, UK
Workshop 2 Mindfulness-Based Cognitive Therapy and Prevention of Relapse in Major Depression
Mark Lau, University of British Columbia, Canada
Workshop 3

Treating Moderate to Severe Depression with Behavioral Activation
Christopher Martell, University of Washington, USA

Workshop 4
Cancelled
Workshop 5 Difficult to Treat? Not Any More: Advances in the Treatment of Primary Obsessions and the Fear of Contamination
S. J. Rachman, University of British Columbia, Canada;
Adam Radomsky, Concordia University, Canada &
Roz Shafran, University of Reading, UK
Workshop 6

CBT for OCD and Health Anxiety (Hypochondriasis): Helping the Patient to Choose to Change is the Ultimate Transdiagnostic Process
Paul Salkovskis, Institute of Psychiatry, London, UK

Workshop 7 Anger Assessment and Treatment
Raymond Novaco, University of California, USA
Workshop 8 Acceptance and Commitment Therapy (ACT) with PTSD
Sonja Batten, VA Maryland Health Care System & University of Maryland, USA
Workshop 9 The Application of Cognitive Therapy in the Context of Neuro-Rehabilitation for Acquired Brain Injury
Jonathan Evans, University of Glasgow, UK &
Fergus Gracey, Oliver Zangwill Centre for Neuropsychological Rehabilitation, UK
Workshop 10 Treatment of Anxiety Disorders in Youth
Philip Kendall, Temple University, USA
Workshop 11 Transdiagnostic Cognitive Behavior Therapy for Eating Disorders
Christopher G. Fairburn, University of Oxford, UK
Workshop 12 Cancelled
Workshop 13

Interpersonal And Emotional Processing Therapy for Generalized Anxiety Disorder
Tom Borkovec, Penn State University, USA

Workshop 14 CBT for Inpatient and Crisis Settings; A Newly Developed CBT Approach to Enable the Individual to Make Sense Of Crisis, and Enhance the Milieu
Isabel Clarke, AMH Woodhaven, UK &
Hannah Wilson, AMH Woodhaven, UK
Workshop 15

Cancelled

Workshop 16

Cognitive Therapy with Command Hallucinations
Max Birchwood, University of Birmingham, UK &
Alan Meaden, University of Birmingham, UK

Workshop 17

Staying Well After Psychosis: A Cognitive Interpersonal Approach to Relapse Prevention and Emotional Recovery
Andrew Gumley, University of Glasgow, UK &
Matthias Schwannauer, University of Edinburgh, UK

Workshop 18

How to Talk Usefully About the Past
Gillian Butler, Oxford Cognitive Therapy Centre, UK

Workshop 19

Dealing with Endings in Therapy: A Cognitive Behavioural Perspective
Andrew Eagle, CNWL NHS Foundation Trust, UK &
Michael Worrell, CNWL NHS Foundation Trust, UK

Workshop 20

Case Formulation-Driven Cognitive Behavior Therapy
Jacqueline Persons, University of California, USA

Workshop 21 Toward More Effective Supervision: Managing the Tension Between Core Supervision Activities and Other Things That Get in the Way
Mark Freeston, Newcastle University, UK , NY.

DETAILS OF EACH WORKSHOP ARE GIVEN BELOW:

  • W 1
  • W 2
  • W 3
  • W 5
  • W 6
  • W 7
  • W 8
  • W 9
  • W 10
  • W 11
  • W 13
  • W 14
  • W 16
  • W 17
  • W 18
  • W 19
  • W 20
  • W 21

Workshop 1

Working with Flashbacks Linked to Type I and Type II Trauma

Helen Kennerley, Oxford Cognitive Therapy Centre, UK and
Deborah Lee, University College London and Berkshire Traumatic Stress Service, UK

Traumatic flashbacks are vivid intrusions, which give rise to feelings of current distress, threat, disgust or shame, for example, even though the traumatic event might have occurred some time in the past. Flashbacks can reflect recent or distant experiences or can result from acute or chronic trauma. Historically, these have been distinguished as 'Type I and 'Type II' related flashbacks, but there has been little systematic exploration of the phenomenology associated with these types of experiences and consequently little exploration of the different treatment approaches necessary to work with these distinctive presentations.

Key Learning Objectives:

  • To appreciate the underlying mechanisms of type I trauma related flashbacks and type II trauma related flashbacks 
  • To consider the similarities and differences between them.
  • To formulate their origin and maintenance.

Dr Helen Kennerley is a consultant clinical psychologist and founder member of the Oxford Cognitive Therapy Centre. She is an experienced Clinician who has specialised in working with survivors of childhood trauma, dissociative disorders and self-injurious behaviours. Amongst other publications she is the author of overcoming childhood trauma. 
Dr Deborah Lee is a Consultant Clinical Psychologist, who has specialist in working with traumatised people for 16 years. She works at UCL as an Honorary senior lecturer and is Head of the Berkshire Traumatic Stress Service.  She has extensive experience in this field as a clinician and has contributed to the dissemination of her clinical knowledge through her writing and workshops. Her interests lie in working with complex cases, shame and developing compassion in cognitive therapy.

Key References:
Terr LC (1991). Childhood traumas: An outline and overview American Journal of Psychiatry 148:1 10-20.

Brewin, Dalgeish & Joseph (1996). A Dual Representation Theory of Post Traumatic Stress Disorder. Psychological Review, 103, 670-686

Workshop 2

Mindfulness-Based Cognitive Therapy and Prevention of Relapse in Major Depression

Mark Lau, University of British Columbia, Canada

This workshop will be an interactive learning experience combining didactic instruction with experiential exercises to train participants in the key aspects of Mindfulness-Based Cognitive Therapy (MBCT).  MBCT is a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence.  It is based on an integration of CBT for depression with components of mindfulness meditation.  Key themes of MBCT include experiential learning and the development of an open and accepting mode of response, in which one intentionally faces behavioral difficulties and affective discomfort.  Increased mindfulness allows early detection of relapse-related patterns of negative thinking, feelings, and body sensations, allowing them to be "nipped in the bud" at a stage when this may be much easier than if such warning signs are not noticed or are ignored.  Formulation of specific relapse/recurrence prevention strategies is included in the later stages of treatment.  MBCT is now included in the National Institute of Clinical Excellence (NICE) Guidelines for prevention of recurrent depression.

Key Learning Objectives:

Participants will learn:

  • The link between the development of MBCT and a model of cognitive   vulnerability to depression;
  • About the structure of MBCT and the core therapeutic tasks that accompany each of the group sessions;
  • 3 forms of mindfulness training used in MBCT: the body scan; mindfulness of the breath, and 3 minute breathing space;
  • Outcomes from two randomized controlled trials of MBCT for the prevention of depressive relapse.
  • About recent developments in MBCT research

Dr. Lau is a Research Scientist and Director, British Columbia (BC) Cognitive Behaviour Therapy Network, BC Mental Health and Addiction Services, a Clinical Associate Professor of Psychiatry at University of British Columbia, Canada and a Founding Fellow of the Academy of Cognitive Therapy.  Dr. Lau has presented over 60 workshops in Mindfulness-based Cognitive Therapy (MBCT) and Cognitive Behaviour Therapy (CBT) across Canada and in the United States including 18 workshops with one of MBCT's founders, Dr. Zindel Segal.  Dr. Lau's research interests include investigating the mechanisms underlying the efficacy of MBCT, the development and validation of the Toronto Mindfulness Scale, and evaluating effective methods of CBT dissemination.  He has been awarded the Excellence in Continuing Mental Health Education Award from the Department of Psychiatry, University of Toronto.

Key References:

Williams, J.M.G., Teasdale, J.D., Segal, Z.V., & Kabat-Zinn. J. (2007). The Mindful Way Through Depression: Freeing Yourself From Chronic Unhappiness.  New York: Guilford Press.

Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2002). Mindfulness Based Cognitive Therapy for Depression: A new approach to preventing relapse. New York: Guilford Press.

Teasdale, J.D., Segal, Z.V., Williams, M.G., Ridgeway, V.A., Soulsby, J.M., & Lau, M.A. (2000). Prevention of relapse/recurrence in Major Depression by Mindfulness-based Cognitive Therapy.  Journal of Consulting and Clinical Psychology, 68, 615-623.

Ma, S.H., & Teasdale, J.D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31-40

Workshop 3

Treating Moderate to Severe Depression with Behavioral Activation

Christopher Martell, University of Washington, USA

Behavioral Activation (BA) represents a resurgence of behavior therapy in the treatment for depression. With an emphasis on the importance of activation and engagement in recovery from depression, BA teaches clients specific strategies to improve mood and address life problems. BA uses a number of core strategies including increasing activity linked with positive mood, modifying avoidance patterns, identifying important life goals, maximizing commitment to acting toward goals independent of mood, regulating routines, increasing contact with naturally reinforcing contexts, and solving problems. This workshop is designed for practitioners and clinicians working with depressed clients. The workshop will discuss the history of BA, the evidence base for BA, and the core principles and strategies of the treatment approach. The emphasis of the workshop will be on treating clients with depression in individual behavior therapy. Emerging adaptations of BA for a range of clinical populations and ways in which the ideas and techniques presented can also inform standard CBT for depression will also be discussed.

Key Learning Objectives:

  • Participants will understand the historical, theoretical and empirical context of behavioral activation and behavior therapy for depression.
  • Participants will learn how to develop a behavioral conceptualization in treatment of depression.
  • Participants will learn and acquire practice in the basic techniques of behavioral activation.

Christopher Martell is Clinical Associate Professor of Psychiatry and Behavioral Sciences, and of Psychology at the University of Washington, Seattle, Washington, USA.  He maintains an independent practice of psychology in Seattle.  Dr. Martell has co-authored four books and numerous chapters and articles.  He is first author of the published treatment manual for behavioural activation Depression in Context: Strategies for Guided Action (with Michael Addis and Neil Jacobson).   He has also written a self-help manual for clients with Michael Addis, Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back. 

Key References:

Dimidjian, S., Hollon, S.D., Dobson, K.S., Schmaling, K.B., Kohlenberg, R., Addis, M., Gallop, R., McGlinchey, J., Markley, D., Gollan, J.K., Atkins, D.C., Dunner, D.L., & Jacobson, N.S.  (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.  Journal of Consulting and Clinical Psychology 74 (4), 658-670.

Jacobson, N.S., Dobson, K., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E., & Prince, S. E. (1996).  A component analysis of cognitive-behavioral treatment for depression.  Journal of Consulting and Clinical Psychology, 64(2), 295-304.

Jacobson, N.S., Martell, C. R., & Dimidjian, S. (2001).  Behavioral activation therapy for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8 (3), 255-270.

Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001).  Depression in Context: Strategies for Guided Action. New York: Guilford

Workshop 5

Difficult to Treat? Not Any More: Advances in the Treatment of Primary Obsessions and the Fear of Contamination

S. J. Rachman, University of British Columbia, Canada;
Adam Radomsky, Concordia University, Canada and
Roz Shafran
, University of Reading, UK

Primary obsessions have been notoriously difficult to treat. More success has been obtained with the treatment of the fear of contamination although it is notable that a significant proportion of patients with these difficulties do not made progress.  This workshop addresses both of the 'difficult to treat' areas by drawing on experience (and data) from a recent randomised controlled trial of primary obsessions and a new approach to contamination incorporating the construct of 'mental contamination.'

Key Learning Objectives:

To enable clinicians to:

  • Successfully understand the cognitive theory and treatment of primary obsessions
  • Learn the concept of 'mental contamination' and be able to assess, formulate and treat this manifestation of OCD

Professor S. Rachman is Emeritus Professor of Psychology at the University of British Columbia, Vancouver. He has been a prolific researcher in a broad range of fields of clinical psychology. He is an internationally recognised expert on fear, anxiety (in particular obsessional problems, panic and trauma), courage, behavioural medicine and emotional processing. His work has involved the development of theories of the maintenance of psychopathology, empirical evaluation of those theories using a range of methodologies (in particular experimental analyses and the development of questionnaires to assess psychopathology) and devising and evaluating empirically based therapies. In addition to his own research, he was for many years the editor of 'Behaviour Research and Therapy.' He has written more than 200 books and journal articles.

Key References:

Rachman, S. (2003). The treatment of obsessions. Oxford University Press.

Rachman, S. (2006). The fear of contamination: Assessment and Treatment. Oxford University Press

Workshop 6

CBT for Obsessive Compulsive Disorder and Health Anxiety (Hypochondriasis): Helping the Patient to Choose to Change is the Ultimate Transdiagnostic Process

Paul Salkovskis, Institute of Psychiatry, King’s College London, UK

Both the understanding and treatment of anxiety disorders has been greatly advanced by the application of cognitive theories as part of “empirically grounded clinical interventions”. Cognitive theories have the important advantage of being closely linked to the phenomenology of the problems, allowing the therapist to take a holistic approach to helping people to choose to change. The model suggests that clinical anxiety is related to the meaning attached to ambiguous situations, manifesting as misperception of severe threat or impending danger. People suffering from anxiety disorders think situations are more dangerous than they really are. The persistence of their anxiety (as in anxiety disorders) is linked to the development of counter-productive reactions to this perceived threat, including safety seeking behaviours, physiological reactions, attention and so on. These reactions sustain or increase the perception of threat in a series of vicious circles. Treatment requires patient and therapist to reach a shared understanding, and then for the therapist to help the patient find ways of changing not only the counter-productive reactions they experience but also the overly negative meanings which drive and motivate such reactions.

An important and highly effective element in CBT for anxiety disorders is the systematic dropping of safety seeking behaviours to help the person discover that the things they are afraid of do not happen (e.g. that they don't have a heart attack if they run up stairs when they have chest pain). Unfortunately, this is often not a useful strategy when the feared catastrophe is less imminent. For example, a health anxious patient may fear that his or her palpitations are the first sign of heart disease, which will result in a long illness and a painful and degrading death many years in the future. By the same token, an obsessional patient may fear that the thoughts they are having will, if not neutralised, result in them going to hell after they die. The fears of those suffering from both Health Anxiety (“Hypochondriasis”) and Obsessive Compulsive Disorder (OCD) tend to have such protracted timescales, requiring a different emphasis in therapy. Treatment for both of these disorders will be described and demonstrated in this workshop, which will be focussed on practitioners operating at the intermediate to advanced level. The clinical application of cognitive-behavioural approaches in understanding, engaging and treating people suffering from OCD and health anxiety will be both described and demonstrated. The importance of fully integrating cognitive and behavioural strategies will be emphasised.

Key Learning Objectives:

How to (a) understand the patient's problems (b) help them to feel understood and “normalise” their experience (c) reach a shared understanding (d) agree goals for both treatment and “life” (e) allow the person to choose to change their behaviour (f) design and implement different types of discussion techniques and behavioural experiments which have the effect of helping people to build not only alternative explanations but also alternative ways of reacting (g) generalise improvements (h) prevent relapse.

Paul Salkovskis is Professor of Clinical Psychology and Applied Science at the Institute of Psychiatry, King's College, London and Clinical Director at the Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Trust. He is editor of “Behavioural and Cognitive Psychotherapy”, the official scientific journal of the British Association for Behavioural and Cognitive Psychotherapy.

Key References:

Salkovskis, P.M. (1996). The cognitive approach to anxiety: threat beliefs, safety seeking behaviour and the special case of health anxiety and obsessions. In P. Salkovskis (ed) Frontiers of Cognitive Therapy. New York: Guilford Press.

Salkovskis, P.M., (1999) Understanding and Treating Obsessive-Compulsive Disorder . Behaviour Research and Therapy, Vol. 37, (Suppl 1) S29-S52

Salkovskis, P., Warwick, H.M.C., Deale, A.C. (2003)  Cognitive-Behavioural Treatment for Severe and Persistent Health Anxiety (Hypochondriasis)  Brief Treatment and Crisis Intervention vol. 3, 3, 353-368

Salkovskis, P.M  & McGuire, J. (2003), Cognitive Behavioural Theory of Obsessive Compulsive Disorder In Menzies & de Silva (eds) Obsessive Compulsive Disorder (2002) J. Wiley & Sons, Chichester 

Salkovskis, P. M. , Forrester, E., Richards, H.C., & Morrison, N.  (1998) The devil is in the detail: conceptualising and treating obsessional problems in Tarrier, N., Wells, A. & Haddock, G.(eds)Treating Complex Cases: The CBT Approach  Wiley & Sons Ltd, Chichester, 46-80

Salkovskis, P.M., Warwick, H.M.C. (2001) Making Sense of Hypochondriasis: A Cognitive Theory of Health Anxiety In G. Asmundson, S. Taylor, B. Cox (eds.) Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions.  John Wiley, NY

Workshop 7

Anger Assessment and Treatment

Raymond Novaco, University of California, Irvine, USA

Anger dysregulation is commonly observed in various personality, psychosomatic, and conduct disorders, in schizophrenia, in bipolar mood disorders, in organic brain disorders, in impulse control dysfunctions, and in a variety of conditions resulting from trauma.  Anger is a common precursor of aggressive behaviour, and it can be unsettling for mental health professionals as a treatment focus.  Clients with recurrent anger problems are often not eager to engage in treatment.  As treatment should be grounded in assessment of anger control deficits, various psychometric, staff-rated, and interview methods will be presented.  CBT anger treatment will be overviewed, highlighting work with forensic patients.  The workshop will address getting treatment engagement with challenging clients, cognitive restructuring and arousal reduction techniques, the stress inoculation provocation hierarchy procedure, and the use of role play to foster behavioural coping skills.  Both individual-based and group-based treatment will be illustrated.  Anger assessment is not straightforward, because of reactivity to the testing situation and the multi-dimensionality of anger.  Targeting anger treatment and ascertaining therapeutic gains, hinges on assessment proficiency and case formulation.   Issues of validity will be delineated, and recommendations for clinical service will be given.  Anger psychometrics, including use of an imaginal provocation test, will be presented.  Getting treatment engagement with chronically anger people presents multiple challenges, especially if they are seriously disordered and historically assaultive.  Cognitive-behavioural anger treatment has demonstrated efficacy with patients in secure hospitals, patients with developmental disabilities, and a variety of community outpatients, including clients having severe posttraumatic stress disorder.  Core themes arising in the treatment process and ways of obtaining leverage for change through a preparatory phase will be discussed.  Achieving therapeutic change by addressing symbolic structures associated with anger and aggression will be illustrated. Participants will be introduced to a new group-based 18-session anger intervention, and will be given the opportunity for intensive training in that treatment protocol.

Key Learning Objectives:

  • Familiarity with anger self-report psychometric instruments and their clinical use 
  • Familiarity with staff-rated measures of anger and aggression 
  • Ability to implement client self-monitoring procedures
  • Use of an imaginal provocation test for anger to assess treatment gains
  • Knowledge of key principles for engaging clients in anger treatment
  • Proficiency in arousal reduction techniques, including breathing, muscle relaxation, and imagery
  • Cognitive restructuring for anger experiences, with attention to key symbolic structures
    Proficiency in provocation hierarchy procedures in stress inoculation format

Professor Ray Novaco pioneered the cognitive-behavioural treatment of anger.  His ongoing research includes treatment studies in Scotland and England with patients in forensic facilities, combat veterans with severe PTSD, and women and children in domestic violence facilities.

Key References:

Novaco, R. W. (2007).  Anger dysregulation.  In T. Cavell & K. Malcolm, Anger, aggression, and interventions for interpersonal violence. Mahwah, NJ: Erlbaum. 

Taylor, J. L., & Novaco, R. W. (2005).  Anger treatment for people with development disabilities.  Chicester, England: Wiley.  Novaco, R. W. (2003).  The Novaco Anger Scale and Provocation Inventory manual.  Los Angeles: Western Psychological Services

Workshop 8

Acceptance and Commitment Therapy (ACT) with PTSD

Sonja Batten, Trauma Recovery Programs, VA Maryland Health Care System, & University of Maryland School of Medicine, USA

Traumatic experiences can have significant, and long-lasting, effects on the individuals who survive them. Frequently, clients who survive trauma experience a host of behavioral, cognitive, emotional, and physical health problems. When these individuals come to therapy, most of them are hoping that they will be able to eliminate the nightmares, memories, anger, anxiety, and other posttraumatic symptoms that they experience. In fact, most of them have tried many things (such as isolation, substance abuse, even suicide attempts) to manage these symptoms. However, what many of these individuals fail to realize is that their heroic efforts to avoid the pain of their posttraumatic experiences may actually be making things worse, and may even be the heart of the problem. In many ways, despite their best efforts, trauma survivors frequently find themselves trapped in a life that is largely devoted to the avoidance of pain. Effective empirically supported treatments for posttraumatic symptoms have been developed to aid trauma survivors in improving traditional PTSD symptoms. However, they are not universally effective, and not all clients are willing to engage in exposure-based treatment. In addition, given the high levels of psychiatric comorbidity with PTSD, treatments are needed that can cut across diagnostic categories and begin to treat presenting problems based on functional dimensions. ACT, a contemporary behavior therapy, provides an alternative to the feel-good agenda and instead focuses on helping our clients to reconnect with those ideals and principles for living that are deeply important to them and that dignify the difficult events that they have survived. This workshop will provide clinicians with the tools to work with trauma survivors on identifying each person's valued life directions and then help motivate behavior change in the service of those values.

Key Learning Objectives:

At the end of the workshop, participants will be able to:

  • Describe an understanding of posttraumatic problems in living based on a framework of experiential avoidance
  • Implement traditional exposure-based interventions as adapted for an acceptance-based model
  • Promote life changes through experiential exercises designed to help clients move toward their values, rather than away from the pain

Sonja Batten, Ph.D., has studied traumatic stress, experiential avoidance, and women's health issues for over a decade. She has published numerous treatment manuals, articles, and book chapters on the implementation of ACT. Dr. Batten is the Coordinator of the Trauma Recovery Programs for the VA Maryland Health Care System and Assistant Professor of Psychiatry at the University of Maryland School of Medicine. Her research and clinical interests include emotional functioning, avoidance, and expression in trauma survivors, and the development of ACT for comorbid PTSD and substance use disorders.

Key References:

Batten, S. V., & Hayes, S. C. (2005). Acceptance and Commitment Therapy in the Treatment of Comorbid Substance Abuse and Post-Traumatic Stress Disorder: A Case Study. Clinical Case Studies, 4(3), 246-262.      

Batten, S. V., Orsillo, S. M., & Walser, R. D. (2005). Acceptance- and mindfulness-based approaches to the treatment of posttraumatic stress disorder. In S. M. Orsillo & L. Roemer (Eds.), Acceptance and Mindfulness-Based Approaches to Anxiety: Conceptualization and Treatment (pp. 241-269). New York: Plenum.

Orsillo, S. M., & Batten, S. V. (2005). ACT in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95-129

Workshop 9

The Application of Cognitive Therapy in the Context of Neuro-Rehabilitation for Acquired Brain Injury

Jonathan Evans, University of Glasgow, UK &
Fergus Gracey, The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire PCT, UK

Research shows elevated rates of mood disorder following acquired brain injury (ABI).  The aetiology of mood disorders following brain injury is complex, due to the interacting organic, cognitive and psychosocial consequences of ABI. There is thus a ready need for the development of psychosocial therapies to address the range of distressing and debilitating emotional consequences of brain injury in both neuro-rehab and adult mental health contexts. Suggestions and guidelines for the use of cognitive and behavioural therapies following stroke and head injury have been published.  There is mixed evidence for the use of CBT with this client group. Significant questions regarding the adaptation of therapy, understanding cognition-emotion interactions, and potential models for adjustment after brain injury are yet to be addressed. This can make delivery of CBT with this client group a challenge.

Key Learning Objectives:

  • Learn about the emotional consequences of brain injury
  • Understand the potential applicability of CBT following brain injury
  • Be aware of the evidence base for the efficacy of CBT with this client group
  • Develop skills in formulating for this client group
  • Learn about the adaptation of CBT techniques in the context of cognitive impairment, identity changes and adjustment to adverse circumstances 

Jon Evans is Professor of Applied Neuropsychology, University of Glasgow, Section of Psychological Medicine, UK, and honorary Clinical Neuropsychologist at The Oliver Zangwill Centre for Neuropsychological Rehabilitation

Dr Fergus Gracey is the Lead Clinical Psychologist at The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, Cambridgeshire, UK, and honorary visiting Clinical Associate at the MRC Cognition and Brain Sciences Unit, Cambridge, UK.

Key References:

Williams, W.H. and Evans, J.J. (Eds.) (2003) Biopsychosocial approaches in neurorehabilitation: Assessment and management of neuropsychiatric, mood and behavioural disorders. Hove: Psychology Press.

Sohlberg, M and Mateer, C  (2001) Management of Depression and Anxiety, in M Sohlberg and C Mateer (Eds) Cognitive Rehabilitation: An Integrative Neuropsychological Approach. London: Guilford Press.

Ponsford, J, Sloane, S and Snow, P (1995) Traumatic Brain Injury: Rehabilitation for Everyday Adaptive Living. Hove: Lawrence Erlbaum Associates.

McGrath, J and King, N (2004) Acquired Brain Injury in Bennett-Levy et al (Eds) Oxford Guide to Behavioural Experiments in CBT. Oxford: OUP

Workshop 10

Treatment of Anxiety Disorders in Youth

Philip Kendall, Temple University, USA

Following an overview of the role of cognition in child psychopathology and treatment, as well as brief comments about the fact that anxiety is normal, the presentation will consider the features that indicate when anxious arousal and related symptoms meet criteria for disorder. The rational for treating anxiety in youth and the features of the preferred therapist “posture” will be presented. Treatment strategies from among those considered to be empirically supported (e.g., coping modelling, changing self-talk, exposure tasks, etc) will be described, and relevant adjustments to the treatments, given diagnostic difficulties and comorbidities, will be presented and discussed. The workshop will include sample treatment sessions (from a training DVD) and sample activities/exercises for youth (from an on-line program for treating anxiety in youth). The workshop will conclude with an overview summary of the research literature (“what we know and what we do not yet know”) about the treatment of anxiety in youth.

Key Learning Objectives:

  • Identification of normal and abnormal anxious distress in youth
  • Application of empirically-supported intervention strategies
  • Awareness of the current state of knowledge with regard to treating anxiety in youth

Director: Child and Adolescent Anxiety Disorders Clinic Distinguished Career Research Award, from the Society of Clinical Child and Adolescent Psychology (Division 53) of the American Psychological Association. Awarded at the APA Convention, San Francisco, August 2007. Research Recognition Award, from the ADAA (Anxiety Disorders Association of America). Inaugural award for research contributions to advance the understanding of anxiety disorders in children and teens. March 2005.

Key References:

Kendall, P. C., Hudson, J., Gosch, E., Flannery-Schroeder, E., & Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology, in press.

Kendall, P.C. & Treadwell, K. (2007). The role of self-statements as a mediator in treatment for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 75, 380-389.

Kendall, P. C. & Hedtke, K. (2006).  Coping Cat Workbook. (2nd ed). Ardmore, PA: Workbook Publishing.

Kendall, P.C. & Hedtke, K. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual (3rd ed.). Ardmore, PA: Workbook Publishing.

Creed, T. & Kendall, P.C. (2005). Empirically supported therapist relationship building behavior within a cognitive-behavioral treatment of anxiety in youth.  Journal of Consulting and Clinical Psychology, 73, 498-505.

Workshop 11

Transdiagnostic Cognitive Behavior Therapy for Eating Disorders

Christopher G. Fairburn, University of Oxford, UK

To date, cognitive behavioural treatments (CBT) for eating disorders have focused on the individual eating disorders in isolation (i.e., bulimia nervosa, anorexia nervosa or binge eating disorder).  Recently, however, a “transdiagnostic” form of CBT has been developed that is designed for all forms of eating disorder including eating disorder NOS (Fairburn, 2008).  For this reason, the treatment has considerable potential clinical utility.  The focus of this workshop will be on how to implement the treatment in real-world outpatient practice.  The emphasis will be on how to mould the treatment to fit the individual patient's psychopathology and circumstances, and on how to implement it flexibly.  The workshop will be exclusively clinical in its orientation.  It will be illustrated with representative clinical examples from across the diagnostic spectrum and will include cases with complex co-existing psychopathology. 

Key Learning Objectives:

  • Participants will be able to create an individualized cognitive behavioural treatment to fit the particular patient's psychopathology and circumstances
  • Participants will be able to adjust the treatment to fit changes in the patient's psychopathology
  • Participants will be able to modify the treatment to accommodate co-existing comorbid psychopathology

Professor Christopher Fairburn is Wellcome Principal Research Fellow and Professor of Psychiatry at the University of Oxford.  He has a well established international reputation for his research on the nature and treatment of eating disorders.  He has a particular interest in the development and evaluation of psychological treatments and is especially well known for his development of the cognitive behavioral approach to the treatment of eating disorders.   Professor Fairburn has twice been a Fellow at Stanford's Center for Advanced Study in the Behavioral Sciences and he is a Fellow of the UK Academy of Medical Sciences.  Professor Fairburn was awarded the “Outstanding Researcher Award” by the Academy for Eating Disorders in 2002.  He is a Governor of the Wellcome Trust, the largest international biomedical research foundation.

Key References:

Fairburn CG (2008).  Cognitive Behavior Therapy and Eating Disorders.  New York: Guilford Press.

Workshop 13

Interpersonal And Emotional Processing Therapy for Generalized Anxiety Disorder

Tom Borkovec, Penn State University, USA

An initial review of basic research on worry and GAD lays the foundation for specific therapeutic interventions. A brief description will be given of the distinctive ways in which I have developed our CBT methods for GAD. The majority of our time will be devoted to our recent incorporation of interpersonal and experiential therapy interventions. Again, basic research on the developmental, interpersonal, and emotional functioning of persons with GAD will form the empirical foundation for these techniques. During this portion, I will (a) describe the features of the Interpersonal/Emotional Processing Therapy, (b) highlight areas of functional analysis useful for this therapy element, (c) describe specific techniques for modifying the client's interpersonal functioning (including the use of the therapeutic relationship), and (d) describe specific methods for accessing client emotional experience and the deepening of that experience. A dramatic therapy session videotape will be shown that exemplifies the application of many of these interpersonal and experiential techniques and that resulted in a significant change event for the client.

Participants should be experienced in CBT for adult anxiety but have little experience with either interpersonal psychotherapy or experiential therapy.

Key Learning Objectives:

  • Become aware of basic research and therapy research that provides the foundation for the use of each therapy element.
  • Become familiar with the specific techniques of interpersonal and experiential therapies and how they can be applied to cases of GAD
  • Become more aware of how therapists can impact on clients therapeutically through the use of the therapeutic relationship.

Tom received his Ph.D. in 1970, was on the faculty of the University of Iowa until 1978 when he joined the faculty of Penn State University, where he is currently Distinguished Professor Emeritus of Psychology. His primary interests have been in basic research on anxiety and therapy outcome investigations on anxiety disorders.

Key References:

Newman, M. G., Castonguay, L. G., Borkovec, T. D., & Molnar, C. (2004). Integrative therapy for generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice, pp. 320-350. New York: Guilford Press.

Safran, J., & Segal, Z. V. (1990). Interpersonal process in cognitive therapy. New York: Basic Books.

Borkovec, T.D., & Sharpless, B. (2004). Generalized Anxiety Disorder: Bringing Cognitive Behavioral Therapy into the Valued Present. In S. Hayes, V. Follette, & M. Linehan (Eds.), New directions in behavior therapy, pp. 209-242. New York: Guilford Press

Workshop 14

CBT for Inpatient and Crisis Settings; A Newly Developed CBT Approach to Enable the Individual to Make Sense Of Crisis, and Enhance the Milieu

Isabel Clarke, Hampshire Partnership NHS Trust, UK and
Hannah Wilson, Hampshire Partnership NHS Trust, UK

The individual hospitalized in crisis has a need to make sense of their situation. Staff in the institution struggle with low morale in the face of increasing pressures and expectations. This workshop demonstrates how these challenges have been met and evaluated by the psychological therapies department at Woodhaven, employing CBT.  We will introduce our third wave CBT approach to brief therapy, comprising emotional focused formulation, leading to skills and group work: also approaches to staff training, reflective practice and care planning support that have been shown to disseminate and promote CBT principles in the inpatient unit, for the benefit of our service users. The approach draws on Clarke's ICS approach to therapy for severe mental health problems (Clarke 1999), and generalises Linehan's skills training (Linehan 1993).   The publication of the pilot evaluation (Durrant et al 2007), and papers presented at the Inpatient Symposia at Barcelona and Brighton BABCP (2006) have generated considerable interest in the approach. It features prominently in the book on Inpatient CBT, edited by us, to appear in July 2008 (Clarke & Wilson, forthcoming). The approach is equally relevant to all work in teams with people in crisis or with major mental health problems, e.g. crisis and assertive outreach teams. We are both experienced at running highly interactive and successful workshops, both locally and further afield.

Key Learning Objectives:

  • Understanding of our cross diagnostic, Third Wave approach to individual work with people in crisis, and its evaluation
  • To be able to use this to formulate a case of someone in crisis using the Woodhaven brief CBT approach.
  • Understand the cognitive science based (ICS) rationale behind the intervention.
  • Extend this to a deeper understanding of psychopathology, and an innovative approach to psychosis.
  • To be able to devise effective, CBT informed, staff training and staff consultation systems, informed by this approach.

Isabel Clarke, Consultant Clinical Psychologist and Psychological Services Lead at Woodhaven, an acute NHS in-patient unit in Hampshire, is developing and evaluating this service with Dr. Hannah Wilson.   Through 12 years experience in Southampton, she developed an ICS based approach to Severe mental Health problems (Clarke 1999), and to psychosis (Clarke 2002).  Her work on psychosis and spirituality has led to frequent engagement as a speaker and workshop leader at conferences (recently: ISPS-UK, Confer).    www.scispirit.com/Psychosis_Spirituality/

Key References:

Clarke, I  (1999)  Cognitive Therapy and Serious Mental Illness.  An Interacting Cognitive Subsystems Approach.  Clinical Psychology and Psychotherapy, 6  375  -  383. Clarke, I. & Wilson, H.Eds. (forthcoming)   Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge.

Durrant, C., Clarke, I., Tolland, A. & Wilson, H.  (2007)  Designing a CBT Service for an Acute In-patient Setting: A pilot evaluation study. Clinical Psychology and Psychotherapy. 14, 117-125

Workshop 16

Cognitive Therapy with Command Hallucinations

Max Birchwood, University of Birmingham, UK and
Alan Meaden, University of Birmingham, UK

Command hallucinations are common in people with treatment resistant psychosis and can lead to harmful compliance with risk to self and others. CBT for psychosis has shown no impact on these experiences, including the need to comply or appease the commanding voice. We have developed a cognitive therapy (CTCH) based on our cognitive model of the distress/behaviour generated by voices, to reduce the need for compliance without necessarily changing voice activity itself.

Key Learning Objectives:

  • To understand our cognitive model of voice hearing, particularly the relevance of social rank theory.
  • To acquire skills in formulating clients from this perspective
  • To develop and implement a CTCH intervention plan.

Max Birchwood and Alan Meaden have together with colleagues developed this model and intervention and conducted a pilot trial, currently undergoing a 3-centre MRC funded evaluation

Key References:

A Casebook of Cognitive Behaviour Therapy for Command Hallucinations Sarah Byrne, Max Birchwood, Peter E. Trower and Alan Meaden, Hove, UK: Routledge, 2005. pp. 145, ISBN: 1-58391-785-3

Trower P, et al. Cognitive therapy for command hallucinations: randomised controlled trial. Br J Psychiatry. 2004 Apr; 184:312-20.

Workshop 17

Staying Well After Psychosis: A Cognitive Interpersonal Approach to Relapse Prevention and Emotional Recovery

Andrew Gumley, University of Glasgow, UK and
Matthias Schwannauer, University of Edinburgh, UK

This workshop presents an individually based psychological intervention targeting emotional recovery and relapse prevention derived from the clinical trials lead by the workshop leaders. Our approach considers the cognitive, interpersonal and developmental aspects involved in emotional recovery and vulnerability to the recurrence of psychosis. The workshop will outline a psychological framework for developing individually tailored strategies for case formulation and staying well that primarily focus on emotional and interpersonal adaptation to psychosis. This approach incorporates:

  • A novel developmental perspective on help seeking and affect regulation in psychosis,
  • Individualised strategies to support self reorganisation and adaptation after acute psychosis,
  • Understanding and treating traumatic reactions to psychosis,
  • Working with core appraisals and cognitive interpersonal schemata during recovery, &
  • Developing coping in an interpersonal context.

Key Learning Objectives:

  • To incorporate a developmental perspective to guide the process of service engagement, formulation and intervention.
  • To develop individualised formulation based approach to emotional recovery, adaptive affect regulation, relapse detection and prevention.
  • To develop a therapeutic approach around the interplay between interpersonal schemata, and underdeveloped and over-developed coping strategies.

Andrew Gumley is Senior Lecturer in Clinical Psychology at the University of Glasgow and Honorary Consultant Clinical Psychologist at ESTEEM: North Glasgow Early Intervention Service.
Matthias Schwannauer is Senior Lecturer in Child and Adolescent Clinical Psychology at the University of Edinburgh and Consultant Clinical Psychologist in the Adolescent Onset Psychosis Service in Edinburgh.

Key References:

Gumley A, O'Grady, M, McNay, L, Reilly, J, Power, K & Norrie, J (2003). Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychological Medicine, 33, 419-431.

Gumley AI & Schwannauer M. (2006) Staying well after psychosis: a cognitive interpersonal approach to recovery and relapse prevention. Chichester: John Wiley & Sons Ltd.

Workshop 18

How to Talk Usefully About the Past

Gillian Butler, Oxford Cognitive Therapy Centre, UK

Talking about the past is not always helpful. It can, for example, provoke distress and flashbacks, the telling can become stuck and repetitive, or it can serve to endorse an unhelpful message concerning blame, or victimhood. This workshop focuses on how to talk usefully about the past with people who have suffered repeated abusive experiences during childhood. Pressures on therapists to help people tell their stories are many. They come from the work on re-living in the treatment of post-traumatic stress disorder, from narrative theories of identity, and from the commonly held assumption which many people bring to therapy, that once the story has been told then they can move on and leave the past behind. Unfortunately this assumption is often false, and succumbing to the pressure to hear the story may be a disappointing experience. This workshop suggests how, and when, to help people talk about their past in ways that are likely to benefit them. The ideas presented have implications for assessment, for the selection of appropriate interventions and for the timing of such interventions. They may also help cognitive therapists to explore more creatively some of the tools, such as metaphor and imagery, that we can all use to represent our experience.

Key Learning Objectives:

  • Clarifying principles that help therapists decide when to encourage people to tell their stories, and when not to.
  • Increasing the options open to therapists in their role as recipients of a story. 
  • Understanding the part that recounting your history can play in self-definition

Gillian Butler is an associate for Oxford Cognitive Therapy Centre. She has recently retired from the NHS, where her clinical work was with people who had suffered traumatic experiences during childhood. She is now writing about the use of CBT to help people who have a fragile sense of identity.

Key References:

Bruner, J. 2002. Making Stories: Law, Literature, Life. Cambridge, Mass, Harvard University Press.

Harter, S. 1999. The Construction of the Self. New York, Guilford.

Pennebaker, J.W 2000. Telling stories: The health benefits of narrative. Lit Med. 19, 3-1

Workshop 19

Dealing with Endings in Therapy - A Cognitive Behavioural Perspective

Andrew Eagle, Central and North West London NHS Foundation Trust, UK and
Michael Worrell, Central and North West London NHS Foundation Trust, UK

The ending phase of therapy has received relatively little theoretical and research attention in the Cognitive Behavioural literature. It is also a phase of therapy that often does not receive due consideration on CBT training courses.  In reality however, this is a key phase in therapy that requires sensitive and skilled clinical management. Successful therapeutic endings are particularly difficult to achieve in cases where outcomes are mixed or have been less than hoped for, and both therapists and patients may struggle to plan and prepare for endings in these cases. Therapists run the constant risk of providing either too little or too much therapy to clients and the judgement of how much is enough? is difficult to make.  Not all therapy endings occur in a planned fashion and patients may prematurely drop out of therapy with associated challenges for clinicians' sense of clinical competence.  A number of broader development in the field of CBT have given new impetus to the importance of managing endings well. These include: Increased emphasis on providing CBT in brief, time-limited formats in services with high demand and patient turnover.  Increased focus on measurement of clinical outcomes and the active use of these measures to guide decision-making about ending therapy.  The application of CBT to an ever-expanding range of complex and/or chronic clinical disorders that may be less likely to respond to treatment e.g., personality disorder, psychosis.  An increasingly educated clinical population with high and sometimes unrealistic expectations about the benefits of CBT.  The workshop aims to introduce participants to a range of models of endings that have historically underpinned clinical practice. A CBT perspective on ending therapy will be outlined and participants will be encouraged to consider the extent to which this model is consistent with their clinical approach. Particular emphasis will be given to the beginning phase of therapy, because a CBT approach to endings must of necessity, involve a discussion of treatment planning and treatment goals.  Attention will be given to identifying clinical criteria that can be used to guide judgements about how and when to end therapy. Consideration will also be given to how to effectively prepare clients for the ending of therapy. Participants will be given an opportunity to present and discuss complex cases where ending therapy has proved to be a difficult and unsatisfactory process.

Key Learning Objectives:

  • For participants to better understand the models of endings that are implicitly or explicitly informing their clinical practice. Learn about a systematic CBT model of Ending.  
  • Strategies for planning therapy to minimise the possibilities of unsuccessful endings. 
  • Learn strategies to minimise the risk of development of unhealthy dependency on therapy and to effectively promote patient autonomy and self-efficacy. 
  • Learn to develop effective clinical criteria for assessing patients' readiness to end therapy. 
  • Learn to more effectively manage endings in cases with poor outcomes and/or dissatisfied clients.

Dr Andrew Eagle is the Head of an Adult Psychology Service in North West London. He has a long-standing interest in Termination Issues in Psychotherapy, with a particular focus on patients and therapists' experience of endings in brief and/or time-limited therapy and the development of an updated conceptualization of Termination. He has conducted research in this area, using qualitative methodologies. 
Dr Michael Worrell is the Course Director for the Royal Holloway/Central North West London (CNWL) Post Graduate Diploma in CBT. He is accreditated as a CBT Trainer and Supervisor and has extensive experience of training and consultation in the field of CBT.

Key References:

Goldfried, M.R. (2002). A cognitive-behavioural perspective on termination. Journal of Psychotherapy Integration, 12, 3, 364-372. 

Murdin, L. (2000). How Much is Enough? Endings in Psychotherapy and Counselling. London: Routledge. 

Quintana, S.M. (1993). Towards an Expanded and Updated Conceptualization of Termination: Implications for Short-Term Individual Psychotherapy. Professional Psychology: Research and Practice, 24 ,4 , 426-432

Workshop 20

Case Formulation-Driven Cognitive Behavior Therapy

Jacqueline Persons, University of California, USA

The cognitive-behavior therapist who is striving to provide evidence-based care confronts many dilemmas in his/her efforts to do this, including patients who have multiple disorders and problems that are addressed by multiple empirically-supported therapies (ESTs); patients who refuse, cannot implement, or fail to benefit from the ESTs; and those who have problems for which no ESTs are available. In cases like these, the therapist faces the challenge of how to provide care in a way that meets the needs of the patient at hand, provides a systematic guide to clinical decision-making, and is evidence-based. Case Formulation-driven CBT addresses this challenge.

Key learning Objectives:

  • To learn a conceptual model that allows the clinician to adapt nomothetic empirically-supported therapies (ESTs) to the needs of the individual case in a way that is evidence-based and systematic;                    
  • To identify the elements of Case Formulation-driven Cognitive-behavior Therapy;
  • To learn strategies for developing a case formulation, including a comprehensive problem list and a hypothesis about psychological mechanisms causing the patient's problems;
  • To learn strategies for monitoring outcome and process of treatment at every session;
  • To learn strategies for using the formulation and monitoring to identify and overcome treatment failure.

Jacqueline B. Persons, Ph.D., Director, San Francisco Bay Area Center for Cognitive Therapy, 5435 College Avenue, Oakland, CA 94618. jbp@sfbacct.com Jacqueline B. Persons is Director of the San Francisco Bay Area Center for Cognitive Therapy and Clinical Professor in the Department of Psychology at University of California-Berkeley. She conducts research studying the process and outcome of cognitive therapy for depression and anxiety and is especially well-known for her writings on the use of the individualized case formulation in cognitive-behavior therapy. Her book, Cognitive therapy in practice: A case formulation approach, is widely viewed as a classic. She recently completed a new book, entitled Case formulation-driven cognitive-behavior therapy, which will be published by Guilford in the summer of 2008. Dr. Persons has presented clinical workshops in the United States, Canada, Europe, and Japan. She is past president of the Association for Advancement of Behavior Therapy (now ABCT) and of the Society for a Science of Clinical Psychology (section 3 of the Society of Clinical Psychology of the American Psychological Association). She received her Ph.D. in clinical psychology in 1979 from the University of Pennsylvania.

Key References:

Persons, J. B. (In press). Case formulation-driven cognitive-behavior therapy. New York: Guilford.

Persons, J. B. (2005). Empiricism, mechanism, and the practice of cognitive-behavior therapy. Behavior Therapy, 36, 107-118.

Persons, J. B., & Tompkins, M. A. (2006). Cognitive-behavioral case formulation. In T. D. Eells (Ed.), Handbook of psychotherapy case formulation (Second edition ed.). New York: Guilford

Workshop 21

Toward More Effective Supervision: Managing the Tension Between Core Supervision Activities and Other Things That Get in the Way

Mark Freeston, Newcastle University, UK

Clinical supervision is a central element both in the development and maintenance of therapeutic skills and in ensuring safe and effective practice with clients. There is a broad consensus around the central goals and functions within clinical supervision, but there is also a range of other important activities that can, at different times, impinge upon the core functions.  These other activities include caseload management, management of team dynamics, professional supervision, training and education, personal development, and personal therapy.  All of these activities are entirely legitimate and indeed often need to be addressed through appropriate means. Within clinical supervision, although a certain degree of attention to any of these other areas may be entirely appropriate at particular points in time in order to ensure that the therapist/supervisee is properly supported in his or her clinical work, situations arise when there is repeated attention to these other activities or continuous drift away from the core activities.  Supervisors may find themselves devoting more and more time to these other activities often in response to particular characteristics of the supervisee or the context in which supervision is taking place and so the focus on the development of therapeutic skill and its application to clients is lost.  This workshop offers participants the opportunity to develop conceptual understanding and practical ways of ensuring a flexible but consistent focus on core activities in supervision and so manage the tensions that arise in an effective way.

Key Learning Objectives:

  • Enhance awareness of core functions of supervision
  • Identify a range of other activities that can impinge on clinical supervision
  • Develop heuristics to detect that unhelpful drift is occurring
  • Develop a conceptual map that provides guidance
  • Identify strategies to manage the tension and maintain flexible focus

Mark Freeston is course director the Newcastle Diploma in Cognitive Therapy. Together with colleagues from Newcastle has developed a conceptual framework to understand supervision as well as supervision training courses.  He regularly provides workshops on supervision in the UK and Europe as well as working with organisations to develop appropriate training and supervision systems.

Key References:

Armstrong, P. V.  & Freeston, M. H. (2006). Conceptualising and formulating cognitive therapy supervision. In Tarrier, N. (Ed), Case formulation in cognitive behavior therapy: The treatment of challenging and complex cases. (pp. 349-371). New York, NY, US: Routledge/Taylor & Francis Grou