With so many developments in the field of psychotherapy, so many integrations, innovations, and shifts from evidence-based to common factors, its hard to keep up! Therapy On the Cutting Edge is a podcast with hour long interviews of clinicians that are creating, innovating, researching, developing, and perfecting treatments for clients.
Competency Based Supervision Including Alliance, Integrity, Feedback and Cultural Humility in Supporting Supervisees in Their Development
In this episode, Carol discusses how early in her career she was hired to be the assistant director of training for a child and family guidance clinic, and became very intrigued in the processes of clinical supervision. After a decade, she became Director of Training at another American Psychological Association accredited program and developed the site visit documentation, which led her to collaborate with her future coauthor, Ed Shafranske, Ph.D., to develop a model of supervision. She explained how their model is transtheoretical, providing a framework for supervisors to provide supervision systematically and intentionally. She said that most clinicians provide supervision the way they were supervised, through osmosis, or internalizing practices done unto them, rather than using a particular model or being guided by research and evidence. She pointed out that increasingly, high rates of inadequate and even harmful supervision are being reported by supervisees, and how the process of becoming a supervisor varies dramatically. Some supervisors simply begin, utilizing practices that were done unto them during their training trajectory; others have taken a workshop, and some have a longer training period with a substantial sequence of courseswork, experiential training, video review, and targeted feedback to develop their skills as a supervisor. She explained that in their model focus is on a process that includes development of the supervisory alliance, monitoring that alliance over time attentive to the perspectives of cultural humility with respect to the clients, supervisees, and supervisor. Additionally it includes focus on reacivity or countertransference, supervisee self-care, legal and ethical issues, attending to a communitarian constellation, an environment of caring, respect, and support. We discussed having strong boundaries around supporting the supervisee in instances of reactivity in regards to client, while at the same time, never crossing the boundary to provide psychotherapy to the supervisee. In talking about supporting supervisees, she discussed trauma informed supervision and helping supervisees to have an understanding how their nervous system is affected, as well as helping them have tools for regulating their activation. She pointed out that the ultimate job of the supervisor is to protect clients, and gatekeeping, ensuring that unsuitable supervisees do not enter the profession. Carol discussed cultural humility and power in the supervisory relationship and how she and her co-author encourage supervisors to be open about their various identities and privilege from the outset of the supervisory relationship and throughout. She encourages giving feedback regularly throughout supervision, and being honest and transparent about the supervisee’s development and scaffolding their strengths to improve the areas that are in development, rather than avoiding giving corrective feedback until review time. She discusses how monitoring client outcomes and feedback is critical and often left out in supervision, as well as encouraging supervisee self-assessment and not being fearful of give needed feedback to the supervisee.
Carol Falender, Ph.D. is co-author of multiple books on clinical supervision including Clinical Supervision: A Competency-based Approach (2004; second edition, 2021), Getting the Most Out of Clinical Training and Supervision: A Guide for Practicum Students and Interns (2012) The Essentials of Competency-based Clinical Supervision (2017), co-editor of Casebook for Competency-based Clinical Supervision and all with Edward Shafranske; Multiculturalism and Diversity in Clinical Supervision: A Competency-based Approach (2014) edited with Edward Shafranske and Celia Falicov. She edited one book on consultation, Consultation in Psychology: A Competency-based Approach (2020) with Edward Shafranske. She has written numerous articles and conducted workshops and symposia internat
Infant and Child’s Sleep: A Process of Separation and Emotional Regulation
In this episode, Angelique discusses her career as a sleep consultant for parents of newborns. She explained that she started off as a midwife, then a birth doula, and a post partum doula, and spent a great deal of time helping babies sleep through the night, and new families navigate the transition to parenthood. She explained that she saw sleep as a portal into multiple areas such as post partum depression, parent-infant bonding, and other aspects of the transition to parenthood. She found that there was not a great deal of research on the subject, only research focused on extinction or “cry it out” method of helping infants with sleep issues when she started in the field. She went to conferences, obtained a doctorate in psychology, and used her field work to develop an approach to helping children sleep, which she named the MIllette Method, which takes into account development, temperament, attachment, culture, and numerous other factors that play in to sleep and separation between caregiver and child. She talked about assessing the proximity of the parent to the child, range of crying, parental responsiveness, and charting these factors in order to develop a plan for the family. She discussed the “rinse and repeat” method where the parent will notice sleep signs, put the baby down, soothe them, step away, and then come back again after a little bit to continue soothing, then stepping away again. She explained that sleep is also a process of developing self regulation and the different self regulating behaviors that babies aquire as they develop. Angelique pointed out that the research is mixed on cosleeping or having the child sleep in another room, so it really depends on the family’s preferences, although early on, the rate of Sudden Infant Death Syndrome (SIDS) is lower when the baby is sleeping in the room with the parents for the first six months. She discussed the interval method of sleep training, which allows for more crying, where there may be more crying, but isn’t used until the infant has a number of self soothing abilities. Lastly, she described her approach to helping toddlers and children falling asleep, using two phases. The first is based on her child psychology background, and using play activities to help parents and children practice separation, since separation is the key element of sleeping alone. Sometimes, that in itself leads to better sleep, but if not, she institutes the second phase where the parent sleeps in the child’s room for a few nights, and slowly moves out of the room after consecutive nights. She explained that the key element of separation that is inherent in helping infants and children sleep.
Angelique Millette, PhD, CLE, CD/PCD is a parent-child coach, pediatric sleep consultant, and family sleep researcher. Angelique’s diverse background includes training in child play, art, and nature therapies, child development and sleep, and work as a child psychologist. Her commitment to children and parents spans twenty-five years and she continues to develop programs to meet families “where they are at.” Her approach allows her to work with diverse communities both nationally and internationally. Angelique has developed The Millette Method™ a multi-disciplinary approach to family sleep and child behavior. The Millette Method™ does not follow one specific sleep or behavioral method, but rather uses a “tool-box” of different methods and approaches and takes into account various factors including child temperament and history, culture, family social support, access to nature/play, parental overwhelm, history of trauma, and parent/child mental health and wellness. Angelique has worked with more than 15,000 families, and presents professional workshops to non-profits, government agencies, Fortune 500 companies, universities, and parents groups across the country and internationally. She also consults with juvenile products manufactur
Couples With Substance Disorders: Strategies for Treating the Trauma of the Addiction Helping To Develop a “Couple Recovery”
In this episode, Bob discussed how originally substance misuse was not an area that he worked with, but after it kept showing up with his clients he decided he needed and pursued more training. He discussed how he was part of the Family Recovery Project at the Mental Research Institute with Drs. Stephanie Brown and Virginia Lewis, a study aimed at what happens in couple and family systems after beginning recovery. Bob’s research, a qualitative study on long-term couple recovery, led to him creating a model called the “Couple Recovery Development Approach (CRDA), a theory for explaining how couples can successfully navigate the challenges found in the transition from active addiction to active recovery. Bob talked about the impact of the trauma of addiction, and the trauma of recovery relating that the first year in recovery was challenging, and that relapse rates are high in that first year. He explained how with couples he externalizes addiction and explores how it has invaded their relationship, in a way so that they can both talk about the impact of this unwanted intruder. He discussed how clinicians often believe it’s important not to work on the couple relationship in the beginning of recovery, because each partner is supposed to focus on their individual recovery, but he pointed out that couples impacted by addiction have the highest divorce rate of any other comorbidities, and there actually isn’t any empirical studies to support that approach; in fact research does support the concept that healthy relationships are found to be the biggest predictor of long-term sobriety. It turns out that couples work is one of the most effective ways to identify addiction and move people into recovery. Rather than the common belief that addiction is contraindicated for couples therapy, We addressed the issues of codependency. While it can be helpful in defining issues for the non-using partner, it’s limited. Bob said he feels it is important to add the concept of secondhand harm, and post-traumatic-stress-disorder to normalize partner’s experiences and not pathologize them with the singular term “codependency”. He described his intervention called H.E.A.R.T. (Healing Emotions from Addiction Recovery and Trauma), which helps partners to process the trauma from addiction, without blame or defensiveness.
Robert Navarra, Psy.D, LMFT, MAC is a Licensed Marriage and Family Therapist, Certified Gottman Therapist and Master Trainer, and holds National Certification as a Master Addiction Counselor. He has trained counselors and therapists nationally and internationally. Dr. Navarra has co-authored several book chapters with Drs. John and Julie Gottman, and co-authored articles on Gottman Therapy for The Encyclopedia of Couple and Family Therapy with Dr. John Gottman. Based on his research at Mental Research Institute in Palo Alto California, Bob created “Roadmap for the Journey: A Path for Couple Recovery”, a two-day workshop for couples in recovery from an addictive disorder. “Roadmap for the Journey” has been a featured workshop at Hazelden Betty Ford and has been given at treatment programs as well as in small, semi-private workshop settings. Bob and John Gottman are currently researching the impact of Roadmap for the Journey in helping couples integrate recovery into their relationship, a missing element in most treatment programs. In collaboration with the Gottman Institute, Bob has also created a one-day training workshop for counselors and therapists, called “Couples and Addiction Recovery.” He also teaches graduate classes on addictive disorders at Santa Clara University. You can learn more about Bob at www.drrobertnavarra.com.
Understanding Shame and Using it to Evolve, Open, and Unleash Creativity
In this episode, I speak with Sheila about her lifelong work of working with clients with shame. She explained that she got interested in this subject from her experience as a child and being shy, but overcoming it by becoming a children’s magician and performing. She explained how she trained in a number of approaches such as Emotionally Focused Couples Therapy, Drama Therapy, Dialectical Behavior Therapy, Cognitive Behavioral Therapy, AEPD, Accelerated Experiential-Dynamic Psychotherapy, Hakomi and others, but wasn’t finding a particular approach really addressing shame. She discussed how she helps clients to understand that shame has an evolutionary purpose, both in protecting us when we are young, but also helping us to evolve in the present, using it as a signal the client to set boundaries, make changes, and take risks to be more of their authentic self. Sheila talked about how shame is evolutionary by subduing an anger response towards a parent, because it might not be safe, or threaten the connection with parents. She talks about the continuum of shame, which goes from stage fright or imposter syndrome, to never feeling good enough, having a lot of shoulds and perfectionism, and all the way to experiences of humiliation. She discussed how PolyVagal Theory was a great addition to the puzzle, where she was able to have language and a biological explanation for the freeze or shut down that happens for someone when shame comes up. Sheila discussed noticing it in the moment, in the session, when the interpersonal bridge breaks, and helping clients to see the shame, and how it shifts their nervous system. She talked about working with the inner critic, the parent who might have been the critic, using parts work and drama therapy to help clients replay those experiences and becoming the person that could be the hero and protect and save their younger parts. Sheila discussed how helping clients to use mindfulness to notice when the shame comes up, sitting with it, and using compassion for themselves, leads them to be able to be open, rather than shutting down.
Sheila Rubin, LMFT, RDT/BCT is a marriage and family therapist and a leading authority on Healing Shame. She developed the Healing Shame Therapy work over the last two decades and is the co-director, with Bret Lyon, of the Center for Healing Shame. in Berkeley, California. Sheila has delivered talks, presentations and workshops across the country and around the world, at conferences from Canada to Romania. She is a Board Certified Trainer through NADTA and past adjunct faculty for the CIIS Drama Therapy Program and JFK University’s Somatic Psychology Department. Sheila's expertise, teaching, and writing contributions have been featured in numerous publications, including seven books. Her writings on shame include the chapter “Women, Food and Feelings: Drama Therapy with Women Who Have Eating Disorders” in the book The Creative Therapies and Eating Disorders, the chapter “Almost Magic: Working with the Shame that Underlies Depression: Using Drama Therapy in the Imaginal Realm” in the book The Use of Creative Therapies in Treating Depression, and the chapter “Unpacking Shame and Healthy Shame: Therapy on the Phone or Internet” in Combining the Creative Therapies with Technology: Using Social Media and Online Counseling to Treat Clients (all books edited by Stephanie L. Brooke). Sheila offers therapy through her private practice in Berkeley and online via Zoom. She also provides consultations to therapists via Skype and leads workshops in Berkeley, internationally, and online. You can learn more about her workshops, writing, and on demand trainings at www.HealingShame.com
Regulating Together: An Evidence Based Group for Children with Autism That Utilizes the Parents As Coaches, Creating Lasting Change
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.
Cognitive Behavioral Play Therapy (CBPT) : Adapting CBT For Young Children Using Play
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.