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.
A Career in Trauma Treatment and the Trauma Informed Stabilization Treatment (TIST) for PTSD and Complex PTSD
In this episode, Janina discusses her career in learning, treating, and teaching about PTSD and Complex PTSD. She discusses being inspired when hearing Judith Herman talk about how that the events in one’s life shape our experiences, as opposed to just being driven by childhood sexual fantasies as was the main viewpoint based on Freud’s work. She explained how the prevailing thought in treating trauma for decades has been that the client needed to tell the story of the trauma, but we have no research that proves that view. Instead, she proposes that the way to treat trauma is to change one’s relationship to the symptoms, rather than re-live the event. She discussed her experience working with Bessel Van Der Kolk, and how he encouraged her to teach about working with PTSD. Additionally, he encouraged all of his clinicians to be trained in a Somatic approach, which lead her to Sensorimotor Psychotherapy training and to EMDR. She discussed her work and how she helps clients to engage their frontal lobes, the thinking brain, and works with clients as fragmented, incorporating Internal Family Systems and working from a Structural Dissociation perspective. We discussed how she treats suicidality in trauma clients as a part trying to protect the client from being overwhelmed by vulnerability. She discussed how her model, Trauma Informed Stabilization Treatment (TIST) is an integrative approach, incorporating parts work, EMDR, somatic, and Structural Dissociation, and she is training others in her model throughout the world. Finally, we discussed the clients’ experience in therapy and working with them where they are, as the client who has experienced trauma may not be able to “trust” the therapist enough to try something new.
Janina Fisher, Ph.D. is a licensed clinical psychologist and a former instructor at the Harvard Medical School and former instructor at The Trauma Center, a research and treatment center founded by Bessel van der Kolk. She is known as an expert on the treatment of trauma, and has also been treating individuals, couples and families since 1980. She is past president of the New England Society for the Treatment of Trauma and Dissociation, an EMDR International Association Credit Provider, and Assistant Educational Director of the Sensorimotor Psychotherapy Institute. Janina lectures and teaches nationally and internationally on topics related to the integration of the neurobiological research and newer trauma treatment paradigms into traditional therapeutic modalities. Janina is the author of Healing the Fragmented Selves of Trauma Survivors: Overcoming Self-Alienation (2017), Transforming the Living Legacy of Trauma: a Workbook for Survivors and Therapists (2021), and The Living Legacy Instructional Flip Chart (2022). She is best known for her work on integrating somatic interventions into trauma treatment, and the development of her approach Trauma Informed Stabilization Treatment (TIST), which one can be trained in by going to https://therapywisdom.com/healing-the-fragmented-selves/. You can learn more about Janina at her website, www.janinafisher.com.
Using Play, the Language of Children, and Filial Therapy to Help Youth and Families
In this episode, I speak with Karen about her past as a Child Protective Services caseworker and how she was confused by the therapists who did play therapy, not understanding it fully until she herself got her LCSW and began training in play therapy in Philadelphia. She discussed her experience working with the developers of Filial Therapy, which uses child centered play therapy developed by Virgina Axline and based on Rogerian humanistic theory. In Filial, which in this context means parent-child, parents are taught to hold nondirective, dyadic play sessions with their children, so that the parent becomes the agent of change. Karen discusses learning from numerous experts in play therapy, being trained in Gestalt, and in sand tray therapy. She also discusses how she uses these modalities to help children express their inner experiences, and to help parents learn how to create this space for children and to see the world from their child’s perspective. We discuss areas where parents and therapists get frustrated in their efforts to use play therapeutically, and how the work creates a shift not only in the children, but also in the parents. In addition, we discuss the differences between a Rogerian non-directive play therapy, and a psychodynamic play therapy; in the Rogerian approach, the clinician is reflecting what they see as the child plays, as opposed to interpreting what they see. We also discuss right brain approaches such as play, art therapy, and sand tray, and their application to adults as well as children.
Karen Pernet, LSCW, RPT-S, SEP is a Licensed Clinical Social Worker, Registered Play Therapist Supervisor & Somatic Experiencing Practitioner. Karen returned to school to obtain her MSW at Bryn Mawr College of Social Work and Social Research in mid-life after a career in child welfare. She is known for her encouraging and down to earth approach and has been described as knowledgeable, supportive, and playful. Karen’s postgraduate education includes certificates in Gestalt Therapy, Somatic Experiencing, and Filial Therapy. In addition, she has had intensive training in Child Centered Play Therapy, sand tray therapy, Gestalt Play Therapy, trauma treatment, interpersonal neurobiology, and Internal Family Systems. Karen is in private practice in Oakland, CA and provides professional trainings, consultation, and supervision. From 2006 to 2021 she was a certified Filial Therapy trainer with the Family Enhancement and Play Therapy Center and currently a Filial Therapy supervisor with the National Institute for Relationship Enhancement (NIRE).
Helping Adolescents Unlock Their Potential Using the DNA-V Frame for Applying Acceptance Commitment Therapy (ACT) in Treatment
In this episode, I speak with Louise about her journey from switching careers as a retail buyer, to going to university and getting a degree in psychology, and working as a behavioral therapist. She discussed being introduced to Acceptance Commitment Therapy (ACT) and really liking the model, and applying it in her work with adolescents. She explained that the developmental differences between adolescents and adults lead her to think about many aspects, such as evolutionary science, attachment, and how these natural processes can be tapped into when a teen is stuck by using ACT, to help them enhance their development and thrive. She explained that DNA-V was a framework for ACT that helped with growth and development. The Discoverer is the ablility of us that learns through trial and error and taking risks, the Noticer part is the ability where we are mindful andaware of our embodied self, being present with ourselves and the world around us, the Advisor our ability for self-talk, another way to consider thoughts, and the Values aspect are split between the vitality and values, where the therapist learns about what the teen is passionate about, and derives their values from that. She explained that she will additionally bring in parents and discuss the work and will often access their Advisor, which has lead to her and her colleagues extending this approach to working with adults. The DNA-V model has been helpful in conveying the ACT principals to adolescents, as well as providing a frame for clinicians learning the model.
Louise Hayes, Ph.D. is a clinical psychologist, author, and international speaker. She is a Fellow and Past President of the Association for Contextual Behavioral Science. She is a peer-reviewed Acceptance and Commitment Therapy/Training (ACT) trainer, engaged in training professionals all across the world. Together with Joseph Ciarrochi, she developed DNA-v, which is a leading model of acceptance and commitment therapy that has sparked international studies and school curricula. She is the co-author of the best-selling books for young people, Get Out of Your Mind and into your Life for Teenagers; and Your Life Your Way released in 2020. She is the author of the practitioner book, The Thriving Adolescent. In 2022 she will release a new book using DNA-V with adults, What Makes You Stronger. Louise is also an active clinician, working with adults and adolescents. She is a former Senior Fellow with The University of Melbourne and Orygen Youth Mental Health. Louise leads a community of mindfulness practitioners, is a certified Buddhist meditation teacher and takes professionals into the Himalaya to develop their mindfulness skills, raise funds for poor children in remote Nepal and has built a school in remote Nepal. To learn more about Louise, go to www.louisdehayes.com or https://dnav.international
Using Deliberate Practice in Training to Increase Therapist Effectiveness in a Field That Has Little To No Opportunity to Practice and Only Performs Behind Closed Doors
In this episode, Tony discusses being inspired as an early career clinician to track his outcomes with clients, and upon doing so, saw that 50% of his clients were not progressing. He was concerned about this, and reviewed the research, he found that is within the average range of progress that clinicians were having. He explained that psychotherapy is one of the only fields where students and interns don’t practice before they start treating clients. He talked about how he could write a paper on theory and technique, write treatment plans, but when it came out of the abstract and into the real world, there were many nuances to therapy that he was learning. He gave the metaphor of being as if someone said, “I want to play baseball and make it to the major leagues, but I’ll only play in the games and not come to any of the practices”. He discussed his work on Deliberate Practice, and how he and the clinicians he has worked with have created resources for those in training to practice through role play. He explained that they reached out to a number of leading therapy approaches and had them identify the 10 core skills that one would need to practice the particular approach, and came up with role plays to practice these skills and published this through the American Psychological Association. He also explained that he and colleagues have started Sentio University, which will train masters level clinicians using the Deliberate Practice approach, and 50% of each class, and the entire program will consist of practice through role plays. Tony discussed how continuing to practice, and recording sessions and reviewing is so important in developing the skills of the practitioner, since psychotherapy is one of the only fields where what the clinician does is not transparent, with know one seeing exactly what the therapist is doing. He also explained the anxiety that this causes in therapists and training therapists as they may be demonstrating their abilities through role play, video, or one way mirror, and their fear that their performance will not be as good as their ability to talk to others about their performance.
Helping Children and Teens to Develop the Concepts of Consent, Respect, Pleasure, and Safety in Relationships, Creating a Foundation for a Healthy Relationship with Sexuality
In this episode, I speak with Shafia about her path to becoming a health and sex educator. She discussed how she had worked in case management and social work with kids who were experiencing dual and triple diagnosis, and a common theme was having a history of being harmed. She decided she wanted to try to help increase the prevention of such harm, and was fortunate enough to work at a great school, Marin Academy, where they allowed her the resources to create an in depth class where she could help the kids process the foundational concepts related to relationships, being respect, dignity, safety and pleasure. After 25 years of teaching in many schools, Shafia wrote a book: Sex, Teens, and Everything in Between. We discussed her book, which is written to help parents and teens have conversations about consent, sex, their rights, and many other topics. We discussed her use of Emily Nagoski’s metaphor of the garden and deciding what to leave, what to take out, and who we’re going to let in to our sexual guardian, and the beliefs and feelings we have about sexuality and how we connect with others. She also shared a conversation she has with the students about how they would feel if the sat down with some French fries and everyone started grabbing them. This leads into conversations about consent, power, respect, and a whole host of other concepts. She also shared that it is very important for parents, as well as therapists, to think of their own relationship to sexuality, body image, relationships, gender, sexual orientation because these will influence how we respond in guiding teens.
Shafia Zaloom is a health educator, parent, consultant and author whose work centers on human development, community building, ethics, and social justice. Her approach involves creating opportunities for students and teachers to discuss the complexities of teen culture and decision-making with straight-forward, open and honest dialogue. Shafia has worked with thousands of children and their families in her role as teacher, coach, administrator, board member, and outdoor educator. She has contributed articles to The New York Times, The Washington Post, and numerous parenting blogs. Shafia’s book, Sex, Teens and Everything in Between has been reviewed as “the ultimate relationship guide for teens of all orientations and identities.” It is one that “every teen, and every parent and educator - and every other adult who interacts with teens - should read.” Shafia is currently the health teacher at the Urban School in San Francisco, and develops curricula and trainings for schools across the country. She was honored by the San Francisco Giants Foundation in 2018 for her work with Aim High, a program that expands opportunities for students and their teachers through tuition-free summer learning enrichment, and was recently granted CAHPERD’s Health Teacher of the Year Award for 2021. Her work has been featured by many media outlets including, The New York Times, USA Today, NPR, KQED, and PBS.
Clients Aren’t Sick, They’re Stuck: Using Strength Based Culturally Informed Integrated Model to Understand the Client’s World and Create Change
In this episode, Terry discusses his experience initially being trained psychodynamically and psychoanalytically, but finding that it did not seem to be a good fit for the population whom he was working with, which were families in Chinatown in San Francisco, many of which were immigrants. He discussed how a training at the Mental Research Institute (MRI) had a profound impact on him when he heard the person teaching saying that people are not sick, they are stuck. The therapist's job is to help them get unstuck. Terry discusses the four elements that he feels are important to working with clients and families, which are related to the relationship, being humanistic in approach, understanding the client’s cultural context, activating the clients’ strengths, and the placebo effect, which is the client’s belief that positive change is possible. We discussed the differences between the Brief Strategic MRI model and Jay Haley’s Strategic Family Therapy model, and the 180 degree shift in solution. This is based on the idea that the attempted solution has become the problem. We discussed one example of a session Terry had written about, and how both the cultural competency and the MRI model came into play. The case involved a Vietnamese woman who was encouraged by her previous therapists to stop taking care of her sick father and instead individuate and take care of herself. She flatly rejected this idea. Terry understood the importance of certain roles in collectivists cultures. Instead of encouraging her to take care of herself more, he helped her to become more effective in caring for the father. He used different metaphors to step into the clients’ worldview and shifted the system, which worked within the client’s cultural context. The intervention was a success and the father and the client experienced great improvement. Terry discussed his approach called, Strength Based Culturally Informed Integrated Model, and how the two most important parts are adaptability and flexibility, and collaborating with your clients on creative interventions to disrupt the stuck cycle and generate new more effective solutions.
Terry Soo-Hoo, PhD is currently professor at the California State University East Bay in the Marriage and Family Therapy Program, and was the Clinical Director of MRI in Palo Alto. He completed his Ph.D. in clinical psychology at the University of California, Berkeley and is Board Certified in Family and Couples Psychology (ABPP). Prior to university teaching he devoted over twenty years as a psychologist in Community Mental Health Services in San Francisco working with a diverse range of people with many different psychological problems. Terry's publications include topics on multi-cultural issues in psychotherapy and consultation, brief therapy and couples therapy. He has special interests in the area of innovative culturally relevant approaches to psychotherapy. He has also provided extensive presentations, training, supervision and consultation on these topics to agencies and other professionals in many countries around the world.