Introducing MPA’s 2003-2004 Post-Doctoral Institute on Couples Therapy Course Descriptions and PDI Details The Maryland Psychological Association/Foundation Post-Doctoral Institute (PDI) was created to provide focused training in specific clinical skills for psychologists and other post-graduate mental health professionals. This Post-Doctoral Institute on Couples Therapy provides an opportunity for clinicians to obtain in-depth continuing education targeting issues relevant to assessment and psychotherapy with couples. PDI fellows also benefit from the opportunity to participate in small group discussions and case presentations highlighting relevant topics with the training coordinators (Drs. Brown and Epstein). This PDI spans two academic years (April 2003 through October 2004) and therefore allows the clinician to acquire knowledge and applicable strategies in a long-term framework. A special Post- Doctoral certificate of completion will be awarded to those licensed psychologists who are enrolled and complete the total PDI. CE certificates will be awarded following each workshop for the number of credit hours earned in that workshop (total of 33 hours). Those enrolled in the complete post-doctoral institute will also receive CE certificates for the small groups discussion seminars (totaling 18 hours). The Ethics workshop by Dr. Brown will qualify for the Maryland Board of Examiners Ethics requirement of 3 hours. Couples Therapy The most common complaint for individuals who seek out mental health professionals involves difficulties in relationships, particularly intimate relationships. Increasing numbers of couples are presenting to ministers, psychologists, social workers, counselors, and other helpers to repair damaged relationships or deepen their level of intimacy and satisfaction. Moreover, recent literature has clearly documented the importance of satisfying intimate relationships, showing that, for example, more successful long-term relationships are associated with better emotional, financial, and physical health. Mental health professionals’ training in couple’s treatment has not caught up with demand; most psychologists have had only sporadic coursework and supervision dealing with dyads. This is in spite of the fact that individual models of pathology and treatment, in which most of us were thoroughly schooled, do not always apply to assessment of and intervention into relationship distress. This PDI is aimed at presenting the major empirically supported techniques of assessment and intervention with troubled couples along with approaches to specific problems encountered by all couples’ therapists, so it should be valuable for experienced and relatively inexperienced therapists in laying a solid foundation for couples treatment. One way responsible practitioners have attempted to expand their scope of competence is through continuing education. Surprisingly, however, there is very little evidence as to what constitutes effective continuing education in mental health. What little evidence we have suggests that traditional CE workshops have little impact on either practitioner behavior or patient outcomes. Studies designed to tease out what factors constitute effective CE suggest that programs that involve active vs. passive learning, practitioners’ knowledge of the gap between their performance and best practices, reinforcement of correct responses, post-CE feedback, reminders or other enabling tools, and multiple educational interventions all increase the likelihood of enhancing the quality of professional practice. This post-doctoral institute on couples therapy is constructed to attempt to employ as many of the components of effective CE as possible within the limitations of practitioners time and expense. It will involve some active learning (discussion of a variety of interventions and attempts to implement them into practice), practitioners self- assessment of their knowledge and skills regarding couple’s distress and its remediation, small group discussion and possibly role playing of effective intervention techniques, feedback on the quality of interventions, and multiple educational experiences (workshops, small group discussions, website discussion). The PDI will comprise three six-hour workshops on empirically supported couple’s treatment (cognitive- behavioral, emotionally focused, psychodynamic) and five three-hour workshops on critical treatment issues (infidelity, sexuality, violence) or issues related to best-practice (assessment, ethical and legal concerns). It will also include nine, two-hour small group seminars and discussions focused on theory, research, or techniques presented in the workshops. Additionally, there will be an unmoderated website where participants will be encourage to query and comment. Finally, for those who have not participated in workshops by John Gottman, there will be an opportunity to share and discuss the videotapes of his two- day workshop. Specific Objectives 1. To enhance the participants’ ability to assess their knowledge and skills in couple’s treatment and to develop an educational plan to remediate deficiencies and develop new and improve existing skills. 2. To understand the major objectives and techniques of the three major empirically supported approaches to the treatment of distressed couples. 3. To understand the issues and learn the treatment techniques involved in several major types of dilemmas in couple’s treatment (dealing with sexuality, violence, infidelity). 4. To enhance practitioners’ awareness of the legal and ethical concerns arising in the treatment of couples distress. 5. To apply the principles of effective continuing education to the learning experience in order to enhance the quality of the participants’ practice of couples therapy. PDI Details All accepted PDI fellows will complete a self-assessment, prior to the start of the PDI, and set a yearlong goal on how to maximize their current strengths and remedy deficiencies. There will also be nine small group seminars lasting two hours each. The first seminar will be held prior to the first workshop and will be aimed at structuring the experience, sharing expectations and concerns, and reviewing the results of the self-assessments. An additional eight seminars will be held two-four weeks following each workshop. These would briefly review the “take-home” points from the preceding workshop, and each participant would indicate which of the theoretical/practice issues that have implemented into their practice. This discussion will include why that particular point was chosen, the specific nature of the activity (including what was done and the timing of the intervention), and the results of the application. They will receive feedback on the nature and quality of the intervention, possibly including role-playing of more effective ways of presentation. The focus of the discussions will be on “declarative” and procedural” knowledge, i.e., a focus not only on knowledge and understanding of the intervention but also on the ability to implement it. The schedule for these small group meetings will be: March 2003, May 9 or 16, 2003, Aug. 29 or Sept. 12, 2003 (before the September workshop), October 24 or 31, 2003, December 5 or 12, 2003, February 20 or 27, 2004, April 16 or 23, 2004, June 11 or 18, 2004, and October 1 or 15, 2004. Finally, PDI fellows will have access to an unmoderated interactive website. This will provide a forum for questions, reactions, discussion, and suggestions among all the fellows and the training coordinators. PDI Coordinators/ Director of Training Robert Brown, Ph.D., ABPP Dr. Brown received his doctorate from the University of Iowa and has held full-time faculty positions at the University of Texas Southwestern Medical School at Dallas and in the Clinical Psychology program at the University of Maryland, College Park. He is currently on leave from UMCP and is in independent practice in Columbia, MD. He is a Fellow of the Divisions of Clinical Psychology, State and Provincial Association Affairs, and Independent Practice of APA; holds the Diplomate in Clinical Psychology; was named a Distinguished Practitioner of Psychology of the National Academies of Practice; has served as President of MPA; has been elected to the APA Council of Representatives and to its Board of Directors, and as chair of its Policy and Planning Board and the Board of Professional Affairs. His interests, publications, and invited talks have focused on the prevention and remediation of relationship distress, sexual dysfunction and treatment, ethical and professional issues, and continuing education. He has received awards from MPA for Outstanding Professional Contributions and for Outstanding Educational Contributions. He has taught graduate courses on couples therapy and has co-directed two previous MPA post-doctoral couples therapy institutes. Norman Epstein, Ph.D. Dr. Epstein is Professor of Family Studies at the University of Maryland, College Park and teaches in the department’s accredited marital and family therapy program. He is a Fellow of the American Psychological Association (Divisions of Family Psychology and Psychotherapy), a diplomate of the American Board of Assessment Psychology, a Founding Fellow of the Academy of Cognitive Therapy, and a Clinical Member and Approved Supervisor of the American Association for Marriage and Family Therapy. He has published extensively on his research and on clinical assessment and therapy with couple and family relationships. He is author/editor of four books on assessment and treatment of marital and family problems, author of 38 book chapters on marital and family relationships and therapy, and author of 39 articles in professional journals. His most recent book, Enhanced Cognitive-Behavioral Therapy for Couples: A Contextual Approach (APA Books, 2002), is co-authored with Donald H. Baucom, his long- time collaborator in developing cognitive-behavioral couple therapy. Dr. Epstein has been licensed and in private practice for 26 years and has extensive experience in the assessment and treatment of individuals, couples and families. He also has been very actively involved in training of marital and family therapists, as a university faculty member and supervisor, and through presentation of numerous workshops for professionals nationally and internationally. PDI Cost The cost of the total PDI is $995.00 for MPA members and $1200.00 for non-members. This fee covers attendance at all workshops plus; 18 hours (9 sessions) of small group discussion/case presentation, and access to an interactive website. Workshops are also offered on an individual basis. The 6-hour workshops are $110 for MPA members and $130 for non-members (lunch is included), and the 3-hour workshops are $59 for MPA members and $79 for non-members. Certificates for CE credit will be awarded at the end of each individual workshop for the appropriate number of hours, for all participants. Also, all licensed psychologists enrolled in the entire PDI will receive a special Post-Doctoral certificate of completion (for display purposes) indicating their participation in an in-depth continuing education program on Couples Therapy. This certificate will indicate that they completed a total of 51 hours of continuing education in the area of assessment and treatment of couples. PLEASE NOTE: APA Standards for awarding credit prohibit offering variable credit for partial attendance, i.e., those arriving late and/or leaving a workshop early will not receive CE credit. The Maryland Psychological Association is approved by the American Psychological Association to offer continuing education for psychologists. The Maryland Psychological Association is approved by the Maryland Board of Examiners of Psychologists as a sponsor of Continuing Education. The Maryland Psychological Association maintains responsibility for the program. The Workshops April 25, 2003 1. The Distressed Couple: Assessment and Treatment Planning Robert Brown, Ph.D. and Norman Epstein, Ph.D. 9:00 a.m. – 12:00 noon Loyola College Graduate Center, Columbia, Md. For successful intervention with distressed couples, a sound case formulation and treatment plan are critically dependent on accurate, clinically useful assessment. The overall goals of the assessment are to identify the couple’s problems and strengths, and influential contextual factors, in order to determine whether couples therapy is indicated, and if so, what therapeutic goals are feasible and what therapeutic strategies could be employed. The workshop leaders will discuss critical information to be gathered, various sources of valuable information, specific measures, and strategies to arrive at a useful case formulation. The presentation also will describe how the therapist uses the assessment process to begin to develop a balanced collaborative relationship with the partners, establish the nature and structure of the therapy, and meet guidelines for record keeping and informed consent to treatment. The leaders will also discuss important considerations in identifying the core components of the relationship distress, obtaining histories of the relationship and the individual partners, evaluating current relationship functioning, and identifying origins of current relationship problems. They will stress the importance of assessing those factors expected to be directly useful in developing a collaborative treatment plan and will present guidelines for organizing the data and presenting the findings to the couple. Learning Objectives 1. To learn methods to identify couples’ problems, strengths, and influential contextual factors affecting relationship functioning. 2. To learn what data to collect in initial sessions with couples, and how to collect it. 3. To understand how to use information gained through assessment to develop a treatment plan. 4. To learn several ways of organizing initial assessment information and strategies for presenting an understandable plan based on therapist/couple collaboration. June 13, 2003 2. Cognitive-Behavioral Couple Therapy: A Contextual Approach Norman Epstein, Ph.D. 9:00 a.m. – 4:30 p.m. Columbia Hilton, Columbia, Md. This workshop expands the boundaries of traditional cognitive behavioral therapy with a framework that takes into account the personal characteristics of the two individuals, their dyadic interactions, and influences of the couple’s interpersonal and physical environment. The presenter emphasizes what each partner brings to the relationship, including past relationship experiences, current needs, personality style, and psychopathology. Assessment and intervention also address environmental influences such as the couple’s broader family system, community and cultural factors, and other life events such as job loss or a death in the family. This contextual approach helps couples understand their healthy individual differences, any unresolved personal issues and psychopathology, and individual and familial needs. The couple’s behavioral, cognitive, and affective responses are viewed within the context of broader relationship patterns and themes such as boundaries, distribution of power, and investment in the relationship. The workshop describes interventions for modifying behavior, cognitions, and deficits or excesses in emotional responses, addressing individual psychopathology, assisting couples in coping with environmental demands, and enhancing relationship strengths. The presenter’s approach is firmly grounded in empirical findings concerning relationship functioning and treatment efficacy. Learning Objectives 1. To become familiar with an enhanced contextual cognitive-behavioral model for couple therapy. 2. To become familiar with questionnaire, interview, and behavior observation methods for cognitive- behavioral assessment. 3. To learn a variety of interventions for modifying behavior, cognitions, and deficits or excesses in emotional responses. 4. To learn how to assess and intervene with broad relationship patterns such as boundaries, distribution of power, and investment in the relationship. 5. To learn options and strategies for intervening with partners’ unresolved personal issues and psychopathology in the context of couple therapy. September 19, 2003 3. Creating Connection: Emotionally Focused Couples Therapy (EFT) Susan M. Johnson, Ed.D 9:00 a.m. – 4:30 p.m. Columbia Hilton, Columbia, Md. EFT is a short-term (8-20 sessions), structured approach to couples therapy. It is based on an explicit conceptualization of couples’ distress and adult attachment. It maps the change process into discrete steps and specifies change events, strategies, and interventions. Over 15 years of empirical research has shown its ability to create significant and lasting change with many different problems and populations. Its goals are to expand and re-organize key emotional responses, create shifts in partners’ interactional positions, initiate new cycles of interaction, and foster the creation of a secure bond between partners. Learning Objectives 1. To understand the phenomena of marital distress in an attachment context. 2. To be able to describe the basic tenants of Emotionally Focused Therapy. 3. To identify specific interventions to help couples reprocess negative affect and restructure negative interactions. 4. To learn to create powerful change events in therapy that foster a more secure bond between partners. 5. To learn to deal with common impasses and difficult issues in couple’s therapy. November 14, 2003 4. Integrating Insight-Oriented Techniques Into Couple Therapy Douglas Snyder, Ph.D. 9:00 a.m. – 4:30 p.m. Columbia Hilton, Columbia, Md. An important source of couples’ current difficulties involves partners’ previous relationship injuries resulting in sustained interpersonal vulnerabilities and related defensive strategies interfering with emotional intimacy. This workshop will describe the integration of insight-oriented techniques within a hierarchical, pluralistic approach to couple therapy to address partners’ persistent maladaptive relationship patterns. Initial assessment methods and case formulation, structural considerations, and assumptions underlying the therapist’s role as well as the selection and timing of interventions are considered from both the precepts of affective construction and this broader pluralistic model. Videotaped examples from two cases will highlight intervention techniques and issues in selective implementation. Learning Objectives 1. To become familiar with questionnaire, interview, and behavior observation methods for assessing the individuals, the dyad, and the couple’s environment; 2. To learn a variety of interventions for modifying behavior, cognitions, and deficits or excesses in emotional responses; 3. To learn how to assess and intervene with broad relationship patterns such as boundaries, distribution of power, and investment in the relationship; 4. To learn options and strategies for intervening with partners’ unresolved personal issues and psychopathology in the context of couple therapy; 5. To learn how to enhance a couple’s functioning through improved adaptation to healthy individual differences and more effective use of their resources. January 16, 2004 (3 hour) 5. Not Just Friends: Treating the Trauma of Infidelity Shirley P. Glass, Ph.D., ABPP 9:00 a.m. – 12:00 noon Columbia Hilton, Columbia, Md. Today’s workplace and the Internet have triggered a new crisis of infidelity among good people in good marriages. This workshop will explore how therapists can approach the serious threat of friendships that insidiously evolve into intense love affairs. It will offer a trauma recovery model to cope with the obsessing, flashbacks, and hyper-vigilance following the disclosure of infidelity that integrates the trauma literature with the most recent infidelity research. Participants will learn how to open a window between spouses, erect a wall between the unfaithful spouse and the extramarital partner, and move couples from inquisition to an empathic search for meaning. Learning Objectives 1. To learn to differentiate between platonic friendships and extramarital emotional involvement. 2. To validate and manage post-traumatic reactions in betrayed partners. 3. To help couples reverse walls and windows in extramarital triangles to create safety and establish appropriate boundaries. 4. To use the content of disclosure to change the process from a truth-seeking inquisition to an empathic search for meaning. 5. To develop clinical approaches to infidelity that are consistent with research findings. March 26, 2004 6. Strategies and Techniques to Resolve Sexual Dysfunction and Dissatisfaction, Including Relapse Prevention Barry McCarthy, Ph.D. 9:00 a.m. – 12:00 noon Loyola College Graduate Center, Columbia, Md. This workshop will cover the major sexual dysfunctions, comprehensive treatment strategies, the relationship between couple and sex therapy, and relapse prevention strategies. Learning Objectives 1. To understand the importance of taking a sexual history 2. To understand the personal responsibility/intimate team model of resolving sexual problems 3. To learn to integrate medical interventions into the couple's intimacy, pleasuring, eroticism sexual style. 4. To learn the crucial importance of an individualized relapse prevention program May 21, 2004 (3 hour) 7. The Assessment and Treatment of Couple’s Violence Christopher Murphy, Ph.D. 9:00 a.m. – 12:00 noon Loyola College Graduate Center, Columbia, Md. The workshop is designed to increase participants’ understanding of physical and psychological forms of domestic abuse and their assessment and treatment within the context of marriage and family practice. Basic information will be provided on the prevalence, forms, and dynamics of partner abuse in marriage clinic settings, along with strategies for assessing abuse and its functional dimensions. Intervention methods will be presented to address key aspects of abusive behavior perpetration. These will include individualized assessment and case conceptualization of abusive behavior; methods to enhance motivation to change abusive behavior patterns; common beliefs and attributional styles associated with abusive behavior, and common behavioral deficits that impede non-abusive conflict resolution. The workshop will address guidelines for providing individual versus conjoint intervention in cases of partner violence, strategies for enhancing safety in work with these couples, and when to introduce conjoint work in the process of individual treatment of abusive spouses. Learning Objectives 1. To enhance participants’ understanding of domestic abuse as it influences the practice of marriage and family therapy. 2. To impart strategies and tools for the detection and assessment of abusive behavior. 3. To provide case management and intervention strategies for abusive behavior in marriage and family therapy. September 10, 2004 (3 hour) 8. Ethical and Professional Issues in Working with Couples Robert Brown, Ph.D. 9:00 a.m. – 12:00 noon Loyola College Graduate Center, Columbia, Md. This workshop will focus on the unique ethical and professional issues posed by working with couples rather than individuals. It will briefly cover several ethical frameworks and levels of ethical analysis, will present a limited number of ethical principles that should be helpful in helping recognize and make sound judgments about ethical dilemmas, and will examine professional responsibilities as outlined under the Maryland and new APA ethics codes. It will identify and suggest best practices for dealing with general and practical issues as confidentiality, informed consent, multiple relationships, extra-therapy contacts, fees and billing, systemic effects of interventions, identification of the primary patient and the therapist’s obligations to all parties, telephone calls between sessions, family secrets, and individual in addition to conjoint sessions. In addition, there will be information on how to monitor oneself with regard to “slippery slopes” towards unethical or unprofessional practice. Learning Objectives 1. To be able to cite three general ethical principles that can guide ethical decision making in couples therapy. 2. To be able to recognize the major ethical concerns in dealing with couples as dealt with in the APA and Maryland codes of ethics. 3. To identify several major ethical concerns in assessing and treating couples and to offer potential solutions. 4. To be able to name a minimum of two cues that one can use to alert oneself to the possibility that a given course of action may be risky for oneself, one of the patients, or the couple’s relationship. FACULTY Robert Brown, Ph.D., PDI Director of Training, received his doctorate from the University of Iowa and has held full-time faculty positions at the University of Texas Southwestern Medical School at Dallas and in the Clinical Psychology program at the University of Maryland, College Park. He is currently on leave from UMCP and is in independent practice in Columbia, MD. He is a Fellow of the Divisions of Clinical Psychology, State and Provincial Association Affairs, and Independent Practice of APA; holds the Diplomate in Clinical Psychology; was named a Distinguished Practitioner of Psychology of the National Academies of Practice; has served as President of MPA; has been elected to the APA Council of Representatives and to its Board of Directors, and as chair of its Policy and Planning Board and the Board of Professional Affairs. His interests, publications, and invited talks have focused on the prevention and remediation of relationship distress, sexual dysfunction and treatment, ethical and professional issues, and continuing education. He has received awards from MPA for Outstanding Professional Contributions and for Outstanding Educational Contributions. He has taught graduate courses on couples therapy and has co- directed two previous MPA post-doctoral couples therapy institutes. Norman Epstein, Ph.D., PDI Director of Training, is Professor of Family Studies at the University of Maryland, College Park and teaches in the department’s accredited marital and family therapy program. He is a Fellow of the American Psychological Association (Divisions of Family Psychology and Psychotherapy), a diplomate of the American Board of Assessment Psychology, a Founding Fellow of the Academy of Cognitive Therapy, and a Clinical Member and Approved Supervisor of the American Association for Marriage and Family Therapy. He has published extensively on his research and on clinical assessment and therapy with couple and family relationships. He is author/editor of four books on assessment and treatment of marital and family problems, author of 38 book chapters on marital and family relationships and therapy, and author of 39 articles in professional journals. His most recent book, Enhanced Cognitive-Behavioral Therapy for Couples: A Contextual Approach (APA Books, 2002), is co- authored with Donald H. Baucom, his long-time collaborator in developing cognitive-behavioral couple therapy. Dr. Epstein has been licensed and in private practice for 26 years and has extensive experience in the assessment and treatment of individuals, couples and families. He also has been very actively involved in training of marital and family therapists, as a university faculty member and supervisor, and through presentation of numerous workshops for professionals nationally and internationally. Shirley P. Glass, Ph.D, ABPP, is author of the book titled: NOT “Just Friends”: Protect Your Relationship from Infidelity and Heal the Trauma of Betrayal, which replaces popular myths about extramarital relationships with documented findings. The New York Times referred to her as "the godmother of infidelity research" because she has been studying extramarital involvement since 1975. Dr. Glass is a Diplomate in Family Psychology and a Fellow of the American Psychological Association. She is a highly sought after presenter at professional meetings, such as AAMFT, and is regularly cited in USA Today, LA Times, and Psychology Today for her relationship expertise. She has appeared on Good Morning America, Oprah, and The Today Show and has also been featured as a guest on “This American Life” which is hosted and produced by her son, Ira. Dr. Glass maintains a private practice in the Baltimore area. Susan Johnson, Ed.D., is Professor of Psychology and Psychiatry at Ottawa University and Director of the Ottawa Couple and Family Institute. She is a registered psychologist in the province of Ontario, Canada, and is a member of the editorial boards of the Journal of Marital and Family Therapy and the Journal of Couple and Relationship Therapy. She is one of the originators of EFT, now one of the best-validated couple’s interventions in North America. She has authored several books on EFT, including Emotionally Focused Therapy for Couples with Leslie Greenberg (1988) and The Practice of Emotionally Focused Marital Therapy: Creating Connection (1996), and was Senior Editor of The Heart of the Matter: Perspectives on Emotion in Marital Therapy (1994). Her most recent book is Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds. She has also authored number articles and research studies on couples therapy. She has received numerous awards, including the Year 2000 award from the American Association of Marriage and Family Therapy for Outstanding Contribution to the Field of Marriage and Family Therapy. Barry McCarthy, Ph.D., practices couple and sex therapy at the Washington Psychological Center and is a professor of psychology at American University. With his wife, Emily, he is author of seven books, the latest being Sexual Awareness: Couple Sexuality for the Twenty-First Century (2002) and Rekindling Desire: A Step By Step Program to Help Low-Sex and No-Sex Marriages (2003). He is currently working on a book with Michael Metz on a new treatment program for premature ejaculation. His current interests are primary and secondary prevention of sexual problems and relapse prevention strategies for marital and sexual problems. Christopher Murphy, Ph.D., received his degree in Clinical Psychology from the State University of New York at Stony Brook in 1991. He is an Associate Professor of Psychology and director of the doctoral program in clinical psychology at the University of Maryland, Baltimore County. Dr. Murphy coordinates the New Behaviors Program at the Domestic Violence Center of Howard County, Maryland, a comprehensive clinical training, service, and research program focused on perpetrators of intimate partner violence. His research focuses on cognitive-behavioral and motivational treatments for abusive behavior in intimate adult relationships. Douglas Snyder, Ph.D., is Professor of Psychology and Director of Clinical Training at Texas A&M University in College Station. He has been recognized nationally for his programmatic research on actuarial approaches to marital assessment and for his outcome research on marital therapy. He is the author of the widely used Marital Satisfaction Inventory. In 1992, the American Association for Marriage and Family Therapy honored Dr. Snyder with its Outstanding Marriage and Family Therapy Research Publication Award for his four-year follow-up study comparing behavioral and insight-oriented approaches to couples therapy, funded by the National Institute of Mental Health. Dr. Snyder is a Fellow of the American Psychological Association in Divisions of Family Psychology, Clinical Psychology, Psychotherapy, and Evaluation and Measurement. He is also a Fellow of the Society for Personality Assessment. He has served as Editor of the Clinician's Research Digest and as Associate Editor for the Journal of Consulting and Clinical Psychology, and currently serves as Associate Editor for the Journal of Family Psychology.
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