This action might not be possible to undo. Are you sure you want to continue?
2012-[MONDAY & WEDNESDAY- (6/17/2014 & 6/19/2014)-9.00AM-4.00PM TRINITY CAMPUS, MANN HALL, RM 211 COURSE SYLLABUS Jane Okech, Ph.D. & Megan Johnson, M.S., LCMHC. Office Phone: (802) 656-1481 Counseling Program Office Fax: (802) 656-3173 College of Education and Social Services Email:Jokech@email@example.com Trinity Campus, Mann Hall, Room 111 D Office hours by appointment Course Description: Dialectical Behavior Therapy is unique in that it places equal emphasis on change and acceptance. This course provides an overview of the acceptance strategies that balance the change strategies in DBT practice. Research indicates that offering validation along with the push for change creates an environment where clients are more likely to cooperate and less likely to suffer distress associated with the idea of change. Dialectics work to resolve the seeming contradiction between acceptance and change through the ideas that (1) all things are interconnected, (2) change is constant and inevitable, and (3) opposites can be integrated to form a closer approximation of the truth. This course will expose students to: what constitutes validation and invalidation; the six levels of validation in DBT; how to implement these six levels of validation as interventions in therapeutic conversations; three dialectical dimensions (emotional vulnerability vs. self-invalidation, active passivity vs. apparent competence and unrelenting crisis vs. inhibited grief); and strategies for investigating and synthesizing the two poles of dialectical dilemmas. *Pre-requisites: None **Eligibility: Counseling Majors, MA level practitioners or Instructor permission; for permission call 656-3888 or email Shelly.Ho@uvm.edu *Maximum Enrollment: 15 2009 Council for Accreditation of Counseling & Related Educational Programs (CACREP) Standards: The course objectives and content are also designed to meet the 2009 Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards: This course addresses the following 2009 CACREP Common Core Standards: o Social and Cultural Diversity-2 [d, e] o Helping Relationships-5 [f] This course addresses the following Clinical Mental Health Counseling Standards: o Foundations (Knowledge-A)-[1-5, 7-8, 10] o Foundations (Skills & Practice-B)- o Counseling, Prevention & Intervention (Knowledge-C)-[1, 3, 5, 8-9] o Diversity and Advocacy (Knowledge-E) [1, 4-6]
This course addresses the following Counseling Program Standards: Counseling Program curricula and experiences are designed to help students meet the following program objectives. These overall objectives will enable students to work as professional counselors in a way that is consistent with the Counseling Program philosophy. This course addresses the following standards: o Demonstrate relevant knowledge and skills specific to his or her area of practice (e.g., school counseling, mental health counseling); o Articulate a well-developed and informed personal theory of counseling; o Demonstrate an awareness of, sensitivity to, and ability to work effectively with crosscultural differences in clients as well as differences due to physical or mental disability, age, sexual identity, race or ethnicity, and gender; o Demonstrate competence in understanding and addressing variances in human behavior and emotions including exceptional behavior, psychopathology, and what is considered maladaptive in relation to developmental, social, cultural, environmental, and other contextual factors o Adhere to the ethical and legal standards of the profession of counseling. Multicultural & Diversity Statement: The American Counseling Association 2005 Code of Ethics stresses the need for counselors and counseling students to gain awareness, knowledge, and skills in the competencies of multicultural practice. The Code of Ethics utilizes a definition of diversity that includes race, class, gender, sexual orientation, and ability, and emphasizes the acquisition of awareness, knowledge, and skills that will allow counselors to work effectively with clients of diverse backgrounds. In this course, in order to become competent in addressing issues of multiculturalism and diversity, you will be exposed to issues about race, ethnicity, gender, and religion, among others, in class. Reasonable Accommodation for Students with Disabilities: If you have a diagnosed disability or believe that you have a disability that might require reasonable accommodation on the part of the instructor, please call Accommodation, Consultation, Counseling & Educational Support Services at 656-7753. As part of the Americans with Disabilities Act, it is the responsibility of the student to disclose a disability prior to requesting reasonable accommodation. Intellectual Property Statement Consistent with the University’s policy on intellectual property rights, it is the Counseling Program’s policy that teaching and curricular materials (including, but not limited to, classroom lectures, class notes, exams, grading rubrics, handouts, and presentations) are the property of the instructor. Therefore, electronic recording and/or transmission of classes or class notes is prohibited without the express written permission of the instructor. Such permission is to be considered unique to the needs of an individual student (e.g. ADA compliance), and not a license for permanent retention or electronic dissemination to others. Required Texts: 1. Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford. 2. Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford.
Required Readings: Huss, D. B., & Baer, R. A. (2007). Acceptance and change: The integration of mindfulness-based cognitive therapy into ongoing dialectical behavior therapy in a case of borderline personality disorder with depression. Clinical Case Studies, 6(1), 17-33. doi:10.1177/1534650106290374 Koons, C. R. (2008). Dialectical behavior therapy. Social Work in Mental Health, 6(1-2), 109-132. doi:10.1300/J200v06n01_10 Linehan, M. M. (1997). Validation and psychotherapy. In A. Bohart & L. Greenberg (Eds.), Empathy Reconsidered: New Directions. Washington, DC: APA. Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., & Linehan, M. M. (2006). Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations. Journal of Clinical Psychology, 62(4), 459-480. doi:10.1002/jclp.20243 Schechter, M. (2007). The patient's experience of validation in psychoanalytic treatment. Journal of the American Psychoanalytic Association, 55(1), 105-130. Swales, M. A. (2009). Dialectical behavior therapy: Description, research and future directions. International Journal of Behavioral Consultation and Therapy, 5(2), 164-177. A WORD ABOUT WRITING AND ASSIGNMENTS: Writing is an important skill for everyone, particularly for trained professionals working in the human service professions. We believe that writing facilitates clear thinking when one allows oneself to work at the product for a period of time. Through the process of committing thoughts to paper and then revising those thoughts, questioning one’s ideas, examining the material more carefully, and clarifying intent (again and again), meaningful papers are born and important ideas are expressed. In the end, we believe that clear writing reflects clear thinking. Naturally, we expect all students to use their writing assignments as a process for learning the material covered in this course. We also expect completed assignments to be well written. In this vein, we expect students to demonstrate appropriate writing mechanics (i.e., spelling, punctuation, sentence and paragraph structure, etc.) in all of their written work. If writing has been difficult for you in the past, you may wish to obtain help from the UVM Writing Center, 105 Bailey/Howe Library (call 802-656-4075 to make an appointment). READING: You are expected to complete all assigned readings prior to each class. It is likely that we will not discuss in class everything that you are reading; however, whenever you want to discuss a specific group issue, do feel free to bring it up in class. Additional recommended reading will be made available through the UVM Blackboard service. ASSIGNMENT: 1. DBT Theoretical Conceptualization Paper (***Due on June 20, 2014 at 6.00pm): A. This paper consists of a brief consideration of a selected client scenario that presents contextual, clinical, ethical, legal, cultural, diagnostic, and intervention challenges for the
professional. The client scenario to be considered for the purposes of this assignment is provided below. B. The Case of Sally Smith (See below) C. The brief papers are to be typed and written in with appropriate citations provided in the advancement of one’s conceptualization and recommendations for the case. Papers shall be double spaced and a maximum of (4) pages in length excluding references. D. The paper shall describe contextual, clinical, ethical, legal, cultural, diagnostic, and intervention challenges for the professional contained in the scenario above (The case of Sally Smith. The paper shall also review DBT theoretical principles and guidelines that provide guidance on how the scenario can be conceptualized and addressed. In keeping with acceptable professional standards, the student is encouraged to consult with student colleagues, practicing professionals, or any written materials in the development of the theoretical conceptualization of the case and recommendations made to address emergent client concerns. E. The paper shall be presented in the following format: 1. DBT Theoretical Conceptualization: The concerns the client in the case study is experiencing from the perspective of DBT theoretical approach. 2. Presenting Concerns: 3. Actual/Core Issues: 4. Diagnosis: Identify the diagnosis and specific diagnostic considerations. Include specific examples from the case and their influence on your conceptualization and intervention process. 5. Diversity & Multicultural Considerations: Identify the diversity and/or multicultural considerations. Include specific examples and their influence on your conceptualization and intervention process. 6. Ethical and/legal Issues: Identify the ethical and/or legal issues involved. Include professional standards of practice, as well as specific legal or ethical standards. What is the tension? What are the competing issues or concerns? 7. Counseling Goals (List BOTH short-term and long-term goals): 8. Indicators of Progress: (Identify specific examples of behavioral changes that provide evidence of improvement e.g., reduction in intensity/frequency of depression symptoms OR ongoing abstinence): 9. Recommended course of action: State your recommended course of action. Define how your recommendation(s) is in the best interest of the client and addresses the presenting and core client concerns. In your recommendations, be sure to Identify and prioritize treatment targets. Be sure to specify aspects of the client’s presentation that would be considered (a) life interfering behaviors, (b) therapy interfering behaviors, (c) quality of life interfering behaviors. Within this section, infuse your recommendations with specific acceptance strategies covered in this course as part of the set of interventions used. Pay particular attention to incorporating change and acceptance startegies covered in the course. 10. Personalization: (Identify and claim any personal values and/or moral conflicts that are pushing or pulling you either toward or away from a certain course of action). CASE STUDY Client name: Sally Smith Date of Birth: 8/28/1978
Ethnic/Religious affiliation: Sally stated that she is agnostic and indicated that she identified as a Caucasian female on the intake paperwork. Sexual orientation: Sally indicated that her relationship with Simone was her first same-sex relationship. She said that she “fell in love with Simone, but I don’t think that means I’m gay.” She explained that she had several romantic relationships with men, but stated “at this point I don’t think I want to be with anyone—men or women.” Marital Status: Divorced. Education History: Bachelor’s degree. Financial Situation: Strained due to medical leave partial pay and she is losing money each month because what she is renting her condo out for is less than the mortgage. Leisure Interests: She stated that currently she has none. Historically Sally indicated that she enjoyed the outdoors, camping, reading, spending time with friends, going to concerts, etc. Work History: Sally is an LPN at an assisted living facility. She has worked there for approximately 3 years. Reason for Referral: (reasons given by referring provider and Sally regarding need for treatment): Gretchen Struthers referred Sally for treatment when she learned that Sally regularly engaged in selfharm behaviors. Precipitating Events / Recent stressful life events: (financial problems, work, move, illness) Sally explained that approximately three weeks ago she experienced a breakup with her partner, Simone, who she had been with for a little over a year. The breakup occurred shortly after moving out of a condo that Sally owns and into her father and step-mother’s home. The condo had flooded and they were displaced. “We were living with at my parents’ house and that was really stressful. We broke up one night during an argument. We haven’t talked since then. She left town and changed her number.” After the breakup, Sally explained how she became severely depressed. Her ex-husband Tim, who Sally describes as her main support, became concerned about her depression because she was “crying all the time, staying in bed, not eating, not leaving the room, so he called Gretchen and told her how bad I had gotten. Nobody else has checked in with me. They probably all think Simone is better off without me.” Sally declined to answer questions about specific relationship difficulties she experienced with Simone and what led to the breakup. She stated “I want to get help and if I tell you what happened you will probably side with Simone and won’t want to help me anymore.” Even after assurance that help would still be extended, regardless of the disclosure, Sally would not speak further about the breakup. Depression: Score on Beck Depression Inventory-II: 48 (Severe Range) Symptoms Endorsed: !Sadness ! Pessimism
! Past Failure ! Crying ! Guilt Feelings ! Loss of Interest ! Punishment Feelings ! Irritability ! Self-Dislike ! Loss of Pleasure ! Self-Critical ! Agitation ! Indecisiveness ! Worthlessness ! Hopelessness ! Loss of Energy ! Sleep Disturbance ! Changes in Appetite ! Difficulty Concentrating ! Loss of interest in sex ! Tiredness/Fatigu
Duration of current episode: “About a month.” Frequency and duration of previous episodes: “I’ve been depressed before, but not for more than a few days and then pulled out of it. It has never been this bad.” Anxiety: Score on BAI: 40 (Severe Range) Current Medication: Celexa 60 mg Ambien (for sleep) 10 mg at bedtime Lorazepam 0.5 mg PRN up to 3 times per day Medication trial history: Has tried Prozac, Wellbutrin, Effexor, Zoloft, and Celexa Suicide Ideation/ Risk Assessment: Score on BSS: 3 History of Suicide Attempts and Parasuicidal Behaviors: Suicide Ideation: "No !Yes: Sally acknowledges passive thoughts of death. She stated that she “took a bunch of Effexor to see what would happen, back in high school. But nothing happened and I never told anyone.” She denies having any plan or intention to kill herself. She stated “I’ve had thoughts about death, but I’m too scared to do anything.” Self-Harm Behaviors: Sally acknowledges burning herself with cigarettes in college “especially after breakups.” She indicated that she began cutting when she became involved with Simone. Last reported self-harm incident was yesterday when she cut herself with “a blade I pulled out of my razor in the shower.” She indicated that she has cut almost daily for the past several weeks. History of Abuse: (Physical/Emotional/Sexual/Invalidation) : " No ! Yes When asked about a history of abuse Sally became somewhat withdrawn and made less eye contact. She nodded when asked if she had a history of abuse, but was reluctant to give details. She stated that when she was 19 or 20 she was physically abused by a boyfriend and that she moved away to get away from him. She also indicated that she was “abused through childhood” but would not elaborate. Family Violence: " No ! Yes- stated that there was domestic violence when her parents were divorcing when she was seven and she thinks her mother was violent. She stated that emotions were “never talked about” in the family. Sally explained “if I anyone would be upset about something, my mom would start crying and go to her bedroom. She wouldn’t come out for the rest of the night. I tried to not upset my mom. But I think I’m sensitive like she is.” Posttraumatic Stress Disorder (if hx of trauma) Traumatic event persistently re-experienced via: # Recurrent and intrusive distressing recollections of the abuse
# Recurrent distressing dreams # Acting or feeling as if the abuse were recurring or trauma specific reenactment ! Intense psychological distress when reminded of the abuse # Physiological reactivity when reminded of the abuse Avoidance:
! Efforts to avoid thoughts feelings, or conversation related to the abuse
# Efforts to avoid activities, places, or people that arouse recollections of the trauma # Inability to recall important aspects of the trauma ! Markedly diminished interest or participation in significant activities # Feelings of detachment or estrangement from others # Restricted range of affect # Sense of a foreshortened future Symptoms of increased arousal: ! Difficulty falling or staying asleep- up until recently with medications ! Irritability or outbursts of anger # Difficulty concentrating
! Hyper vigilance ! Exaggerated startle response Eating Disorder History: "No ! Yes Sally reported binge eating once or twice per week. She indicated that she restricts calories on other days to compensate for the calories consumed during binging episodes. This was the only compensatory behavior she identified engaging in. She denied purging through vomiting, exercise or laxative use. Client Homicide/Violence: ! No " Yes Substance Use: " No ! Yes Sally stated that she had 2 beers three days prior to intake appointment. Before that she reports having one beer last week. She said it had been over a month since she had 4 or more drinks. On average she states that her use varies from not drinking at all in a month to going out with friends once or twice in a month. Sally also has a history of cocaine use. She indicated that she used ten times last month and prior to that it had been over a year since using. It is interesting to note that 2 years ago, however Sally reported using 3 days per week (of unknown quantities, but “more than a few lines daily) for a six-month period before deciding to quit because it was “ruining my life.” Family History (Psychiatric, Substance, Medical, Legal): Sister has depression. Sally is not aware of other family members with diagnosed mental illness. Past and Current Living Situation/ Where born and raised: Sally was born and raised in Vermont. When her parents divorced at age six, she lived with her father in Burlington. He is remarried. She currently lives with her father and step-mother since moving out of her condo a month ago. Social Supports Identified by Sally: The only support Sally named was her ex-husband Tim. When asked to describe him, Sally explained “Tim is great. We got divorced because we just were not attracted to each other anymore. He is the only person who understands me and supports me. I thought Simone was great too. But it turned out she was like everybody else. Except for Tim, the only people who deal with me have to deal with me. If anyone else loved me they would have taken care of my after Simone left.”
Stated goal: “To get back to the point where I can function. I want to move forward and live like a normal person.” *Assignments turned in late will have 3 points deducted unless prior arrangements have been made with the instructor.
Grading Rubric Criteria
Points /6 /4 /4 /3 /4 /2 __/5 /4 __/6 __/2 40
1. DBT Theoretical Conceptualization (incorporate client conceptualization) 2. Presenting Concerns 3. Actual Core Issues 4. Diagnosis 5. Diversity & Multicultural Considerations (Provide specific examples) 6. Ethical &/Legal Issues (Cite specific codes & standards of practice) 7. Counseling Goals (List BOTH short term & long term goals) 8. Indicators of Progress (Measurable outcomes) 9. Recommended Course of Action (Including interventions incorporating specific change & acceptance strategies) 10. Personalization (TOTAL POINTS: 40)
*Assignments turned in late will have 3 points deducted unless prior arrangements have been made with the instructor. CLASS ATTENDENCE: Students are expected to attend, and fully participate in, all class sessions and work collaboratively with each other when appropriate. In line with DBT’s theoretical stance that practicing a skill is vital to learning it, students are also expected to actively engage in the clinical skills practice component of the course. Please notify the instructor, in advance if possible, of absolutely unavoidable absences. You are expected to be punctual to class and to stay until the end of the class. Your behavior and activities in class need to reflect your emerging professional ethics and standards of practice. Academic Honesty Students are required to be familiar with and adhere to the Academic Honesty policy and procedures delineated in the most recent edition of “The Cat’s Tale”: http://www.uvm.edu/~dosa/handbook/ Electronic Devices Ringing and beeping pagers and cell phones are disruptive to the classroom learning environment. As a courtesy to others, we expect that students will turn off audible signals for these devices while attending class and during laboratory segments.
We will communicate occasionally through email; therefore, it is essential that you activate your UVM e-mail account and check it regularly to avoid missing important information. All course readings will be posted on Blackboard, so check the course board regularly. Counseling Program Grading Scale: Final grades will be issued as follows: A+ = 100 pts. B+ = 89 pts. A = 94-99 pts. B = 84-88 pts. A- = 90-93 pts. B- = 80-83 pts. Course Grading Scale: DBT Theoretical Conceptualization Paper……………………………………………………60 Classroom Participation……………………………………………………………………… 40 TOTAL 100 Points C+ = 79 pts. C = 74-78 pts. C- = 70-73 pts.
CLASS SCHEDULE: Course Overview: Day 1: June 17, 2014: Acceptance Strategies - Course overview - DBT2-Assignment Review - DBT3-Assignment Expectations - Review DBT 1 & DBT 2 - Acceptance procedures overview - Validation strategies - Acceptance-oriented coping skills (Radical acceptance, mindfulness, turning the mind) - Interventions aimed at the environment Day 2: June 19, 2014: Dialectics and Mindfulness - Course overview/ Assignments - Review Day # 1 - Review validation strategies, acceptance-oriented coping skills (Radical acceptance, mindfulness, turning the mind) - Intervening with the environment - Dialectics - Dialectic strategies - Dialectical Dilemmas
ACTIVITIES Skill demonstrations Role-playing Video clip presentations Case study discussion groups
CRITERIA FOR GRADING PAPERS 1. Examination of content a. Follows guidelines of the assignment b. Demonstrates in-depth understanding of the subject c. Demonstrates understanding of contextual application of subject matter 2. Overall organization of the paper a. Ideas within paragraphs are well-developed b. Introductory and concluding paragraphs are informative and brief c. Paragraphs follow logical order throughout the paper d. Logical sequencing of paragraphs e. Smooth flow between paragraphs/transitional phrases and ideas utilized 3. Writing mechanics a. Appropriate sentence beginnings/endings (i.e. avoids beginning sentences with conjunctions, ending with prepositions, etc.) b. Evidence of basic editing skills (spelling, grammar, sentence structure, etc.) c. Language is technical 4. Writing style a. Ideas are clearly articulated b. Sentences are clearly articulated c. Sentences are concise d. Supporting statements are concrete, substantive, specific, illustrative, and effective e. Transitions are smooth f. Information is explained carefully and clearly g. Enthusiasm for topic is clearly communicated 5. Followed APA guidelines a. Sentence structure b. Paragraph structure c. Within context citations d. References *Refer to the APA manual for additional information
CLASS PARTICIPATION ASSESSMENT RUBRIC 2 Attendance / Promptness Student is late to class or leaves early both days and/or misses class. 4 Student is late to class or leaves early more than once and attends both classes. 6 Student is late to class or leaves early once and attends both classes. 8 Student is always prompt, stays to the end of class, and attends both classes. Student proactively contributes to class by offering ideas, engaging in group activities and clinical skills practice, and asking questions regularly and appropriately. Student listens when others talk, both in groups and in class. Student incorporates or builds off of the ideas of others. Student almost never displays inappropriate behavior during class. POINTS
Level of Engagement in Class
Student never contributes to class by offering ideas, engaging in group activities, clinical skills practice, and asking questions.
Student rarely contributes to class by offering ideas and asking questions or engaging in clinical skills practice.
Student proactively contributes to class by offering ideas, asking questions, and engaging in clinical skills practice two or three times per class.
Student does not listen when others talk, both in groups and in class. Student often interrupts when others speak.
Student does not listen when others talk, both in groups and in class.
Student listens when others talk, both in groups and in class.
Student usually displays inappropriate behavior during class.
Student occasionally displays inappropriate behavior during class.
Student rarely displays inappropriate behavior during class.
Student is almost never prepared for class with assignments and required class materials.
Student is rarely prepared for class with assignments and required class materials.
Student is usually prepared for class with assignments and required class materials.
Student is almost always prepared for class with assignments and required class materials. TOTAL (40 max.)
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.