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SUMMER 2014-[MONDAY & WEDNESDAY- (6/10/2014 & 6/12/2014)-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 E-mail: Jokech@firstname.lastname@example.org Trinity Campus, Mann Hall, Room 101B Office hours by appointment Course Description: Building from the base of Cognitive Behavioral Therapy's theoretical underpinnings, Dialectical Behavior Therapy consists of four fundamental change strategies: skills training, exposure therapy, contingency management, and cognitive therapy. In this course students will learn: techniques in recognizing and challenging negative thought patterns and replacing them with more balanced, neutral descriptions that more closely reflect reality (Cognitive Therapy); systems for exposing oneself to feelings, thoughts or situations which were previously feared and avoided in order to desensitize oneself to the anxiety-producing stimuli (Exposure Therapy); methodology for teaching the four DBT coping skill modules: Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance (Skills Training); and how to identify the ways that maladaptive behavior and adaptive behavior are punished or rewarded and using this knowledge to modify behavior through consequences (Contingency Management). *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:
DBT 2: Change Strategies 2 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 cross-cultural 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: Axelrod, S. R., Perepletchikova, F., Holtzman, K., & Sinha, R. (2011). Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. The American Journal of Drug and Alcohol Abuse, 37(1), 37-42. doi:10.3109/00952990.2010.535582
DBT 2: Change Strategies 3 Harned, M. S., Banawan, S. F., & Lynch, T. R. (2006). Dialectical behavior therapy: An emotion-focused treatment for borderline personality disorder. Journal of Contemporary Psychotherapy, 36(2), 67-75. doi:10.1007/s10879-006-9009-x Harned, M. S., & Linehan, M. M. (2008). Integrating dialectical behavior therapy and prolonged exposure to treat co-occurring borderline personality disorder and PTSD: Two case studies. Cognitive and Behavioral Practice, 15(3), 263-276. doi:10.1016/j.cbpra.2007.08.006 Lindenboim, N., Comtois, K. A., & Linehan, M. M. (2007). Skills practice in dialectical behavior therapy for suicidal women meeting criteria for borderline personality disorder. Cognitive and Behavioral Practice, 14(2), 147-156. doi:10.1016/j.cbpra.2006.10.004 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 13, 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 Victor Val (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 Victor Val). 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
DBT 2: Change Strategies 4 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 specific change 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 Name: Victor Shisky Date of Birth: 5/12/52
Reason for Referral: (reasons given by referring provider and client regarding need for treatment): Mary Reller, MD and Vanessa Snyder, MA referred Victor for an intake assessment to address depressive symptoms that have not abated despite outpatient psycho-therapy, ECT and medication management. He indicated that his current depressive state is not as severe as the one that led to hospitalization in 2009, but that his providers recommended that he seek a higher level of care at this time. Age: 60 Sexual orientation: Victor identifies as a heterosexual man. Identifies as a caucasian. Born in Armenia and moved to the US in his twenties. Marital Status: Separated. Married for over 20 years. Precipitating Events / Recent stressful life events: Victor explained that he has struggled with severe depression for several years, to varying degrees, but that this summer he has experienced a particularly deep
DBT 2: Change Strategies 5 episode. In his reported history, Victor stated that he and his wife (Marie) moved to Vermont with their son (Albert) in 2005 in order to start an auto-body business. At that time he described experiencing a “debilitating depression” that interfered with his ability to function and led to failing in this endeavor. After his wife separated from him (with custody of their son), Victor explained that he fell into a deep depression, early in the fall of 2008. At that time he overdosed on Tylenol and Sertraline and called his wife and disclosed the overdose. She immediately called 911 and paramedics arrived at Victor’s home and transported him to Fletcher Allen Health Care. He was admitted to the medical unit for one night. After stabilization Victor was transferred to Shepardson 3 (voluntary psychiatric unit), where he remained for an additional 12 days. Since that hospitalization in 2008, Victor has participated in an IOP program and outpatient services with varying degrees of symptom relief. He attributes this current intensification of the depression symptoms to: losing position as a waiter in May, feeling demoralized by looking for work unsuccessfully, having financial problems, and disappointment about his son’s attitude toward their relationship while visiting this summer from college. Symptoms that Victor identified as most problematic include ongoing suicidal thoughts, fatigue, lack of energy, agitation, and a tendency to isolate. During the intake on several occasions Victor described himself as an “empty vessel.” Psycho-social stressors include unemployment, financial problems, separation from his wife, more distance than he would like with his adult son, and very limited sources of social support. He explained that he is ashamed of the depression and his current life circumstances so has isolated from the historic friends he had. He also indicated that he “burns people out” because due to the chronic nature of his difficulties, depression and emotional “neediness.” Current Medication: Lorazepam 1 mg for sleep; Celexa 60 mg. Suicide Ideation, Attempts, and Self-harm: Victor currently denies suicide planning and intentions. He indicated that he does have active suicide ideation when his wife engages in conversations about moving forward with a divorce. He endorses having daily recurrent intrusive thoughts of death (such as seeing himself with a gun in his mouth). He named his 82 yearold mother, his wife and son as deterrents. Victor readily agreed to contract for safety, but did say that he was not sure if he could maintain the agreement if his wife did file for divorce or if his mother died. After a lengthy conversation about the requirement for a commitment to stay alive, at least through the month, he agreed to use on-call crisis lines as needed to maintain this agreement, even if his wife did file for divorce. Self Harm: Denies any self-injurious behaviors, aside from the suicide attempt. Trauma: Victor was born in Armenia and immigrated to the United States when he was 28 years old. He had extended family members killed in civic strife and frequently heard bombs and gunshots. He did not experience direct violence. The only items of posttraumatic stress that Victor endorsed were: hypervigilance, sense of a foreshortened future, and difficulty controlling anger. Alcohol/Substance Use: Victor reports drinking “ in moderation.” When questioned for more detail, he indicated that he typically drinks one drink (a beer or glass of wine) several times per month with days that he does not drink at all. On occasion, Victor explained however, that he drinks to excess “more than 6-7 drinks” when he is upset, typically after an argument with his wife. He agreed to the abstinence policy at Crossroads without hesitation and is aware of the 12-step contingency. Family issues: Victor was the only child of Narek and Katya. He described his father as respectable, a perfectionist and impatient. Victor explained that Narek used physical punishment, in the form of hitting with a
DBT 2: Change Strategies 6 belt and smacking him the face, but Victor expressed his perspective that his “childhood was not abusive.” Victor expressed self-judgment thoughts about being “weak” because he is “so emotional.” He described how his father would mock him if he was sad or scared and called him a “little girl” when he cried. Victor expressed that he is frustrated by how upset he gets and how long it takes him to calm down after anger or sadness have been triggered. When asked about his temperament and peer relationships, Victor indicated that he “got in trouble quite a bit” usually because of anger outbursts. He described having a “hot temper” and having difficulty controlling anger. Victor indicated that he lost two jobs as a result of angry outbursts at work. Since his wife left, Victor stated that he sometimes feels like he “can’t stand it” and “doesn’t know who he is anymore.” Victor’s major complaints about relationships are that his wife and son do not engage with him as often as he would like them too and that his wife does not want him to move home. Victor expressed anger in the intake interview that his son “doesn’t call or visit unless it serves him, even after all I have given him his whole life. In Armenia children honor their parents. Maybe it’s wrong, but I feel like he owes me at least some attention.” Victor’s perception is that his wife “took my son away from me and is just selfish.” He indicated that suicide thoughts are most intense when his wife brings up divorce paperwork. He stated “I have told her that I could not handle it if she goes through with this. I tell her that I see myself shooting myself in the head.” When asked what happens when he makes those sorts of statements, Victor indicated that Marie “gets more gentle and usually doesn’t bring up divorce for a long time.” Stated Goal: “Simply, I would like to have a more hopeful attitude, a set of tools to implement in order to go ahead, accept my situation as it is, get a job. Figure out a way to work things out with my wife.”
DBT 2: Change Strategies 7
Grading Rubric Criteria
Points /6 /4 /4 /3 /4 /2 __/5 /4 __/6 __/2 40
1. DBT Theoretical Conceptualization 2. Presenting Concerns 3. Actual Core Issues 4. Diagnosis 5. Diversity & Multicultural Considerations 6. Ethical &/Legal Issues 7. Counseling Goals (List BOTH short term & long term goals) 8. Indicators of Progress 9. Recommended Course of Action (Including interventions incorporating specific change 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.
DBT 2: Change Strategies 8 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 CLASS SCHEDULE Day 1: June 10, 2014: Course overview, training context, DBT implementation - Review DBT # 1 Assignmens - Overview of DBT - Review of DBT, Borderline Personality Disorder, Biosocial Theory, Structure of DBT, & Treatment Delivery Methods. - Core problem-solving strategies (Targets, Behavioral analysis, insight, didactic, solution analysis, orienting and commitment strategies) - Contingency Procedures (managing contingencies and observing limits) - Exposure Day 2: June 12, 2014: Behavioral therapy change strategies - Review Day # One - Cognitive Therapy - Cognitive Modification - Coping Skills (*Emotion Regulation, *Interpersonal Effectiveness, Mindfulness and Distress Tolerance) - Exposure therapy; systems of desensitization ACTIVITIES Skill demonstrations Role-playing Video clip presentations Case study discussion groups 100 Point C+ = 79 pts. C = 74-78 pts. C- = 70-73 pts.
DBT 2: Change Strategies 9 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
DBT 2: Change Strategies 10 CLASS PARTICIPATION ASSESSMENT RUBRIC 2 Attendance / Promptness Student is late to class or leaves early both days and/or misses class. Student never contributes to class by offering ideas, engaging in group activities, clinical skills practice, and asking questions. 4 Student is late to class or leaves early more than once and attends both classes. Student rarely contributes to class by offering ideas and asking questions or engaging in clinical skills practice. 6 Student is late to class or leaves early once and attends both classes. Student proactively contributes to class by offering ideas, asking questions, and engaging in clinical skills practice two or three times per class. Student listens when others talk, both in groups and in class. 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. Student is almost always prepared for class with assignments and required class materials. TOTAL (40 max.) POINTS
Level of Engagement in Class
Student does not listen when others talk, both in groups and in class. Student often interrupts when others speak. Student usually displays inappropriate behavior during class. Student is almost never prepared for class with assignments and required class materials.
Student does not listen when others talk, both in groups and in class.
Student occasionally displays inappropriate behavior during class. Student is rarely prepared for class with assignments and required class materials.
Student rarely displays inappropriate behavior during class. Student is usually prepared for class with assignments and required class materials.
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