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| CBT The Center for Brief Therapy, PC, 10319 Dawson's Creek Blvd, Suite J, Fort Wayne, Indiana, USA 46825 260-969-5583; fax 260-969-5584; email: freemancbt@aol.com |
ENHANCING TREATMENT EFFECTIVENESS: Problem Formulation and Treatment Planning With
Difficult and Complex Patients
Workshop Leaders: Arthur Freeman, EdD, HSPP, ABPP and Sharon Morgillo Freeman, PhD, APRN-CS
Case conceptualization and treatment planning for patients with the more typical and uncomplicated
diagnoses of depression and anxiety are relatively uncomplicated. In fact, some authorities believe that they
are likely to get well regardless of the therapeutic maneuvers employed or the therapist. These patients
respond well to medication, self-help and traditional Cognitive Behavioral strategies.
However, an increasing proportion of patients have more complex problems that so interfere with their
functioning that they pose significant therapeutic challenges and can be difficult to help. They often require
more time in therapy, require more energy and time from the therapist, may have great difficulty making
progress in treatment, or make no progress at all. Their progress may be blocked by low levels of motivation,
limited coping resources, and multiple, interacting symptoms (they may well have diagnoses on all four DSM
axes). These patients may come to therapy at the request or demand of others, and they see their problems
to be externally caused and outside of their control or responsibility. Such patients will have diagnoses that
include all the personality disorders (especially Cluster B - Borderline, Narcissistic, Histrionic and Antisocial),
dual diagnoses, schizophrenia, bipolar disorder, and refractory depression and anxiety.
Through the use of videotapes, role playing, experiential techniques, didactic presentations, discussion, case
presentations and readings, this workshop will focus on a practical approach to conceptualizing patients
problems and needs, and a systematic approach to planning treatment. The material to be covered is
relevant to a variety of applications of Cognitive Behavioral Therapy with difficult clinical problems and
complex patients.
Workshop Objectives
Participants will be able to:
Identify and describe the steps required to develop a Cognitive Behavioral treatment conceptualization for
treating patients with personality disorders and other complex problems.
Use the Diagnostic Profiling System (DPS) to gather data and direct the therapy plan.
Describe the differences between therapeutic strategies and technical interventions.
Define four areas of impediment to therapeutic progress.
Describe the rationale for using cognitive and/or behavioural interventions.
Identify ten cognitive interventions for treating difficult patients.
Identify ten behavioural interventions for treating difficult patients.
Intended Audience:
This workshop is relevant to the needs of mental health professionals such as: psychologists, psychological
associates, clinical social workers, psychiatric nurses, psychiatrists, physicians practicing psychotherapy,
counselors, and advanced graduate students in these disciplines.
The Agenda
DAY ONE
8:30 Registration
9:00 Understanding the complex patient: An integrative approach.
10:15 Coffee Break
10:30 Developing conceptual models for treatment, data collection, assessment, and treatment planning.
12:00 Lunch
1:30 Differentiation between substance misuse and Personality Disorders
2:45 Coffee Break
3:00 Conceptualization and treatment planning.
4:15 Clinical illustrations, questions and discussions.
5:00 Adjournment
If this is a two day workshop, the following is presented on Day Two:
9:00 Dealing with resistance and impediments to change. Countertransference.
10:15 Coffee Break
10:30 Cognitive, affective and behavioural interventions.
12:00 Lunch
1:30 Clinical illustration.
2:45 Coffee Break
3:00 Clinical illustration.
4:15 Wrap-up, discussion, questions and evaluation.
5:00 Adjournment
Difficult and Complex Patients
Workshop Leaders: Arthur Freeman, EdD, HSPP, ABPP and Sharon Morgillo Freeman, PhD, APRN-CS
Case conceptualization and treatment planning for patients with the more typical and uncomplicated
diagnoses of depression and anxiety are relatively uncomplicated. In fact, some authorities believe that they
are likely to get well regardless of the therapeutic maneuvers employed or the therapist. These patients
respond well to medication, self-help and traditional Cognitive Behavioral strategies.
However, an increasing proportion of patients have more complex problems that so interfere with their
functioning that they pose significant therapeutic challenges and can be difficult to help. They often require
more time in therapy, require more energy and time from the therapist, may have great difficulty making
progress in treatment, or make no progress at all. Their progress may be blocked by low levels of motivation,
limited coping resources, and multiple, interacting symptoms (they may well have diagnoses on all four DSM
axes). These patients may come to therapy at the request or demand of others, and they see their problems
to be externally caused and outside of their control or responsibility. Such patients will have diagnoses that
include all the personality disorders (especially Cluster B - Borderline, Narcissistic, Histrionic and Antisocial),
dual diagnoses, schizophrenia, bipolar disorder, and refractory depression and anxiety.
Through the use of videotapes, role playing, experiential techniques, didactic presentations, discussion, case
presentations and readings, this workshop will focus on a practical approach to conceptualizing patients
problems and needs, and a systematic approach to planning treatment. The material to be covered is
relevant to a variety of applications of Cognitive Behavioral Therapy with difficult clinical problems and
complex patients.
Workshop Objectives
Participants will be able to:
Identify and describe the steps required to develop a Cognitive Behavioral treatment conceptualization for
treating patients with personality disorders and other complex problems.
Use the Diagnostic Profiling System (DPS) to gather data and direct the therapy plan.
Describe the differences between therapeutic strategies and technical interventions.
Define four areas of impediment to therapeutic progress.
Describe the rationale for using cognitive and/or behavioural interventions.
Identify ten cognitive interventions for treating difficult patients.
Identify ten behavioural interventions for treating difficult patients.
Intended Audience:
This workshop is relevant to the needs of mental health professionals such as: psychologists, psychological
associates, clinical social workers, psychiatric nurses, psychiatrists, physicians practicing psychotherapy,
counselors, and advanced graduate students in these disciplines.
The Agenda
DAY ONE
8:30 Registration
9:00 Understanding the complex patient: An integrative approach.
10:15 Coffee Break
10:30 Developing conceptual models for treatment, data collection, assessment, and treatment planning.
12:00 Lunch
1:30 Differentiation between substance misuse and Personality Disorders
2:45 Coffee Break
3:00 Conceptualization and treatment planning.
4:15 Clinical illustrations, questions and discussions.
5:00 Adjournment
If this is a two day workshop, the following is presented on Day Two:
9:00 Dealing with resistance and impediments to change. Countertransference.
10:15 Coffee Break
10:30 Cognitive, affective and behavioural interventions.
12:00 Lunch
1:30 Clinical illustration.
2:45 Coffee Break
3:00 Clinical illustration.
4:15 Wrap-up, discussion, questions and evaluation.
5:00 Adjournment