The Therapeutic Challenge
Feelings of shame and inadequacy are often at the core of most therapeutic encounters. Regardless of the presenting symptom or historical background, the majority of our clients enter treatment because they have experienced some degree of early attachment failure, which often leaves a life-long residue of trauma and internalized feelings of shame in its wake.
At the heart of good psychotherapy lies an understanding of the relationship between early attachment failures and learned defense structures that our clients create in an attempt to prevent feelings of inadequacy from breaking into conscious awareness. Therapeutic change, therefore, relies in large part on repairing injuries of attachment and letting go of shame resistant defenses, in exchange for the discovery of one’s authentic strengths, talents, gifts, and resilience. Thus, confronting the defenses that guard against shame becomes a fundamental focus of treatment. This is often one of the most challenging clinical situations for even the most experienced therapists.
This program is designed to assist licensed mental health practitioners, supervisors, and educators in understanding and treating defensive structures that mask feelings of shame. We offer therapists an integrative theoretical model and method of tracking that deepens skills in therapeutic listening and intervention techniques. At the core of our training is a tracking system that helps therapists to recognize the telltale signs of shame by framing our client’s beliefs and behaviors as strategies of over-compensation. These learned over compensations are often unconscious attempts to keep feelings of shame from coming to the surface. Anticipating and attuning ourselves to “shame sensitivity” is one of the therapist’s greatest safeguards against therapeutic rupture or premature termination.
What makes this course unique is that we provide a deeply attuned, context-driven model that acts as a blueprint of the patient’s psyche. Our Four-Quadrant Model illustrates a three-dimensional grid that allows the therapist a better grasp of the meaning of client’s statements, behaviors, and beliefs, especially as these are driven by underlying shame. Defensive postures ranging from grandiose drives for perfectionism to critical self-effacement, from wishes for salvation or rescue, or devaluation of others will be addressed through our treatment model.
Dismantling defensive postures requires an intensive psychological posture of therapeutic listening that allows us to more effectively intervene in the contextual present. Our program provides techniques to help the clinician develop deeper inquiry skills in treatment. We will visually show subtle processes such as “slowing the dialogic process down” or “working with the therapeutic relationship” to repair early, defensively-based relational patterns.
Through lecture, cogent video-taped case demonstrations and small group discussion, we will examine how therapeutic listening and intervention techniques can be effectively used to penetrate the narcissistic structures underlying dissociative splitting, grandiose expansiveness, cognitive distortions, self-destructive behaviors, and revenge enactments.
The Wayne Institute Certificate Program in Advanced Psychotherapy at Bellarmine University offers licensed practitioners and clinical supervisors an opportunity to refresh, renew, and deepen their proficiency through this yearlong professional development program. Our integrative model emphasizes practical application through the instruction of skill-building techniques and case examples that illustrate training examples and techniques. In addition our program incorporates cutting-edge discoveries in attachment theory, interpersonal neurobiology, trauma, and systems theories to help practitioners improve and enhance their skill sets and expertise.
The onsite residency portion of the program offers participants the experience of an interactive collegial environment with nationally acclaimed faculty who provide students with “hands-on” experience, through a combination of lecture, practice application, videotaped case illustration, and group discussion, all of which provide a lively and rigorous learning environment. Each onsite residency lasts for three full days and take place on the Bellarmine Campus in May 2018, October 2018, and May 2019. The knowledge level required before beginning the Advanced Certificate Program through the Wayne Institute assumes that participants will enter having acquired a beginning level of knowledge that is typically achieved upon completion of most doctoral training programs. The course material and content of each of the Wayne Institute residencies and webinars is geared toward the advancement of knowledge at an intermediate level of instruction.
After each three-day residency, participants return to their regular clinical settings, where the distance-learning portion of the program will continue throughout the year.
The distance learning structure will include:
- Three 90-minute case consultation meetings a month
- Six live, interactive webinars. These three-hour webinars occur every other month the schedule is to be determined
- Each clinician trainee will have the opportunity to present case examples from their practice settings as a way of integrating classroom material with daily clinical challenges, thereby increasing clinical proficiency and confidence.
- Participants who are clinical supervisors will be afforded three 90-minute group consultation meetings per month and will be paired with faculty with the goal of becoming more proficient with the integrative training model used in the certificate program. Further Information:
The Post-Graduate Certificate Program in Advanced Psychotherapy through the Wayne Institute is approved for CEU Credit through the APA, NASW, NBCC, and LMFT. A total of 72 credit hours will be awarded.
Please note: Participants who register must be licensed professionals in any of the above disciplines and have an on-site supervisor assigned to them at their facility.
- Application Fee: $65 (non-refundable)
- Full Tuition for the Program: $6,400
- Tuition and fees must be paid in full by May 1, 2019 or student must be enrolled in payment plan (outlined below).
- $750 down payment and application due by May 1, 2019
- The remaining balance of $5,650 will be divided into eight equal payments due by the 10th of each month beginning in June of 2019 and ending in January of 2020.
- Early-bird Tuition of $5,000 for students who enroll by November 30, 2018!
- $750 due by November 30, 2018
- $4,250 balance (or enrollment in payment plan) due by May 1, 2019
- 100% refund through May 15, 2019
- 50% refund through May 19, 2019
- No refund after first day of program on May 20, 2019
- Contact Linda Bailey at 502.272.8161 for more information about tuition, fees, and payment plan schedules
Actual dates will be determined based on student and faculty availability.The webinars are listed below, but are not necessarily in order of how they will be scheduled.
Module 1: An Overview of Psychopharmacology for Mental Health Professionals:
This three-hour webinar will educate participants about the psychopharmacological theory and medication interventions for the major psychiatric disorders. Discussion points will center on specific medications targeted for each disorder as well as their mechanism of actions. Our focus will highlight typical patient symptom presentations including: Major Depression, Bipolar Disorder, Psychosis, Anxiety Disorders, and Attention Deficit Disorders. As each diagnostic category is explained, the complicating overlay of psychological factors will also be discussed. Understanding genetic, biological and dynamic psychological vulnerabilities must be viewed together for successful treatment. As such, medications can reduce symptoms directly but also provide a “transitional object-like” factor in promoting the psychotherapeutic process.
Module 2: Sexualities in the Clinical Setting
Gender, sex, gender identity are part of each clinical situation, and cultural views are shifting. This program will focus on recent scientific and psychodynamic views of sex, sexuality, gender identity, sexual choice, and addressing these characteristics in clinical treatment. Participants will review nature/nurture questions of development, social and clinical attitudes toward sex, gender and gender identity. Particularly, we will focus on the confluence of psychic and social components and how they combine within the individual. Participants will identify how these facets contribute to deepening clinical work, especially aiding in individual choice and conscious awareness. In addition, we will address how to maintain appropriate boundaries to protect the client and facilitate the deepening of therapeutic process. Given our cultural mix of omnipresent sex and a concurrent dearth of healthy attachments, students will explain and describe the importance of allowing a safe and private discussion of a patient’s sexual issues.
Module 3: Addiction from a Relational Psychodynamic Perspective
This program is shaped to address current understandings and contemporary clinical responses to the ever-increasing prevalence of addiction and addictive processes among client populations. Regarding the status of addiction treatment today, psychologist Peter Levine has stated that “some twenty-million Americans who could benefit from treatment are not getting it. The costs in human suffering, family disintegration, and lost productivity are staggering. The lingering questions remain: What is effective treatment? & How can it best be administered? This course will approach the phenomena of addiction and addictive processes from the relational bases. This will include bringing to bear the lens of attachment theory and the way in which early attachment trauma links to the mergence of addiction, as well as exploring recent discoveries in neuroscience, neurochemistry and relational, developmental conceptualization as they contribute to the process of “addiction recovery.”
Module 4: Integrating Spiritual Beliefs and Practices into the Treatment Dialogue
Once considered an ethical line not to be crossed, the topic of spirituality has recently gained renewed interest in our field. As neuropsychological and medical findings support the benefits of spiritual practices and beliefs in improving mental and physical well being, psychotherapists are exploring ways of incorporating spiritual practices as an adjunct to traditional clinical care. Yet, the subject of psycho-spiritual integration presents its own unique challenges and opportunities. We will begin with a brief examination of how spiritual self-exploration and traditional modes of psychotherapy became segregated into two different domains of practice. In addition we will review various types of spiritual practices have been shown to be effective in reducing stress, depression, and anxiety. Ethical considerations, such as maintaining boundaries, clinical competence, and respect of cultural differences will also be explored. Numerous case vignettes will help participants differentiate between a client’s defensively based spiritual longings and beliefs vs. healthy, evolving curiosity about this domain of adult growth and development.
Module 5: Culture & Context: The “Other Side” of the Treatment Process
This program aims to expose the essential relevance for therapists to understand multiple dimensions of self that each client brings to every therapy session—culture, race, ethnicity, sexual orientation, socioeconomic status, religious affiliation, family structure, gender, trauma history, developmental history, body type or physical appearance. Failure to understand and allow oneself to be informed by such complexity runs the very risk of missing and/or reducing the “wholeness” of our patients: Toward that end, this course is designed to introduce students to particular ways of “seeing” and “hearing” during their therapeutic work that honor the wholeness of their clients. Students will gain experience identifying multiple contexts that may be extant at any time during a session, between themselves and their patient, or in the patient’s symptom picture. Students will practice integrating these two phenomena (context and complexity) into their understanding of particular case examples. And finally, students will demonstrate the ability to articulate the reciprocity of influence between in-session experience and a patient’s narrative of his or her life outside world.
Module 6: Dying, Death and Bereavement
The spectrum of issues and challenges that surround the end of life is the subject of this module. Death is included in Erik Erikson’s 8th Stage of Life: Ego Integrity vs. Despair, and how we assist our clients and their loved ones to navigate this last stage is an important part of clinical work. The grief that typically accompanies the dying process often has an effect on the bio-psycho-social-spiritual aspects of a person’s being, and this webinar will identify expectable symptoms. Normalization of the loss experience, which often feels so outside normal functioning, is a key task of the grief therapist. In addition, identifying patterns of normal and expectable grief versus complicated grief, as well as learning how we can most effectively be with a grieving individual, listening to their story, sitting with their feelings, and helping clients and their families let go and say goodbye, is what provides comfort and preserves a meaningful life narrative.
By way of background, we will trace how the goals of the modern hospice movement founded by Dr. Dame Cicely Saunders in 1948 are much the same as those of Erickson’s final stage of development. We will look to the work of a modern hospice scholar, Dr. Ira Byock, for guidance on how we can help foster satisfying closure in attachments and completeness for the dying. Also, we will devote considerable attention to facilitating healing for the grieving as we so often encounter them in our practices. Finally we’ll consider the newest models that focus on the context of a loss and consider each individual’s loss experience unique.
May 21-23, 2018
Three-Hour Morning Modules:
Each morning module will be devoted to theoretical overview that anchors an integrative framework clinically informing our assessment, listening, and intervention approaches.
Day One: This first module will present an overview and a review of the developmental history of psychoanalytic theory leading up to current theoretical practices that utilize the framework of relational theory as an over-arching meta-theory of human functioning. This meta-theoretical framework also incorporates the neuroscientific bases of attachment, principles of affect-driven self-regulation, functional developmental competencies classically understood as “ego strengths”, and the role and conserving nature of defense along the non-conscious to conscious continuum (as both a psychological and brain-based activity). At the cutting edge of this fruitful process, “hard” neuroscience is now providing evidence-based confirmation that human beings are “hard-wired” for growth and resilience in the context of a biologic imperative for attachment. We seek to integrate these cutting-edge movements in a theoretic and clinical model that unifies these evolving trends.
Day Two: The historical evolution of Attachment Theory will be presented, illustrating how this theoretical paradigm is anchored in a two-person approach to the therapeutic relationship. Students will gain a working knowledge of non-normative attachment patterns often resulting in developmental consequences, such as compulsively driven defense mechanisms that affect capacities around self-regulation, self-confidence, and relational difficulties in adulthood. We will move from Bowlby’s Attachment Theory to the evolution of Allan Schore’s Neurobiologically-Based Regulation Theory. An exploration of elements that constitute a solid therapeutic relationship will be discussed within the context of creating an “earned secure attachment”, a solid piece of evidence of healing and change.
Day Three: The neurobiology of trauma will be presented to assist participants in understanding how trauma creates both cognitive and affect dysregulation. Emphasis will be on treating relational trauma that effects Attachment style as well as single event traumas. Post Traumatic Stress Disorder and recent changes to the DSM-V will be discussed. Research from neuroscientific findings around the polyvagal theory and epigenetics will be tied to early childhood relational development. An overview of the ACE study will be presented, explaining how this study correlates to symptom presentation both physically and psychologically in adulthood. In addition we will explore techniques that speak to “right brain to right brain” communication, between the therapist and the patient that is, in part, based on the Polyvagal theory of Stephen Porgess.
Three-Hour Afternoon Modules: All of the afternoon sessions will be geared toward application, putting theory into practice. This will be centered on a Four-Quadrant Model that is aimed at improving clinical skills in: Assessment, Therapeutic Listening, and Intervention Techniques.
Day One: “Character Formation.” Participants will be presented with working assumptions that discuss the etiology of degrees of narcissist injury. Injury to one’s sense of self stems from failures with early attachment figures that result in a formidable residue of characterological damage. Participants will also be presented with new considerations about the importance of character, character formation, and character defenses as these pertain to the presentation of symptoms, learned coping strategies, and analysis of defensive over-compensations to mask feelings of shame, unworthiness, and/or feelings of inadequacy. Psychological conflict or the eruption of symptoms will be explored through the lens of “character solutions”, attempts to create a defensively constructed homeostatic balance.
Day Two: “The Four Quadrant Model” - The Four-Quadrant Model is a deeply dynamic assessment tool and picture of the psyche from a relational, intrapsychic, and systemic vantage point will be presented and explained in detail. Video-case examples that illustrate each quadrant in action will be presented for discussion and review. The importance of understanding the power of shame as the invisible driver behind most narcissistically driven defenses will be explained in detail. Videotaped case examples will be provided to illustrate how shame can be hidden from view as well as how to modulate and metabolize feelings of shame once they emerge within the session.
Day Three: “Therapeutic Techniques” - Three newly developed techniques to improve clinical facility will be covered in the afternoon session. Participants will be shown how all techniques can be directly applied to The Four Quadrant Model and to the participant’s already existing theoretical orientation. The three clinical techniques are: a. entry points, which is a way to listen for and use the patient’s phrases and assumptions to gain deeper access to the clients organizing schemas both cognitively and affectively both within conscious awareness and outside of awareness; b. moment-to-moment tracking, which is a process of staying in the contextual moment with clients and thereby feeling their unfolding dialogic process as a means of seeing where defensive splitting is occurring; and c. an anticipatory form of forecasting, which is “seed-planting” operation where the therapist introduces questions, words or phrases that give the patient permission to focus on topics that may be taboo or too hot to handle.
October 18-20, 2018
Three-Hour Morning Sessions:
Day One: This program will focus on a historical overview of trauma, including the origins of the diagnostic category of Post-Traumatic Stress Disorders and Complex Traumatic Stress Disorders and the current movement supporting a new category, Complex Traumatic Stress Disorders. The reasoning for the changes in DSM – V relating to PTSD will be outlined and explained. Participants will be presented a three-phase model of trauma treatment that includes: Safety and stabilization, Memory and emotional processing of trauma, Consolidating therapeutic gains. The goals and focus of each phase will be examined. Participants will also have the opportunity to discuss and explain diverse methods of treating trauma, spanning the spectrum from cognitive-behavioral, to EMDR, to expressive mind-body interventions. Participants will learn how to design a case conceptualization that includes assessment and treatment protocols. In addition, students will be able to identify the biological processes involved in “re-regulating” the nervous system.
Day Two: The process of dissociation as a defense mechanism will be reviewed and defined. Participants will be provided an historical overview of dissociation as a spectrum of defenses that have evolved into our current understanding of dissociative process as comprised of a continuum of severity, ranging from normal mental processes, to mild or micro-dissociative episodes, to a more classic understanding of severe dissociative experiences. Participants will be able to connect the history of trauma, abuse, and insecure or disorganized attachment styles and thereby assess where patients fall on the Dissociative Spectrum Scale. In addition participants will be shown how dissociation can be understood as a phenomenon that can be affectively as well as cognitively disconnected.
Day Three: Participants will learn how to create an evolving dynamic formulation. This approach to assessment is both non-linear and non-causal. Innate capacities within the personality will be contrasted with learned, defensive compensatory mechanisms. Case conceptualizations will include participants learning to assess: the degree of fragility of coping mechanisms, the rigidity of organizing schemas and beliefs, personality strengths and supports, and the consideration of contextual and environmental factors such as race, gender, and class. The critical matter of the timing of interventions will be discussed in light of the above factors.
Three Hour Afternoon Sessions:
Day One: “Differentiating Healthy Self-Development from Defensively Based Character Solutions” - This session is devoted to exploring deeper aspects of the healthy self-realizing-self throughout the entire span of adult development. A new Four-Quadrant model that depicts aspects of the “Innate Self-realizing-Self” will be presented. This model describes aspects of the manifest self both from an intrapsychic and relational perspective. Self-care and lifestyle balance will be explored. In addition we will discuss how healthy individuals handle disappointment, limitation, mortality and loss in a manner that leads to acceptance rather than resignation. Participants will contrast the healthy model of self, using the Four Quadrant model as a point of comparison. These two models will be utilized to help in assessing degrees of fragility of pathology, as well as identifying how the authentic self can begin to manifest within the treatment process. Participants will also be presented with new considerations about how character defenses can be worked within the treatment setting to uncover masked feelings of shame, unworthiness, and/or feelings of inadequacy. Case presentations and application exercises will be used to illustrate assessment methods and modes of inquiry.
Day Two: “Understanding Transference from a Relational Perspective “. - The therapeutic relationship and positive and negative transference will be the topic of the first afternoon session. Participants will be instructed as to how to access feelings of shame most poignantly through “palpating” transferential material. Using the frame that transference is how the historical past is connected to the experiential present, participants will be shown the value of using transference as an important tool or leverage point in creating therapeutic change. Both positive and negative transference will be explored within the context of the developing therapeutic alliance.
Day Three: “Consolidation of Gains”. – Gains in treatment are not limited to the ending phase of therapy. Participants will see how micro-shifts in the therapeutic process can be used to consolidate newly forming changes, where signs of the authentic self begin to emerge. The process of mirroring will be used to instruct participants in helping patients to internalize newly forming behavior patterns and organizing schemas. Participants will develop a greater understanding of how mechanisms of defensive organization initially try to “swallow up” newly forming gains as a reflexive attempt to preserve the old homeostatic balance of the character solution. Because the dismantling of defensively created solutions is not a linear process, participants will be given the opportunity to present their own selected case material to track the ebbs and flows of change, and engage in a shared discussion around observations, reflections, and further suggestions moving forward.
May 23 - 25. 2019:
Day One: This program will discuss and review the ACE Study (Adverse Childhood Experience) and attachment theory in the service of deepening the understanding and influence of “nature” and “nurture” on neurobiological emotional development. We will examine the science of epigenetics to demonstrate the complex interdependence of nature and nurture rather than looking at these factors as either/or conditions. Concepts discussed in the first year course work material on the ACE Study, attachment theory, and poyvagal theory will be integrated into the understanding of traumatic sequelae. Epigenetics, a sub-category of the science of genetics, discovered as an outcome of the human genome project, has demonstrated the significant influence of past trauma that is generationally carried through gene markers. Factoring in this information and giving it appropriate weight directly affects both our assessment and treatment protocols. Because earlier therapeutic modalities focused on the treatment of trauma from either a Cognitive Behavioral, Psychoanalytic, or Neuropsyiological vantage point, the science of epigenetics points us in the direction of integrating all three modalities simultaneously, as the treatment of the whole person involves multiple levels of attention to the process of mind-body healing.
Day Two: This theoretical session will cover the topic of professional development and self-care, ranging from research and discussion on how to prevent compassion fatigue and burnout. Participants will be shown conditions that change stress to burn-out. The cardinal feature of burn-out correlates to a grief process, where the original dream of goals to be achieved upon entering the field get lost. Risk factors, such as depersonalization of energy and distancing from patients can occur. Students will be given a list of the top risk factors to help assess conditions of burn-out, also known as compassion fatigue. They will also participate in a Burn-out Risk Survey, assessing conditions ranging from physical symptoms, environmental and organizational conditions, to mental and emotional symptoms. In addition we will leave time for discussion around how to avoid stress and burn-out prevention as well as providing strategies and options to help each individual participant increase his or her professional networking and marketing opportunities.
Day Three: The spectrum of issues and challenges that surround the end of life is the subject of this three-hour module. Death is included in Erik Erikson’s 8th Stage of Life: Ego Integrity vs. Despair, and how we assist our clients and their loved ones to navigate this last stage is an important part of clinical work. The grief that typically accompanies the dying process often has an effect on the bio-psycho-social-spiritual aspects of a person’s being, and this webinar will identify expectable symptoms. Normalization of the loss experience, which often feels so outside normal functioning, is a key task of the grief therapist. In addition, identifying patterns of normal and expectable grief versus complicated grief, as well as learning how we can most effectively be with a grieving individual, listening to their story, sitting with their feelings, and helping clients and their families let go and say goodbye, is what provides comfort and preserves a meaningful life narrative. By way of background, we will trace how the goals of the modern hospice movement founded by Dr. Dame Cicely Saunders in 1948 are much the same as those of Erickson’s final stage of development. We will look to the work of a modern hospice scholar, Dr. Ira Byock, for guidance on how we can help foster satisfying closure in attachments and completeness for the dying. Also, we will devote considerable attention to facilitating healing for the grieving as we so often encounter them in our practices. Finally we’ll consider the newest models that focus on the context of a loss and consider each individual’s loss experience unique.
Three-Hour Afternoon Sessions:
Day One: “Part-Whole Analysis: Integrating Trauma, Attachment Theory & Psychodynamic Approaches”. This program will focus on integrating trauma-based approaches with psychodynamic theory and the Four Quadrant Model. Participants will focus on actual case scenarios involving therapist – client treatment exchanges to help them understand how various interventions can address right-brain-to-right-brain communication (Allan Schore) to help increase feelings of safety and trust and solidify the therapeutic relationship. These techniques will also review methods discussed in the first two residencies such as slowing the dialogic process down in a way that deepens therapeutic inquiry skills through a method of tracking called “part-whole analysis. In addition, students will be able to learn tools with regard to the biological processes involved in “re-regulating” the nervous system. Limitations include the exclusion of the integration of Cognitive Behavior Theory. However, effective cognitive techniques used in approaches with trauma, such as DBT will be discussed. They will then be integrated into and applied to the application of the Four Quadrant Model.
Day Two: “Transference Revisted”. The therapeutic relationship and positive and negative transference will be the topic of the first afternoon session. Participants will be instructed as to how to access feelings of shame most poignantly through “palpating” transferential material. Using the frame that transference is how the historical past is connected to the experiential present, participants will be shown the value of using transference as an important tool or leverage point in creating therapeutic change. Both positive and negative transference will be explored within the context of the developing therapeutic alliance.
Day Three: “Wrap-up and Integration”. This final session will review the entire yearlong course with the objective of allowing participants to consolidate their own learning and gains throughout their experience. A list of survey questions for reflection will assist this final wrap-up discussion. Participants will also use this wrap-up session to discuss long-term professional development and how to avoid burnout. Attention will include maintaining ongoing peer and professional supervision and identifying areas of specialization.