THE Integrative Therapist

Transcription

1 Society for the Exploratio SEPI of Psychotherapy Itegratio Volume 2, Issue 4 October 2016 Missio Statemet The Society for the Exploratio of Psychotherapy Itegratio (SEPI) is a iteratioal, iterdiscipliary orgaizatio whose aim is to promote the exploratio ad developmet of approaches to psychotherapy that itegrate across theoretical orietatios, cliical practices, ad diverse methods of iquiry. Jeffery Smith Editor Jeifer Davidtz Associate Editor I This Issue Curret Challeges to Pursuig Itegrative Cliical Traiig: A Graduate Studet Perspective A Begier s Mid Stadig o the Shoulders of Giats Startig a Career i Research Recosolidatio of Emotioal Memories A New Theory of Edurig Chage That Ca Potetially Promote Itegratio Across Major Psychotherapy Modalities The Alliace: Recoverig the Dyad ad Decostructig Its Parts Brigig the Practice ad Implemetatio of Research ito a Accoutable Care Orgaizatio Testig, Aalyzig, ad Establishig Markers for Resposiveess i Psychotherapy Report o Activities of SEPI Regioal Networks..19 SEPI XXXIII ANNUAL MEETING THE Itegrative Therapist A R T I C L E S I N T E R V I E W S C O M M E N T A R I E S A Word From the Editor Dear SEPI members ad frieds, THE RESEARCH ISSUE Jeffery Smith As cotributios came i for our fall issue, some expected ad some by pleasat surprise, the theme for this issue became the future of research. To start with, three itriguig cotributios highlight the experiece of youger cliicias ad researchers. They are our future, so we put them first. Carrie Potter ad Joah Cohe give a rare ad importat glimpse ito the reality of embracig a itegrative perspective withi the silo of a traditioal traiig program. Next, Alexader Vas brigs us a amazig collectio of what some of the giats i our field wished they had heard whe they first started. Fially, Adreea Visla tells of the challeges of breakig ito research with a PhD from a Easter Europea coutry ad shares what the experiece has taught her. Betwee these three articles, there are importat isights ito how the field eeds to evolve i embracig globalizatio ad makig traiig relevat to therapists of the 21 st cetury throughout the world. The, startig with Richard Lae ad edig with Michael Costatio, we tur to the future of research. Richard explais how the discovery of recosolidatio poits the way towards ew research o the greatest mystery of psy- Cotiued o page 5 Presidet s Colum A woderful meetig i Dubli comig up soo! Dear SEPI colleagues: Beatriz Gómez This is aother woderful opportuity to greet you all. We are happy to have i our hads a ew amazig issue of our Newsletter usherig i a challegig topic for itegrative therapists: RESEARCH. I a field where we are still puttig major efforts ito bridgig the gap betwee practice ad research, with great expectatios of reachig our destiatio, we are ecouterig excitig ew challeges o our way. Oe of them is directly poitig at us, itegrative psychotherapists, ad we are facig it with vigor. Sice the tred toward psychotherapy itegratio has advaced over the years ad the movemet has become strog ad ifluetial, efforts have bee made to develop differet aveues of research o itegratio. SEPI members have cotributed alog differet paths, ad there is a growig cotributio i proposig directios i which research could stregthe itegrative practice, as well as ways i which the itegrative psychotherapists could cotribute to psychotherapy research. There is a cosesus that there is still much to be doe. The ature of itegratio makes this challege especially complex but far from impossible. We eed to icrease awareess of the eed to ivestigate our methods; apply iovative Cotiued o page 7

2 The Itegrative Therapist Volume 2, Issue 4 October 2016 Curret Challeges to Pursuig Itegrative Cliical Traiig: A Graduate Studet Perspective Carrie Potter ad Joah Cohe Temple Uiversity...callig oeself a itegrative therapist seems to be all the rage, but o the other had, tryig to bled disparate cliical approaches is ofte met with strog disapproval. There are uspoke limitatios placed o the type of itegrative thikig that most graduate studets are ecouraged to egage i. Today s cliical psychology graduate studets are set a cofusig message: o the oe had, callig oeself a itegrative therapist seems to be all the rage, but o the other had, tryig to bled disparate cliical approaches is ofte met with strog disapproval. A itegrative approach seems to have become acceptable perhaps eve preferable but oly up to a certai poit. It is hard to idetify where that poit is, but ay graduate studet who has told her CBT supervisor that she is readig Freud or asked a psychodyamic supervisor if she should try ageda-settig with a cliet kows that it does, i fact, exist. I the iaugural issue of The Itegrative Therapist (2015), Paul Wachtel wrote about the challeges that the SEPI commuity faces ow that itegrative thikig is, i may settigs, cosidered the orm. I Dr. Wachtel s words, Blad ecumeical platitudes, tamely itegrative thikig, ca dull the cuttig edge of our movemet (p. 3). Dr. Wachtel s article helped us uderstad a icliatio that we have had throughout graduate school but struggled to describe. There are uspoke limitatios placed o the type of itegrative thikig that most graduate studets are ecouraged to egage i. I our view, if we do t idetify ad challege these limitatios, we are sellig ourselves ad our future patiets short. Now that we are reachig the ed of our graduate school careers, we are reflectig o our cliical traiig ad cosiderig what has helped ad hidered us from becomig itegrative therapists. We hope that by sharig our reflectios with the SEPI commuity we ca cotribute to the ogoig dialogue about how to promote itegrative thikig. Itegrative Traiig at the Theoretical Margis Whe we started graduate school, we kew we had joied a primarily CBT-orieted program. Still, because our itroductory courses reviewed differet types of evidece-based treatmets, we believed we were beig tutored o a broad rage of therapy approaches. We were t just learig how to do thought records ad exposures; we were also debatig dialectical world views ad the differeces betwee acceptace ad resigatio. Cotrary to stereotypes, our CBT supervisors were t rigid about stickig to mauals or prioritizig symptom reductio. We felt radical for begiig CBT sessios with midfuless exercises ad thought to ourselves, This is what doig itegrative therapy must feel like. Although our cliical traiig was rigorous, durig our secod year of graduate school we bega to woder what we were t beig taught. We grew curious about the schools of therapy that were ot metioed i our courses, particularly psychodyamic therapy. Were those approaches passé, usupported, or simply ot the faculty s preferece? Our program s faculty members are warm ad supportive, but we were still afraid to ask them this questio. We did t wat to offed them or sed the message that we did t value their cliical traiig, yet we believed that if we did t educate ourselves about o-cbt or third wave behavioral approaches, we would be rejectig somethig we did t uderstad. The Practical Side of Pursuig Itegrative Traiig After realizig that we lacked traiig i the larger purview of theoretical orietatios, we bega to step outside of our comfort zoes. We pursued traiig opportuities i psychodyamic theory ad practice, a departure from the experieces studets typically completed i our program. Seekig traiig that seemed less tha socially acceptable withi our program was erve-wrackig. We were cocered that our advisor might become disappoited ad that we would be labeled by our program s faculty ad eve by our fellow graduate studets as somehow betrayig our scietific roots. Cotiued o page 3 Society for the Exploratio of Psychotherapy Itegratio 2

3 The Itegrative Therapist Volume 2, Issue 4 October 2016 We grew curious about the schools of therapy that were ot metioed i our courses... The focus was ofte o covertig us rather tha just expadig our repertoire of perspectives. Goig through the itership applicatio process last year made it all the clearer to us that there are mixed opiios withi the field about what it meas to be a itegrative therapist. We felt valued i our ew traiig eviromets, but our practicum supervisors were ot much more welcomig of our cogitive behavioral backgroud tha our program faculty was about psychodyamics. The focus was ofte o covertig us rather tha just expadig our repertoire of perspectives. Simultaeously, supervisors from our graduate program were dubious, sayig thig such as, It s okay to coceptualize psychodyamically, as log as you itervee cogitive behaviorally or, i respose to a psychodyamic iterpretatio, All of this ca be easily explaied withi a cogitive model why do you eed to thik about it psychodyamically? Distrust of the other theoretical camp was palpable. Although may of our supervisors across theoretical allegiaces advocated for a itegrative approach to psychotherapy i priciple, i practice we foud a ladscape that was relatively closed to this pursuit. We expaded our familiarity with a larger umber of theoretical orietatios from which to itegrate, but our task was ot aided by the theoretical dogmatism we ecoutered i the process. O the cotrary, we oticed ourselves gettig sucked ito the dogmatism ad tryig to figure out which was the best orietatio (of course, our coclusio chaged routiely ad was probably more iflueced by our affectio for a particular supervisor tha aythig else). Playig Politics: Marketig Ourselves as Itegrative Therapists Goig through the itership applicatio process last year made it all the clearer to us that there are mixed opiios withi the field about what it meas to be a itegrative therapist. The Associatio of Psychology Postdoctoral ad Itership Ceters (APPIC) asks all itership applicats to list up to three theoretical orietatios to which they subscribe, raked i order of preferece. This task caused cosiderable axiety amog the studets i our graduate program. Some debated whether they should list cogitive behavioral first, sice that was most i lie with their graduate work, versus listig psychodyamic first, which fit more with their emergig iterests. Others feared that listig psychodyamic at all would take them out of the ruig for the iterships that emphasize cogitive behavioral traiig or research. The oly thig we all agreed o was to list itegrative as oe of our orietatios. Sice both of us are iterested i bledig psychodyamic ad behavioral approaches, we decided to list itegrative as our first ad oly orietatio. This choice geerated some iterestig reactios durig our itership iterviews. To our surprise, most iterviewers still assumed we idetified as CBT therapists because we were comig from a CBT-orieted program. A few iterviewers remarked that listig itegrative as our oly orietatio seemed like a savvy move, which was a uderstadable but dishearteig reactio. We wated to covey a geuie iterest i thikig outside the cofies of specific orietatios. Istead, callig ourselves itegrative seemed to be perceived as though we were hidig our true allegiace ad jumpig aboard a tred. Our Hope for the Future We recogize that our graduate school experiece differs from that of may other studets, particularly those comig from more cliically focused or psychodyamic programs. Still, it seems to us that may graduate programs promote a specific approach to therapy ad covey to studets that they are doig somethig wrog if they seek traiig i alterative methods. At the same time, most programs claim opeess to itegratig differet approaches to therapy. We wish to call attetio to this cotradictory stace o psychotherapy itegratio for two reasos. First, we hope to ispire graduate faculty to cosider whether, i their iteractios with studets, they are cotributig to a zeitgeist that hiders itegrative thikig. Secod, we wat to urge studets who are startig graduate school to seek traiig i therapy approaches that are udervalued by their home istitutios. By sharig some of the obstacles we ecoutered as we worked toward becomig itegrative therapists, we hope to add to a larger coversatio about how to bridge the divide betwee differet theoretical camps withi the field.. Society for the Exploratio of Psychotherapy Itegratio 3

4 The Itegrative Therapist Volume 2, Issue 4 October 2016 A Begier s Mid Stadig o the Shoulders of Giats What is the advice you wish you would have received whe you were startig out as a psychotherapist?...makig the iappropriate commets, or missig certai kids of thigs, ca be very problematic. So, be patiet with yourself....i geeral, to be comfortable with discomfort. I thik that s what we eed as psychotherapists... Alexader Vaz Beig iflueced is as ecessary as it is ievitable. I our attempts to grapple at some basic truths ad comforts, psychotherapists are o differet tha most i reachig out to all sorts of sources peers, seior colleagues, ad old books by eve older authors. Recetly, I had the pleasure of iterviewig some of the world s leadig psychotherapy practitioers ad researchers. These Psychotherapy Expert Talks ( all eded with the same questio: What is the advice you wish you would have received whe you were startig out as a psychotherapist?. Here are excerpts from some of the aswers: Joh C. Norcross: So much of what I was taught was bifurcated ito either a treatmet method or the therapy relatioship, whe i fact they re virtually iseparable. ( ) I wish someoe had said these are complemetary, they are ecessarily itertwied, ad it s ot just what you re doig, but also how you re doig it at the same time. Marvi Goldfried: That this [psychotherapy] is very hard to do, because it s goig to require a lot of experiece. ( ) I complicated cases, there s a lot of cliical decisio makig that has to be made i real time durig the course of the sessio. Ad makig the iappropriate commets, or missig certai kids of thigs, ca be very problematic. So, be patiet with yourself. Leslie Greeberg: I thik it would have bee to practice beig attued to my ow bodily sese, ad just develop a trust for my o-coceptual aspects. Which meas attuemet to emotio ot ecessarily the meaig of thigs, but to be sesitive to what s beig felt before it has words. Paul Wachtel: I guess to ot be too certai i the way you see thigs, or were taught to see thigs. To always be lookig outside the frame-of-refereces that you re most comfortable. Ad, i geeral, to be comfortable with discomfort. I thik that s what we eed as psychotherapists, because we eed to make room for the most ucomfortable experieces that our patiets have, but also we will grow if we have that tolerace for discomfort. Jeremy Safra: I thik I was t all too receptive to advice. ( ) But I thik the oe thig which I sort of did, which I thik was very importat to me, was whe I foud somebody who I thought I could lear somethig from, the I really stuck with that perso ad leared what I could. ( ) Look for people who you really feel have somethig to teach you. Larry E. Beutler: You kow, I got a lot of very good advice. Ad I did t follow it, ofte. ( ) I thik it would come back to the oe I actually started with: do t lose sight of the relatioship. Do t lose sight of the relatioship. People get eamored with techiques. Diaa Fosha: The first thig that came to mid is trust yourself. ( ) Because there s somethig fudametally orgaizig about what feels true ad right for a particular perso. Robert Leahy: You ll ever stop learig. I thik that if we approach that, we ll always be learig ad chagig. ( ) There are two kids of theories: theories that were prove wrog, ad theories that have ot yet bee prove wrog! Steve C. Hayes: Be true to yourself, be a whole perso. Wear your sciece hat, but do t just wear it oly. Remember that you re a perso too, ad so is your cliet, ad let s see if we ca get our eyes o the prize, which is creatig a behavioral sciece more worthy of the challege of the huma coditio. Eresto Spielli: I m lucky i that my heart has led me to iterestig places. Ad I ve ot bee too take up with followig the logic, the ratioality of my thikig. I d suggest somethig similar to people who are begi- Cotiued o page 5 Society for the Exploratio of Psychotherapy Itegratio 4

5 The Itegrative Therapist Volume 2, Issue 4 October 2016 Do t lose sight of the relatioship. People get eamored with techiques.... Wear your sciece hat, but do t just wear it oly.... Maybe more tha just your heart, liste to your body. ig to trai, particularly whe they re havig to make decisios about what directio of traiig they wat to take, or what the truths of psychotherapy are. Maybe more tha just your heart, liste to your body. Liste to how your body respods to the statemets that are beig made. Safra s idea of fidig people who we feel have somethig to teach us is, of course, at the core of why I wated to do these iterviews i the first place. The importace of flexibility, impermaece, ad a opeess to experiece ad its complexity, all stad out to me as major threads of these aswers from master therapists. Strivig for begier s mid, as the old Ze sayig goes, is all fie ad jolly. But, as some of these professioals poit out, there is also great value i beig guided by our ethusiasm. There s othig quite like stadig o the shoulders of giats. Society for the Exploratio SEPI of Psychotherapy Itegratio As cotributios came i for our fall issue, some expected ad some by pleasat surprise, the theme for this issue became the future of research. A Word from the Editor, cotiued from page 1 chotherapy, how it really works. Alice Coye, a ew researcher, poits towards the eed for further refiemet i research o the therapeutic alliace. I a third wave of ivestigatio of the therapeutic alliace, she evisios fertile groud ot oly for scietific work, but guidace for herself as a developig cliicia. Samuel Nordberg the brigs ews from the real world where cliical care is beig provided via Accoutable Care Orgaizatios (ACOs). He describes early success i developig a Practice Research Network (PRN) that is able to geerate cliically relevat isight ad is havig a major impact o the kid of treatmet beig doe i their cliic. Now that they are focused o the ecoomics ad reality of resposibility for the overall metal health of a populatio, caseloads have dropped by two thirds ad more troubled patiets are beig treated much more itesively. We achor the sectio o research with a article by Michael Costatio. His cotributio highlights specific research opportuities for measurig ad learig about doig the right thig at the right time i therapy. Followig these directios will lead to further progress i cotext-resposive psychotherapy itegratio. Last, but far from least, Carol Glass ad Diae Arkoff have compiled a complete list (for today) of SEPI s twety Regioal Networks with descriptios of their membership, activities ad photos of their chairpersos. Hit: Readers are urged to joi ad become active i their Regioal Networks. As usual this is followed by iformatio about SEPI, ad a ivitatio to write for us. I hope readers ca see that we are receptive to usolicited pieces ad cotributios that are more persoal ad subjective tha would appear i a peerreviewed scietific joural. Jeffery Smith Society for the Exploratio of Psychotherapy Itegratio 5

6 The Itegrative Therapist Volume 2, Issue 4 October 2016 Most of my post - doctoral applicatios did ot eve get a reply... You might have gotte the impressio that my road has bee bumpy ad difficult. Ad it was! But it also led me to where I am ow. I was lucky eough to fid metors who believed (ad still do because real metors do't stop their metorig whe the project is over)... Startig a Career i Research Adreea Visla, Uiversity of Zurich I did my Ph.D. i Psychology at Babes-Bolyai Uiversity i Cluj-Napoca, Romaia. After graduatio, I moved to aother uiversity i Romaia where I taught for oe year. I caot say I do ot ejoy teachig but my motivatioal trigger for beig i academia will always be research. Sice the I have had o research opportuities i Romaia, so I decided to leave. It seemed almost impossible eve to get a iterview for a positio with a Ph.D. from a uiversity i a developig coutry such as Romaia. Most of my postdoctoral applicatios did ot eve get a reply ad few that did had very brief resposes statig that aother cadidate was better fitted for that positio with o explaatio of why. I eve got a iterview at some poit (yes I kow, just oe sigle iterview from so may applicatios set) for a positio at a good uiversity i the US. The iterview wet pretty well. I ca still remember the surprise o their faces whe I was presetig my work ad aswerig their curious questios. It felt as if they could ot believe how I was able to do so may thigs havig a Ph.D. from a Romaia uiversity (they were probably i the same time also woderig where exactly is Romaia o the map). Hoestly, although I had to leave my coutry i order to develop myself as a scietist, we do have computers ad laboratories i Romaia as well. A few weeks later I wrote to ask about iterview results ad if they made a decisio. Maybe it was bad luck or somethig else (I guess I ll ever kow). I got a reply statig that they were sorry but their selectio criteria had chaged, ad ufortuately, they caot cosider me for a positio aymore. I thought, well, they are researchig techiques for deliverig psychotherapy i space, so they might i the ed eed to hire Americas (my realistic or ot too realistic reappraisal of the situatio at that time). I could write pages about my professioal rejectios or eve a CV of Failures (after the example of may famous professors; see which I ow cosider more as life trials. Istead, I will limit myself to just a few more lies. I m proud of almost everythig i my CV of F: Natioality discrimiatio, geder discrimiatio, epotism-related ijustices, age discrimiatio, eve ot kowig a specific laguage discrimiatio (although I have to metio that besides my ative laguage which is Romaia, I am able to speak Eglish ad Frech, I ca uderstad Italia ad Spaish, ad I am eve curretly learig Germa but, well, you ca ever satisfy everyoe), ad the list will, I m sure, expad as time goes o. You might have gotte the impressio that my road has bee bumpy ad difficult. Ad it was! But it also led me to where I am ow. I am curretly a Postdoctoral Researcher at Uiversity of Zurich (Switzerlad), where I previously had a fellowship durig my Ph.D. i which I ivestigatig depressed patiets hope for improvemet durig psychotherapy. I am curretly workig i a project ivestigatig differet microitervetios aimig at improvig psychotherapy for geeralized axiety disorder patiets. My research iterests are cogitive mechaisms ivolved i psychopathology ad psychotherapeutic treatmet, process ad outcome research, therapist effects, resource activatio models i the treatmet of psychological disorders, ad cross-cultural differeces i psychopathology. I do t fid myself i the positio of givig advice for a successful career i research ad maybe eve ot for a successful start of a career i research. I believe that every path is differet, some more straightforward ad some with detours. Some may eve tur out to be dead eds. As you probably oticed util this poit, givig advice is ot the aim of this story i which I have focused more o the usee successes (i.e., failures), rather tha o the visible oes that I will keep addig to my CV. However, I have gaied some isight that I would like to share with you. I m ot sure they ca be replicated, sice life desig is ever the same, but here we go: Fidig the right metor(s) at the right momet. I was lucky eough to fid metors who believed (ad still do because real metors do t stop their metorig whe the project is over) i my capacity to go beyod of what I myself believed Cotiued o page 7 Society for the Exploratio of Psychotherapy Itegratio 6

7 The Itegrative Therapist Volume 2, Issue 4 October 2016 I have come to believe that validatig ad supportive huma relatioships are very importat i the field of research as well as i life i geeral. The ature of itegratio makes this challege especially complex but far from impossible. The SEPI XXXIII ANNUAL MEETING i Dever, Colorado, USA, o May 18-21, 2017 will be a lad mark evet for psychotherapy itegratio. I could accomplish. It is true that this did ot brig me the Nobel prize (ot eve a Sciece or Nature publicatio - yet), but at least made me gai more trust i myself. I am grateful to them because they made me explore my comfort zoe just to take a step out of it whe the time was right. I am ot oly thikig of metors as idividuals, but also as etworks or people with similar iterests. The Society for Psychotherapy Research (SPR) ad the Society for the Exploratio of Psychotherapy Itegratio (SEPI), both helped me develop my idetity as a researcher. I am grateful to SEPI for awardig me the Paul L. Wachtel Travel Grat who made possible my first SEPI meetig attedace. Validatig ad supportive huma relatioships. I have come to believe that validatig ad supportive huma relatioships are very importat i the field of research as well as i life i geeral. This coclusio was also stregtheed by my work as a psychotherapist. Whe cofroted with alliace ruptures i psychotherapy, I teded to keep usig the techiques prescribed by the maual, my supervisor, or dictated by the case formulatio. Iterestigly, what I oticed was that whe I stopped doig so, reflected o what had take place, ad the shared my experiece, the tesio decreased ad ruptures frequetly got resolved. High frustratio tolerace. The capacity to tolerate the ot so pleasat evets i your life, o matter how bad they actually are, is a ecessary ability for a researcher (ad for everyoe else as well). This is the capacity to tolerate the fact that you did ot obtai the results you were expectig, that your article got rejected, that your grat applicatio did ot receive fudig, or that you did ot get the positio you wated. No matter how much you wat somethig ad o matter how hard you work for it, you should always keep i a corer of your mid the idea that, most of the time, there are several thigs ifluecig these decisios that are out of your cotrol (e.g., what reviewers you have ad their specific prefereces, how much fudig is available, how may people compete for a positio). I would like to coclude by sayig that the start of a research career is ot by far the most challegig part of this process. The scietific process, i its ideal form, is elegat: Ask a questio, set up a objective test, ad do your best to get a aswer. Repeat. But sciece is ot always elegat: It ca be dirty, hard, ad a challege. However, for me persoally, the time that passes betwee askig a questio ad gettig a aswer to that questio is full of excitemet. It is the jourey towards the aswer ad the excitemet that explodes as I get closer ad closer to the aswer. This is what keeps me goig. adreea.visla@psychologie.uzh.ch Presidet s Colum, cotiued from page 1 methodologies; stregthe liks with basic sciece; rely o techological advaces; address possible obstacles; dissemiate ad discuss our research work i meetigs; publish our work. We also eed to icrease all forms of mutual collaboratio. We eed to stregthe the dialogue betwee researchers ad cliicias i a way that both parties see clearly the beefits of workig together ad helpig oe aother, startig by fosterig this attitude i studets ad traiees ad buildig aveues to offer the youger geeratio opportuities to be ivolved i projects, ad we will also largely beefit by expadig iteratioal collaborative etworks. SEPI provides reach aveues to foster the practice-research missio, updatig the sources of commuicatio with a reewed website, our ew Facebook page, which we ivite you all to visit, ad our publicatios: The itegrative Therapist ad the Joural of Psychotherapy Itegratio, which is showig real excellece, as well as the active work of the SEPI Committees, the growig local meetigs of the regioal etworks, ad our aual iteratioal meetig. We have a amazig ew Coferece ahead. The SEPI XXXIII ANNUAL MEETING i Dever, Colorado, USA, o May 18-21, 2017 will be a ladmark evet for psychotherapy itegratio. The topic of this meetig will be: Cliical Decisios at Work: Navigatig the Psychotherapy Itegratio Maze. The time to sed your submissio is about to come! I strogly ecourage you to come, share ad discuss your theoretical work, your cliical experiece, research, traiig ad supervisio work, ad your experiece as studets ad traiees, to collectively geerate aother fulfillig ad woderful meetig! Society for the Exploratio of Psychotherapy Itegratio 7

8 The Itegrative Therapist Volume 2, Issue 4 October 2016 I view emotioal processes as cetral to how psychotherapy works, ad believe that whe edurig chage takes place a learig process has occurred. We proposed that the essetial igrediets of therapeutic chage iclude: 1) reactivatig old memories; 2) egagig i ew emotioal experieces that are icorporated ito these reactivated memories via the process of recosolidatio; ad 3) reiforcig the ew learig by practicig a ew way of behavig ad experiecig the world i a variety of cotexts. Recosolidatio of Emotioal Memories A New Theory of Edurig Chage That Ca Potetially Promote Itegratio Across Major Psychotherapy Modalities Richard Lae I her presidetial address at the 2015 SEPI Aual Meetig, Rhoda Goldma metioed a paper that my colleagues ad I had just published i a leadig eurosciece joural (Lae RD, Rya L, Nadel L, Greeberg L. Memory recosolidatio, emotioal arousal ad the process of chage i psychotherapy: New isights from brai sciece. Behavioral ad Brai Scieces 2015; 38:1-19) that proposed a fudametal mechaism of chage that applied to all major psychotherapy modalities ad could potetially provide a theoretical foudatio for itegratig them. With her ecouragemet we orgaized two symposia at the 2016 SEPI meetig i Dubli oe i which the theory ad implicatios of the model were preseted, ad oe i which the cliical expressio of the pheomea uder discussio were examied. It was hearteig to experiece the warm ad receptive respose from those who atteded. It was also gratifyig to be ivited to briefly summarize the model for this ewsletter ad to highlight some of the implicatios for research. I am a cliical psychiatrist with a special iterest i psychotherapy, a researcher focusig o brai ad peripheral physiological mechaisms likig emotioal states ad health, ad a educator i charge of the psychotherapy curriculum i our psychiatric residecy traiig program at the Uiversity of Arizoa. My origial traiig was i psychodyamic psychotherapy but over time I have sought to icorporate cocepts ad techiques from Emotio-Focused Therapy (EFT) ito my cliical work ad teachig. I view emotioal processes as cetral to how psychotherapy works, ad believe that whe edurig chage takes place a learig process has occurred. Excited by the ewer discoveries about how memories are malleable, ad how memories ca be updated by iformatio that is brought olie whe memories are i a labile state, I teamed up with two experts o the eural basis of memory at my uiversity, Lee Rya ad Ly Nadel, ad the legedary creator of EFT, Les Greeberg, to propose a brai-based model of edurig chage focusig o recosolidatio of emotioal memories. The core idea of this paper is the that therapeutic chage i a variety of modalities, icludig behavior therapy, cogitive-behavioral therapy, emotio-focused ad psychodyamic psychotherapy, results from the updatig of prior emotioal memories through a process of recosolidatio that icorporates ew emotioal experieces. I support of the theory we drew upo emergig evidece from cogitive eurosciece o implicit ad explicit emotio, implicit ad explicit memory, emotio-memory iteractios, memory recosolidatio, ad the relatioship betwee episodic ad sematic memory. We also reviewed cliical research fidigs demostratig the essetial role of productive emotioal arousal i successful psychotherapy outcomes. We proposed that the essetial igrediets of therapeutic chage iclude: 1) reactivatig old memories; 2) egagig i ew emotioal experieces that are icorporated ito these reactivated memories via the process of recosolidatio; ad 3) reiforcig the ew learig by practicig a ew way of behavig ad experiecig the world i a variety of cotexts. Thus, this ew theory of chage was derived from cliical experiece ad both basic sciece ad cliical sciece research evidece. Why is a theory of how psychotherapy works eeded? First, it is surprisig to kow that the mechaisms of chage are poorly uderstood i ay psychotherapy modality. As Kazdi (A Rev Cli Psychol 2007; 3:1-27) stated, After decades of psychotherapy research, we caot provide a evidece-based explaatio for how or why eve our most Cotiued o page 9 Society for the Exploratio of Psychotherapy Itegratio 8

9 The Itegrative Therapist Volume 2, Issue 4 October 2016 First, it is surprisig to kow that the mechaisms of chage are poorly uderstood i ay psychotherapy modality. A key idea is that the repetitive, maladaptive patters that are a commo reaso for people seekig therapy are the procedural expressio of implicit emotioal memories. It is importat to highlight that this ew area of research is a 2-way street, with questios posed by psychotherapists highlightig importat areas for basic research. well studied itervetios produce chage, that is, the mechaism(s) through which treatmets operate. I the paper we argue that a ew theory of chage ca be helpful i several ways: 1) if a therapist kows the essetial igrediets of ay give modality, that kowledge ca be used to improve or make that therapy more efficiet; 2) it provides guidace i kowig what to teach traiees who are learig to become therapists; 3) it ca be used to help select which therapy to provide for a give cliet; 4) it ca provide guidace i idetifyig the eurobiological basis of chage. A core aspect of the theory is what we call the itegrated memory model. This cosists of three compoets: 1) emotioal resposes, which ivolve arousal, actio ad feelig; 2) episodic memories, which are memories of uique episodes or persoal experieces; ad 3) sematic structures or geeralized kowledge. It is our claim that if ay oe compoet is activated, the other two are as well. This meas that if a emotio such as happiess is activated, so too are specific episodic memories of beig happy ad geeralized kowledge about what beig happy ivolves. Aother importat aspect of the theory is the distictio betwee implicit ad explicit emotios. Implicit emotios are bodily aspects of emotio (behavior such as approach or avoidace, ad bodily physiology such heart rate icrease) without coscious feelig. A key idea is that the repetitive, maladaptive patters that are a commo reaso for people seekig therapy are the procedural expressio of implicit emotioal memories. That is, whe cliets are exposed to problematic situatios, procedures or scripts are triggered that are well-leared ad out of awareess. These procedures are thought to serve a emotio-regulatory role. The key to chage is to have corrective emotioal experieces i therapy while the old problematic memories are activated, ad to practice havig ew experieces outside of therapy so that these episodic experieces become edurig sematic structures. I the paper we argue that all major therapies work i fudametally the same way, but that differet therapies gai access to the itegrated memory model through preferred etry poits: Cogitive-behavioral therapy accesses sematic structures; psychodyamic psychotherapy accesses episodic memories; emotio-focused therapy accesses explicit emotioal experieces; ad behavior therapy accesses implicit emotioal resposes. This theory raises a umber of research questios. Oe set of questios ivolves the processes essetial for edurig chage to occur. How may repetitios of the ew experieces ad how large a chage i itesity is eeded for lastig chage to occur? How may cotexts should be tried ad how may times each? Aother set relates to cliical predictio. What are the predictors of who respods best to each poit of etry? A third set relates to relevat physiological processes. Give that recosolidatio of emotioal memories is ehaced by REM sleep, should cliets be ecouraged to ap after sessios to maximize the beefits? If a essetial igrediet of chage is arousal, is it possible to quatify physiologically how much arousal is too much, ad how much is too little? It is importat to highlight that this ew area of research is a 2-way street, with questios posed by psychotherapists highlightig importat areas for basic research. A astute cliicia asked at the presetatio i Dubli, What are the implicatios of the model for whe to itervee? Perhaps the effectiveess of itervetios is greatest whe cliet arousal is moderate. If so, could this be because that is whe sematic structures are more malleable? Does the temporal juxtapositio of corrective emotioal experieces with activatio of the old memories, ad their bodig through recosolidatio, chage the associative etwork of those memories? I may ways the formulatio of this model highlights the may thigs we do t kow. My colleagues at the Uiversity of Arizoa ad I are therefore orgaizig a coferece o the Neurosciece of Edurig Chage: Implicatios for Psychotherapy to be held i Tucso, AZ September 15-16, The purposes of this 2-day coferece for researchers ad cliicias are threefold: 1) review recet basic research fidigs ad their cliical implicatios; 2) defie a research ageda for the eurosciece of edurig chage; ad 3) discuss the mechaisms of edurig chage i psychotherapy from the cliical perspective of the four major psychotherapy modalities listed above. Registratio iformatio ad the cofirmed list of outstadig speakers ca be foud at psychiatry.arizoa.edu. Richard D. Lae, M.D., Ph.D. Professor of Psychiatry, Psychology ad Neurosciece Uiversity of Arizoa Tucso, AZ lae@ .arizoa.edu Society for the Exploratio of Psychotherapy Itegratio 9

10 The Itegrative Therapist Volume 2, Issue 4 October 2016 The Alliace: Recoverig the Dyad ad Decostructig Its Parts Alice Coye...experimetal research (what we might call wave three) has draw o the above fidigs to develop targeted alliace-promotig traiigs ad treatmets, either stadaloe or adjuctive....there has bee a historical mismatch betwee the way we coceptualize the alliace dyadically, ad the way we typically measure it. As a ew psychotherapy researcher, I was immediately draw, like may others, to the costruct of the therapeutic alliace. Ofte defied as patiettherapist agreemet o therapy goals ad tasks ad a felt relatioal bod (Bordi, 1979), the alliace is perhaps the most commoly-studied treatmet factor. Accordigly, the field kows a great deal about the alliace. For example, first wave alliace research has established that a higher quality alliace, whether assessed from the patiet, therapist, or observer perspective, correlates with more positive therapy outcomes across varied psychotherapies for umerous problems (Horvath, Del Re, Flückiger, & Symods, 2011). We also kow, from a secod wave of alliace research, that umerous variables predict alliace quality ad developmet over time (Castoguay, Costatio, & Holtforth, 2006). Additioally, ad perhaps most compelligly, experimetal research (what we might call wave three) has draw o the above fidigs to develop targeted alliace-promotig traiigs ad treatmets, either stadaloe or adjuctive (e.g., Crits-Christoph et al., 2006). However, as both a ivestigator coductig alliace research ad a cliicia usig alliace research, the curret state of the alliace literature is simultaeously compellig ad limitig. O the oe had, it seems clear that the psychotherapy relatioship matters for patiet outcomes. O the other had, the alliace literature has at least two promiet measuremet limitatios with which the field (ad I!) are oly begiig to grapple. Dyadic Alliace Measuremet Although Bordi s alliace defiitio highlights its iheretly dyadic ature (i.e., istrumetal ad emotioal attuemet betwee the participats), most research to date has failed to measure it i a way that fully itegrates the perceptios of both relatioship parters to produce a geuie relatioal pheomeo (i.e., a variable emergig from the relatioship). I other words, there has bee a historical mismatch betwee the way we coceptualize the alliace dyadically, ad the way we typically measure it (i.e., a variable reflectig the participats uique perspectives lookig i o the relatioship). Addressig this gap, we coducted a study that drew o both patiet ad therapist alliace ratigs, but empirically derived a measure of dyadic attuemet, or similarity (Coye, Costatio, Laws, Westra, & Atoy, 2016). For example, i a dyad with high levels of attuemet, both patiet ad therapist might report (o their respective versios of a alliace scale) havig a trustig bod, whereas i a low attuemet dyad, the therapist might report havig a trustig bod, but the patiet might report low trust. Usig this derived variable, we foud that icreases i patiet-therapist attuemet i their alliace ratigs over time, or covergece, predicted subsequet symptom reductio for patiets with geeralized axiety beig treated with either cogitive behavioral therapy (CBT) or CBT itegrated with motivatioal iterviewig (MI). Moreover, this fidig held, eve whe cotrollig for both patiets ad therapists idividual alliace perceptios. These fidigs suggest that uique iformatio may be gaied by takig both the patiet ad therapist perspectives ito accout to create a true dyad-level alliace variable, ad that future research should cotiue to develop methods to capture the relatioship, rather tha two idividual experieces. Disetaglig Patiet ad Therapist Alliace Cotributios Aother challege facig the alliace literature stems from the uique ature of the psychotherapy cotext ad its relatioship. Most therapists treat multiple patiets, but most patiets, especially those i a research cotext, do ot simultaeously iteract with multiple therapists. Because of this estig of multiple patiets withi sigle therapists, the way that the alliace has historically bee measured does ot reveal what variability i it is due to the therapist ad what is due to the patiet. Cotiued o page 11 Society for the Exploratio of Psychotherapy Itegratio 10

11 The Itegrative Therapist Volume 2, Issue 4 October 2016 Thus, if we simply correlate the alliace with outcome, we will get a total correlatio, which reflects the associatio betwee a ambiguous bled of patiet ad therapist alliace variability ad outcome. That is, these correlatios fail to separate withi-therapist variability, or differeces i alliace quality betwee patiets see by the same therapist, from betwee-therapist variability, or differeces i therapists average alliace quality across all patiets i their caseloads (Costatio, Boswell, Coye, Kraus, & Castoguay, 2016). We foud that icreases i patiettherapist attuemet i their alliace ratigs over time, or covergece, predicted subsequet symptom reductio... Importatly, there is already some evidece that betweetherapist alliace sigificatly predicts patiet outcome, whereas withitherapist alliace does ot. Importatly, there is already some evidece that betwee-therapist alliace sigificatly predicts patiet outcome, whereas withi-therapist alliace does ot (Baldwi, Wampold, & Imel, 2007). However, the full implicatios of these fidigs have yet to be fully realized, ad there has yet to be a full wave of research devoted to this alliace decostructio issue. Future Alliace Directios Ispired by the two measuremet challeges discussed here, I ca see the alliace field movig forward i a few importat ways. First, if dyadic research cotiues to support the importace of patiet-therapist alliace covergece over time, it will be essetial to determie what such covergece actually looks like iterpersoally. With this idea i mid, we are curretly usig a observer codig system to ivestigate differeces i iterpersoal micro-processes betwee high- ad low-covergece alliace dyads. This study will help reveal determiats of dyad-level alliace quality. Secod, regardig the disaggregatio of the total correlatio, I ca evisio a replicatio of the historical waves of alliace research discussed above. The progressio would be as follows: Wave 1 cotiue to establish, across various cliical cotexts, whether betwee-therapist alliace variability is most predictive of patiet outcomes. Wave 2 if it is established that betwee-therapist alliace variability is the most potet predictor of outcomes, researchers should focus o learig what it is about certai therapists that allows them to have a stroger alliace across all of their patiets, compared to other therapists. Wave 3 oce such determiats of better therapist-level alliaces are discovered, researchers ca the test experimetally whether traiig therapists o these factors improves their ability to foster alliaces across their patiets, thereby icreasig the likelihood of better patiet outcomes. Third, as with ay patiet-level process-outcome correlatio, research will also eed to determie whether the associatio betwee therapist alliace ad outcome differs or varies betwee therapists; that is, as with research o moderators of the total correlatio, it could be that the alliace is more (or less) associated with outcome for certai therapists. If so, the research would eed to determie these therapist-level moderators. For example, it could be that, for therapists whose primary theoretical orietatio privileges the alliace as a chage mechaism, the alliaces that these therapists form with their patiets might be more predictive of outcome tha the alliaces formed by therapists who do ot view the alliace as a primary chage mechaism. Alteratively, it could be that therapist characteristics, such as the degree to which they persoally value the alliace or eve therapist attachmet style, might moderate the betwee-therapist alliace-outcome correlatio. If there are ideed therapist characteristics or actios that systematically explai whe the alliace promotes good outcomes for their patiets (or fails to do so), the field ca the begi to thik about matchig o a whole other level. That is, ot oly should we be cocered with matchig patiets to therapies or therapists, but also matchig therapists to the itervetios or processes most likely facilitate improvemets for their specific patiets. Fially, ad tyig together my iterests ad the threads of this article, it stads to reaso that if idividual therapists have differet abilities to foster the alliace as perceived by oe parter, therapists may also vary i their degree of dyadic attuemet or covergece i their relatioship perceptios as well. Thus, future research should seek ot oly to further both dyadic ad therapist effects research, but also to itegrate these lies i hopes of gettig closer to realizig the full cliical potetial of the therapeutic alliace. To me, tappig this potetial will also help address the logstadig difficulties of defiig ad achievig expertise i psychotherapy (Tracey, Wampold, Lichteberg, & Goodyear, 2014). Refereces Baldwi, S. A., Wampold, B. E., & Imel, Z. E. (2007). Utaglig the alliace-outcome correlatio: Explorig the relative importace of therapist ad patiet variability i the alliace. Joural of Cosultig ad Cliical Psychology, 75, doi: / X Cotiued o page 12 Society for the Exploratio of Psychotherapy Itegratio 11

12 The Itegrative Therapist Volume 2, Issue 4 October if idividual therapists have differet abilities to foster the alliace as perceived by oe parter, therapists may also vary i their degree of dyadic attuemet or covergece i their relatioship perceptios as well. Bordi, E. S. (1979). The geeralizability of the psychoaalytic cocept of the workig alliace. Psychotherapy, 16, doi: /h Castoguay, L. G., Costatio, M. J., & Holtforth, M. G. (2006). The workig alliace: Where are we ad where should we go?. Psychotherapy: Theory, Research, Practice, Traiig, 43, doi: / Costatio, M. J., Boswell, J. F., Coye, A. E., Kraus, D. R., & Castoguay, L. G. (accepted for publicatio). Who works for whom ad why? Itegratig therapist effects aalysis ito psychotherapy outcome ad process research. To appear i L. G. Castoguay & C. E. Hill (Eds.), Therapist effects. Washigto, DC: America Psychological Associatio. Crits-Christoph, P., Gibbos, M. B. C., Crits-Christoph, K., Narducci, J., Schamberger, M., & Gallop, R. (2006). Ca therapists be traied to improve their alliaces? A prelimiary study of alliace-fosterig psychotherapy. Psychotherapy Research, 16, doi: / Coye, A. E., Costatio, M. J., Laws, H. B., Westra, H. A., Atoy, M. M. (2016). Patiet-therapist covergece i alliace ratigs as a predictor of outcome i psychotherapy for geeralized axiety disorder. Mauscript submitted for publicatio. Horvath, A. O., Del Re, A. C., Flückiger, C., & Symods, D. (2011). Alliace i idividual psychotherapy. Psychotherapy, 48, doi: /a Tracey, T. G., Wampold, B. E., Lichteberg, J. W., & Goodyear, R. K. (2014). Expertise i psychotherapy: A elusive goal?. America Psychologist, 69, doi: /a INVITATION TO SUBMIT ARTICLES, ARTWORK, PHOTOS The Itegrative Therapist wats you to be a cotributor. We are seekig brief, iformal, iterestig ad actioable articles i coversatioal laguage. Thik of the way you would talk to a colleague over luch. Please limit refereces to those that absolutely essetial. Articles should be relevat to the issue s theme ad to SEPI s three missios: itegratio betwee researchers ad cliicias, itegratio across cultures, ad further developmet of psychotherapy itegratio. Geeral Author Istructios Cotributors are ivited to sed articles, iterviews, commetaries, letters to the editor, photos, art, ad aoucemets to Jeffery Smith, MD, Editor, The Itegrative Therapist. All submissios should be ed to jsmd@howtherapyworks.com with the subject lie Cotributio to Itegrative Therapist SEPI Society for the Exploratio of Psychotherapy Itegratio ARTICLE SPECIFICATIONS The preferred legth of submissios is 1,250 words or less Block style, sigle spaced with a extra space betwee paragraphs No paragraph idetatios, page umberig, headers or footers Use subheadigs ad bullet poits freely Bare miimum refereces should be sigle spaced, i approved APA-style format Please iclude a photo of the author or authors, miimum 50K/300dpi file size. Photos should be submitted as JPEG, TIFF, GIF, or BITMAP files, separately ad i additio to ay imbedded i documets. Society for the Exploratio of Psychotherapy Itegratio 12

13 The Itegrative Therapist Volume 2, Issue 4 October 2016 I may behavioral health (BH) settigs, academic research is see as, at best, slightly complemetig cliical practice ad, at worst, aathema to it. A recet shift has resulted i some isurers workig with ACOs to carve i BH services to the total capitated paymet. Over the last three years, Atrius Health has udertake a redesig of its BH care model i aticipatio of takig o BH risk cotracts. Brigig the Practice ad Implemetatio of Research ito a Accoutable Care Orgaizatio Samuel Nordberg Jacob Kaga I may behavioral health (BH) settigs, academic research is see as, at best, slightly complemetig cliical practice ad, at worst, aathema to it. Research takes time, ad requires methodological rigor, which is difficult i may cliical settigs. As such, the cosumptio of research, let aloe its practice, is usually reserved for academic medical settigs. Some recet treds, however, have shifted the eeds of large healthcare orgaizatios toward a icreased focus o rigorous research ito the routie practice of behavioral health treatmets. This article will briefly review the drivers for chage, ad the discuss oe example of robust, itegrated research that is tightly aliged with improvig treatmet quality. The Affordable Care Act brought with it a wave of iovatios i the structure of health care systems, icludig ovel meas for payig orgaizatios to maage the full health risk of a patiet. Health care orgaizatios are ecouraged to itegrate care across specialties, ad to take o fiacial risk for the whole health of the patiet. These are broadly termed Accoutable Care Orgaizatios (ACOs). This movemet is a sigificat departure from traditioal fee-for-service models, i that the orgaizatio is measured agaist a fixed sum per patiet, per moth, with which to cover the etirety of a patiet s health care eeds, from i-home care, to outpatiet visits, to hospitalizatios. The orgaizatio either receives a capitated paymet or some portio of savigs (or loss) agaist that fixed sum. The ratioale for this model is that it ecourages prevetative care ad waste reductio. The oe specialty otably left out of most of these cotracts has bee BH. May isurace compaies have carved out paymets for BH treatmets to a few compaies specializig i maagig those cotracts (most otably, Beaco Health ad Uited Behavioral Health). Util very recetly, BH departmets withi ACOs remaied stuck i the fee-forservice paymet model, which rewarded seeig high-fuctioig patiets with good isurace plas, who atteded their sessios regularly. A recet shift has resulted i some isurers workig with ACOs to carve i BH services to the total capitated paymet. Atrius Health, a ACO servig roughly 750,000 patiets i easter Massachusetts, has recetly begu to iclude BH i its risk cotracts. This has geerated substatial eergy for researchig, withi the practice, the effectiveess of itervetios, the eed for empirically-based stadards, ad iovative methods of itegratig with other departmets such as primary care ad pediatrics. The cocept of the Practice Research Network (PRN) is oe i which research methods are fully itegrated ito routie practice ad used to aswer questios relevat to the practitioer. Robust PRNs exist i more academic settigs, such as college couselig ceters, academic medical ceters, ad the Veteras Admiistratio, as well as i some tightly kit private practice groups. Over the last three years, Atrius Health has udertake a redesig of its BH care model i aticipatio of takig o BH risk cotracts. As part of this iitiative, the orgaizatio has begu developig a PRN that is built ito routie care at 15 sites with roughly 140 providers, ad over 170,000 patiet visits aually. The goal of this PRN is to support cotiuous quality improvemet withi the BH departmet, ad to facilitate experimetatio with ew methods of care. Oe of the first iitiatives udertake was the developmet ad implemetatio of a set of empirically-based stadards for psychotherapy with highly complex, ad/or highly acute patiets. Early i the care model developmet process, a steerig committee, made up of prescribers, therapists, ad admiistrators, became coviced that requirig the use of specific mauals risked alieatig a sigificat portio of providers, who were came from diverse traiig backgrouds Cotiued o page 14 Society for the Exploratio of Psychotherapy Itegratio 13

14 The Itegrative Therapist Volume 2, Issue 4 October 2016 ad orietatios. As a compromise, the steerig committee resolved to develop empirically supported treatmet priciples, based o the work of Larry Beutler ad Louis Castoguay....this effort recruited slightly over half the providers i the departmet to participate i the developmet of priciples for the treatmet of patiets......the priciples have helped illustrate areas of systematic skill deficits, ad have resulted i several cetralized expert traiigs to fill gaps i kowledge ad expertise. Cosistet with the spirit of the PRN, this effort recruited slightly over half the providers i the departmet to participate i the developmet of priciples for the treatmet of patiets meetig criteria for twelve differet disorder areas defiitios of patiets that were a bit broader tha DSM or ICD diagoses, ad focused o the problems of our most complex patiets. For example, oe disorder area was complex trauma, which captured those patiets with sigificat trauma histories ad substatial fuctioal impairmet. The effort was led by a cliical psychologist with a research backgroud, ad cliicias were partly reimbursed for the time they dedicated to the project. Providers self-omiated ito a committee for oe or two of the twelve disorder areas. Each committee had at least oe prescriber ad at least oe therapist, ad raged i size from four to seve members. The committees were give stadard procedures for developig priciples, i order to keep the methodology stadardized. Each committee chair was give three hours of traiig ad research review, to help them frame the work to their committee. The chairs were the provided with ad traied o the protocol for developig priciples, which is summarized below: Defie the Disorder Area ad Patiet Recovery Provide a broad descriptio of the problems faced by the average patiet i this disorder area Describe the key defiig features (e.g. Patiets with this coditio are characterized by ) Defie the Targets/Goals for treatmet (e.g. what eeds to chage, ad i which directio?) Describe what improvemet looks like, whe treatmet is successful. Develop Specific Priciples of Chage for the Disorder Area Cosider three broad areas for focus: Medicatio Psychotherapy Supportive/Adjuctive Services Apply a ratioal/empirical process to develop treatmet priciples which will actively foster recovery i t he patiet Use cliical cosesus as a first pass to derive treatmet priciples Task committee members with fidig two or more supportig publicatios for the priciple All committee members will review the publicatios ad arrive at a cosesus agreemet o the fial priciple Defie recommeded modality, frequecy ad duratio of the itervetio Draft priciples were edited by a cetral resource to have similar formattig ad style. These were the reviewed i a two-day evet atteded by the committee chairs. Durig this evet, draft priciples were approved alog with recommedatios for treatmet frequecy ad duratio. A amedmet ad review process was established, alog with a cliical exceptios process desiged to capture istaces i which priciples may ot apply, ad to provide iformatio about gaps i the documet. Lastly, Receivig the 2016 Atrius Health Cliical Iovatio Team Award the priciples were reviewed by a uaffiliated academic expert i the field, ad ameded to reflect his recommedatios. Most otably, a sectio was created for uiversal priciples which appeared i multiple diagostic areas ad were determied to trasced diagosis. Cotiued o page 15 Society for the Exploratio of Psychotherapy Itegratio 14

15 The Itegrative Therapist Volume 2, Issue 4 October the average therapy caseload before the priciples were applied was over 110 patiets receivig bi-weekly or mothly appoitmets for a full-time therapist. After a six-moth caseload work-dow period, caseloads are at 35 patiets, most of whom are see weekly. The curret icaratio of the treatmet priciples maual is 161 pages log, ad available to all Atrius Health cliicias via a shared web portal. The orgaizatio has agreed o stadard work for the applicatio of priciples to the developmet of stadardized treatmet plas, ad has set aside weekly time for case reviews that are cetered o developig expertise with priciples. Additioally, the priciples have helped illustrate areas of systematic skill deficits, ad have resulted i several cetralized expert traiigs to fill gaps i kowledge ad expertise. A recet audit of case cofereces idicated that there is still sigificat work to do. Adoptio of the priciples approach varies widely from oe practitioer to aother, ad more traiig ad culture chage will be ecessary to move the orgaizatio to the target state. However, the priciples have already dramatically impacted care. For example, the average therapy caseload before the priciples were applied was over 110 patiets receivig bi-weekly or mothly appoitmets for a full-time therapist. After a six-moth caseload work-dow period, caseloads are at 35 patiets, most of whom are see weekly. I additio, the BH departmet has added more tha 50 therapy groups, based o the priciples-based guidelies, to augmet idividual modalities. Lastly, the orgaizatio is implemetig a routie outcomes moitorig (ROM) system i the fall, to provide vital data o how effective our care model is i promotig recovery with our patiets. This work required hudreds of hours of devoted time, ad has completely shifted the cliical routie from the patiets who are see (ow much more complex), to the way they are see (more itesively, with alterate modalities). Future work will eed to focus o sustaiig ad expadig the implemetatio of research-based itervetios, ad o usig ROM ad claims data to uderstad areas of stregth to spread, ad areas of weakess to improve. As the data collectio architecture becomes more robust, the orgaizatio will have a ew opportuity egagig cliicias i the research process, from coceptualizatio through implemetatio. Formig close parterships with academic orgaizatios, ad supportig grat applicatios as well as teachig ad traiig opportuities will be vital to sustaiig the burgeoig practice research etwork at Atrius Health. SEPI Aouces: UPDATED LISTING OF INTEGRATIVE TRAINING PROGRAMS WORLDWIDE Society for the Exploratio SEPI of Psychotherapy Itegratio The SEPI leadership has completed a survey to idetify itegrative traiig programs ad gather pertiet data about each. The list, ow coverig over 60 programs is available o the SEPI website at the followig address: Society for the Exploratio of Psychotherapy Itegratio 15

16 The Itegrative Therapist Volume 2, Issue 4 October 2016 Testig, Aalyzig, ad Establishig Markers for Resposiveess i Psychotherapy I psychotherapy, resposiveess reflects participat behavior affected by emergig cotext, icludig the exchages, perceptios, wishes, ad characteristics of the participats. Simply put, it is historically easier to posit the coceptual importace of resposivity tha to establish it empirically. Perhaps most excitigly, the MI module ca be relatively easily dissemiable to cliicias... Michael J. Costatio Resposiveess i Psychotherapy: Promise, Problem, ad Promise As a itegratioist, I have log take iterest i cliical flexibility ad perhaps its primary maifestatio, resposiveess. I psychotherapy, resposiveess reflects participat behavior affected by emergig cotext, icludig the exchages, perceptios, wishes, ad characteristics of the participats. 1 Iheret here is the otio of beig resposive to somethig, such as the patiet s diagosis or stated prefereces, as well as beig resposive with somethig, such as a particular itervetio or actio. It could be argued that resposiveess, or doig the right thig, at the right time, is the quitessetial itegrative otio for effective therapist behavior! I fact, I would guess that may SEPI members would cocur with the idea that effective therapists are flexibly resposive, applyig techiques that are appropriate to the cliical situatio, rather tha rigidly adherig to a a priori pla across cotexts. That said, resposiveess is elusive i defiitio, ad it poses problems for psychotherapy research desigs ad iterpretatio. As Bill Stiles 2 has argued, resposiveess, with its oliear ad ofte o-predictable course, might obscure treatmet efficacy differeces (or explai their geeral comparability), mask possible process-outcome correlatios, cofoud the meaig of dropout, ad challege dose-respose effects (or lack thereof). Simply put, it is historically easier to posit the coceptual importace of resposivity tha to establish it empirically. However, perhaps the research field is becomig abler to do so. My aim is to illustrate three ways research ca, ad has started to, establish a empirical base for resposiveess. I will draw o a few examples from my ow program that address this topic (1) by prospective experimetal desig, (2) by retrospective process research desig, ad (3) by empirically settig the cliical markers to which there is a eed to be resposive. This list, of course, is ot exhaustive, but rather a heuristic startig poit. Prospective Experimetal Desig Oe way to test resposiveess is to apply the gold-stadard causal desig experimetatio. We ca maipulate therapist resposiveess. For example, we coducted a radomized cliical trial (RCT) that compared the efficacy of 4 sessios of motivatioal iterviewig (MI) followed by 11 sessios of cogitive-behavioral therapy (CBT) fully itegrated with MI (applied i respose to markers of resistace; MI-CBT) versus 15 sessios of CBT aloe for geeralized axiety disorder. 3 I the itegrative coditio, therapists were traied to recogize markers of patiet resistace to them or the CBT ageda, ad to shift away from CBT ad toward MI i these momets. MI therapists, through their spirit of patiet-ceteredess ad focus o autoomy-gratig, helped patiets develop their ow argumets for chage (iteral motivatio) vs. actig as a exterally motivated chage aget. Oce the resistace appeared resolved, therapists would retur to CBT. MI-CBT vs. CBT patiets showed sigificatly greater worry reductio from posttreatmet through 12-moth follow up. As the oly maipulatio was the traiig of therapists to egage i marker-drive, resposive shifts, this additive desig strogly suggests a causal beefit of doig a right thig (MI) at the right time (resistace marker). Perhaps most excitigly, the MI module ca be relatively easily dissemiable to cliicias, at least relative to the more logstadig movemet to lear ad apply more top-dow, full-treatmet packages. Cotiued o page 17 Society for the Exploratio of Psychotherapy Itegratio 16

17 The Itegrative Therapist Volume 2, Issue 4 October 2016 These results suggest that doig the right thig, at the right time is much more potet tha doig that thig (i this case beig MI-ish) at ay old time. It would seem, the, that provider track records i treatig differet types of presetig problems could be a importat marker that helps patiets eve before begiig treatmet. Retrospective Process Research Desig Aother way to aalyze resposiveess is to rely o iovative process research. I a study of CBT, we had observers codify therapist behavior that reflected so-called MI spirit. 4 We foud that eve a small icrease i utraied MI spirit durig the precise momets of patiet-therapist disagreemet had 10 times the ifluece o worry reductio tha similar amouts displayed at radomly selected times durig treatmet. These results suggest that doig the right thig, at the right time is much more potet tha doig that thig (i this case beig MI-ish) at ay old time. Ad this was without traiig! Oe could imagie how much more potet this effect could be with adjuctive traiig i MI. Importatly, ad stickig with the itegrative theme, the poit is ot to solely tout MI, but rather to highlight a empirical desig that demostrated a process-outcome correlatio i the cotext of a particular marker. Oe of my major research goals is to fid the most commoly occurrig of these types of cotextual markers ad the itervetios that best address them (whether MI, somethig else, or eve some meta-level iterpersoal quality). To me, this would reflect the further comig-of-age of evidece-based practice. Research o Cliical Markers Of course, for the resposiveess otio to mature cliically ad empirically, we eed to fid the markers that drive it. As a example, we, like others, have demostrated discoverable differeces betwee therapists with regard to their average cliical effectiveess across patiets i their caseloads. 5 I other words, the perso of the therapist matters for patiet outcomes. Moreover, therapists appear to have relative stregths ad weakesses (whe outcome is measured multidimesioally) withi their ow practices. For example, some therapists might demostrate substatial effectiveess i treatig their patiets depressio, but ieffectiveess or eve harm i other domais, like substace abuse. Ad, these fidigs appear stable; stickig with the depressio example, therapists who were particularly effective i this outcome domai for oe wave of 30 cliets remaied so with a subsequet wave of 30 cliets. For domais i which they were less effective i wave 1, they also remaied so i wave 2. It would seem, the, that provider track records i treatig differet types of presetig problems could be a importat marker that helps patiets eve before begiig treatmet. It is coceivable that we ca draw o such therapist effects data to help iform patiets whe makig metal health care decisios. Despite the seemig importace of this type of iformatio, treatmet seekers rarely have access to therapist performace iformatio, ad there remais a kowledge gap regardig patiets perspectives o the value of such iformatio. To help close this gap, my colleague, James Boswell, ad I have fudig to examie what metal health care stakeholders value ad prefer whe it comes to usig provider track-record data i treatmet decisio makig. 6 We also have separate fudig to begi a RCT comparig the efficacy of matchig patiets to therapists who have a empirically-supported track record of successfully treatig the patiet s presetig problem vs. therapist assigmet-as-usual (typically based o pragmatics like therapist availability). With this therapist effect established, this is yet aother cotextual marker to which we ca be resposive (e.g., via case assigmet), ad for which we ca put this resposivity to experimetal test. Implicatios As causal desigs testig resposivity cotiue to support the assimilatio of marker-resposive strategies ito home base treatmets, flexibility o loger has to be the diffuse opposite of iflexibility; rather, it ca be a fully formed evidece-based strategy that is applied based o theory ad judged based o reliable statistical iferece. [The assimilatio of such focused modules at specific times seems far more dissemiable ad cliically iformative tha research poitig to full-treatmet packages havig efficacy beyod o treatmet or placebo, or beig comparable to other full-treatmet packages.] Cliicias ad researchers should cotiue to go lookig for the right thigs, ad the right times with aecdotal, process-correlatioal, ad discovery-orieted desigs. We ca fid them! We ca use marker research for bigger picture resposiveess, such as patiet-therapist matchig. This work has the promise of ot oly ehacig idividual efficacy, but also fosterig improvemets at the system level. [Of course, we also eed to be midful of what patiets value ad prefer i this regard, to which aother layer of resposiveess may eed to be applied.] Fial Thought The research threads itroduced above are just a few ways to build a evidece base for resposiveess. Not oly do these threads eed to be replicated ad itegrated; there remais a eed for other ovel ways to test, aalyze, ad Cotiued o page 18 Society for the Exploratio of Psychotherapy Itegratio 17

18 The Itegrative Therapist Volume 2, Issue 4 October at this jucture, learig how to respod to commo cliical occurreces, such as resistace, with the right thig, should become the, or at least oe of the, ceterpieces of cliical traiig ad dissemiatio efforts. establish markers for itegrative resposiveess i psychotherapy. To us, though, at this jucture, learig how to respod to commo cliical occurreces, such as resistace, with the right thig, should become the, or at least oe of the, ceterpieces of cliical traiig ad dissemiatio efforts. At a broad level, we call this cotext-resposive psychotherapy itegratio. 7 Refereces 1 Stiles, W. B., Hoos-Webb, L., & Surko, M. (1998). Resposiveess i psychotherapy. Cliical Psychology: Sciece Ad Practice, 5, doi: /j tb00166.x 2 Stiles, W. B. (2009). Resposiveess as a obstacle for psychotherapy outcome research: It s worse tha you thik. Cliical Psychology: Sciece ad Practice, 16, doi: /j x 3 Westra, H. A., Costatio, M. J., & Atoy, M. M. (2016). Itegratig motivatioal iterviewig with cogitive-behavioral therapy for severe geeralized axiety disorder: A allegiace-cotrolled radomized cliical trial. Joural of Cosultig ad Cliical Psychology, 84, Aviram, A., Westra, H. A., Costatio, M. J., & Atoy, M. M. (2016). Resposive maagemet of early resistace i cogitive-behavioral therapy for geeralized axiety disorder. Joural of Cosultig ad Cliical Psychology, 84, Kraus, D. R., Betley, J. H., Alexader, P. C., Boswell, J. F., Costatio, M. J., Baxter, E. E., & Castoguay, L. G. (2016, February). Predictig therapist effectiveess from their ow practice-based evidece. Joural of Cosultig ad Cliical Psychology. Advace olie publicatio. 6 Boswell, J. F., Costatio, M. J., Kraus, D. R., Bugatti, M., & Oswald, J. M. (2016). The expadig relevace of routiely collected outcome data for metal health care decisio makig. Admiistratio ad Policy i Metal Health ad Metal Health Services Research, 43, doi: /s Costatio, M. J., Boswell, J. F., Berecker, S. L., & Castoguay, L. G. (2013). Cotext-resposive itegratio as a framework for uified psychotherapy ad cliical sciece: Coceptual ad empirical cosideratios. Joural of Uified Psychotherapy ad Cliical Sciece, 2, INVITATION TO SUBMIT ARTICLES, ARTWORK, PHOTOS The Itegrative Therapist wats you to be a cotributor. We are seekig brief, iformal, iterestig ad actioable articles i coversatioal laguage. Thik of the way you would talk to a colleague over luch. Please limit refereces to those that absolutely essetial. Articles should be relevat to the issue s theme ad to SEPI s three missios: itegratio betwee researchers ad cliicias, itegratio across cultures, ad further developmet of psychotherapy itegratio. Geeral Author Istructios Cotributors are ivited to sed articles, iterviews, commetaries, letters to the editor, photos, art, ad aoucemets to Jeffery Smith, MD, Editor, The Itegrative Therapist. All submissios should be ed to jsmd@howtherapyworks.com with the subject lie Cotributio to Itegrative Therapist SEPI Society for the Exploratio of Psychotherapy Itegratio ARTICLE SPECIFICATIONS The preferred legth of submissios is 1,250 words or less Block style, sigle spaced with a extra space betwee paragraphs No paragraph idetatios, page umberig, headers or footers Use subheadigs ad bullet poits freely Bare miimum refereces should be sigle spaced, i approved APA-style format Please iclude a photo of the author or authors, miimum 50K/300dpi file size. Photos should be submitted as JPEG, TIFF, GIF, or BITMAP files, separately ad i additio to ay imbedded i documets. Society for the Exploratio of Psychotherapy Itegratio 18

19 The Itegrative Therapist Volume 2, Issue 4 October 2016 Report o Activities of SEPI Regioal Networks Carol R. Glass ad Diae B. Arkoff, former co-chairs of the Regioal Network Committee The purpose of SEPI s Regioal Network (RN) Program is to ecourage metal health professioals to get to kow colleagues i their ow geographical area who share a commo iterest i psychotherapy itegratio......there are ow 20 Regioal Networks o four cotiets. The purpose of SEPI s Regioal Network (RN) Program is to ecourage metal health professioals to get to kow colleagues i their ow geographical area who share a commo iterest i psychotherapy itegratio, which ca help provide a source of idetity ad mutual support as well as a vehicle for sharig cliical ad research expertise. SEPI thus has Regioal Networks aroud the world, ad may offer workshops, case presetatios, discussio groups, ad/or ivited speakers. The RN Program has bee a feature of SEPI sice the early 1990 s, ad most recetly RN Coordiators met at the SEPI coferece i Dubli i Jue of We are happy to say that there are ow 20 Regioal Networks o four cotiets. Here is a summary of recet activities of SEPI RNs from aroud the world. ASIA Japaese Society for the Exploratio of Psychotherapy Itegratio (SEPI-Japa) RN Coordiator: Tetsuo Fukushima, te2fuku@yahoo.co.jp Tokyo, Japa Presidet: Shigeru Iwakabe; siwakabe@mac.com Type: Ope to all metal health professioals SEPI-Japa sposored several workshops over the past 2 years, icludig oe o AEDP (Accelerated Experietial Dyamic Psychotherapy) with ivited speaker Day Yeug, Ph.D., ad oe o ACT with ivited speaker Takashi Muto, Ph.D. Tetsuo ad Shigeru ad some of the youger members have bee coductig collaborative research sice 2008, Psychotherapy Istitute of Turkey RN Coordiator: Tahir Özakka, ozakkas@psikoterapi.com Darıca, Turkey Type: Ope to all metal health professioals The Turkish istitute is ivolved i traslatig ito Turkish ad dissemiatig works o psychotherapy, icludig the Joural of Psychotherapy Itegratio. They have liked 2500 colleagues via a Facebook page ad groups. Last year, they orgaized psychotherapy semiars ad workshops with Lewis Aro, Giuseppe de Beedittis, ad Spyros Orfaos. This year s workshops ad semiars iclude Joe Lichteberg, James Fosshage, Leslie Greeberg, Frak Lachma, ad Asse Alladi. Fially, the istitute offers a 3-year post-graduate itegrative psychotherapy traiig program for more tha 150 studets every year. For a more detailed summary about this Regioal Network, see the September 2015 article o pp. 9 ad 12 of The Itegrative Therapist Cotiued o page 20 Society for the Exploratio of Psychotherapy Itegratio 19

20 The Itegrative Therapist Volume 2, Issue 4 October 2016 EUROPE Austria SEPI Regioal Network RN Coordiator: The previous Coordiator (Silke Gahleiter) has moved, ad the group is curretly tryig to determie who will take over as RN Coordiator. Type: Primarily orieted to Daube Uiversity, but some activities ope to outside metal health professioals Itegrative therapy is taught at the Daube Uiversity, ad icludes activities such as psychotherapy traiig, theory clubs ad research circles. Additioally, more iformal meetigs take place outside the uiversity. Helleic SEPI Regioal Network RN Coordiator: Kyriakos Platrites, cypruspsychotherapy@yahoo.com Limassol, Cyprus Type: Members of Cyprus Society for Psychotherapy Itegratio ad ope to all metal health professioals This ew SEPI Regioal Network was just established, ad plas a umber of future activities i associatio with the Cyprus Society for Psychotherapy Itegratio. That group (fouded i 2008) started the Cyprus Istitute for Psychotherapy, which offers a 4-year itegrative psychotherapy course as well as four psychotherapy/couselig ceters that feature a itegrative approach. Society for Psychotherapy Itegratio, Czech Republic RN Coordiator: Ja Roubal, ja.roubal.cz@gmail.com Havlí k v Brod, Czech Republic Type: Ope to all metal health professioals The group i the Czech Republic is active i traiig i Psychotherapy Itegratio; see their website They also helped to sposor a coferece at the Masaryk Uiversity i Bro, ad do research o traiig i Psychotherapy Itegratio with The Cetre for Psychotherapy Research i Bro. Prague SEPI Regioal Network RN Coordiator: Magdalea Frouzová, magdalea.frouzova@cmail.cz Prague, Czech Republic Type: Ope to all metal health professioals This ew SEPI Regioal Network was recetly established over the summer, ad is associated with the Skala traiig istitute for itegrative psychotherapy i Prague. Magdalea suggests that they will offer a wide rage of programs, icludig workshops, ivited speakers, courses, ad cofereces. Cotiued o page 21 Society for the Exploratio of Psychotherapy Itegratio 20

21 The Itegrative Therapist Volume 2, Issue 4 October 2016 Frech SEPI Regioal Network RN Coordiator: Maximilie Bachelart, maximilie.bachelart@hotmail.fr Paris, Frace Type: Ope to all metal health professioals This ew SEPI Regioal Network was recetly established over the summer. Maximilie has a iterest i the therapeutic alliace ad is writig a book o psychotherapy itegratio. He hopes to commuicate with members of the Frech SEPI etwork usig social etworkig (e.g., LikedI, ResearchGate), ad orgaize cofereces ad get people iterested i psychotherapy itegratio. Italia SEPI Regioal Network RN Coordiator: Agelo Compare, prof.agelocompare@gmail.com Bergamo, Italy Type: Ope to all metal health professioals This ew SEPI Regioal Network was recetly established over the summer. Agelo plas to offer workshops with ivited speakers as well as professioal developmet semiars ad traiig programs. Additioally, he hopes to set up a listserv to share the SEPI ewsletter ad articles o psychotherapy itegratio, ad ecourage collaborative research with SEPI members i other parts of the world. Norway/Swede SEPI Regioal Network Coordiators: Marit Råbu, mariraa@psykologi.uio.o Oslo, Norway Björ Philips, bjor.philips@liu.se Liköpig, Swede Birgitta Elmquist, birgitta@elmquistmail.se Stockholm, Swede Type: Ope to all metal health professioals The Scadiavia coordiators have previously bee active i SEPI ad withi their ow home orgaizatios, ad are startig to compile a list ad cosider reachig out to colleagues i the area to offer future programs ope to all metal health professioals. Marit reports that she ad colleagues i the Dept. of Psychology at the Uiversity of Oslo have had semiars ad meetigs, ad have coducted several research projects relevat to psychotherapy itegratio that they have preseted at SEPI cofereces. Birgitta is associated with the Istitute of Affect Focused Psychotherapy, where they offer courses ad traiig i a itegrative, relatioal, affective-focused approach. Cotiued o page 22 Society for the Exploratio of Psychotherapy Itegratio 21

22 The Itegrative Therapist Volume 2, Issue 4 October 2016 Portuguese Group for Psychotherapy Itegratio RN Coordiators: Atóio Braco Vasco, bracov@etcabo.pt Lisbo, Portugal Joaa Fojo Ferreira, joaafojo.ferreira@gmail.com Lisbo, Portugal Type: Ope to all metal health professioals, but maily ivolves colleagues from the Uiversity of Lisbo ad a Portuguese associatio that coducts psychotherapy traiig. The Portuguese group orgaized a coferece o the Future of Psychotherapy i March 2016, with Joh Norcross ad Mike Lambert as keyote speakers, ad also sposored workshops by Paul ad Elle Wachtel. Additioally, they are ivolved with courses o psychotherapy itegratio at the Uiversity of Lisbo, ad there is a 7-semester traiig program at the psychotherapy associatio (ad most traiig is itegrative). Spaish SEPI Regioal Network RN Coordiator: Luis Botella, lluisbg@blaquera.url.edu Barceloa, Spai Type: Ope to all metal health professioals There are three master s degree traiig programs i psychotherapy that take a itegrative approach at Ramo Llull Uiversity, Uiversitat de Barceloa, ad Uiversidad de Alcala. Barceloa also hosted SEPI s 2013 coferece. This group hopes to reach out to SEPI members i Spai i the future. Swiss SEPI Regioal Network RN Coordiator: Ueli Kramer, ueli.kramer@chuv.ch Lausae, Switzerlad Type: Ope to all metal health professioals This ew SEPI Regioal Network was just established, ad plas to hold evets with 1-2 keyote speaker(s) every November, i cooperatio with a Swiss Uiversity, to focus o themes related to psychotherapy itegratio. They will also be able to ecourage attedace ad paper submissios to the upcomig SEPI coferece. NORTH AMERICA NY-SEPI RN Coordiator: Jill Bresler, drjbresler@gmail.com New York, New York, USA Type: Ope to all metal health professioals The New York SEPI group is the oldest active Regioal Network, with a large list of iterested colleagues, ad sposors two presetatios a year for cliicias i the New York City area. The most recet speaker was Fra Aderso, a specialist i body-based work. Others have icluded Jill Bresler ad Kare Starr talkig o the history of assimilative psychoaalytic itegrative therapy, ad a talk o itegrative treatmet of addictios by Debra Rothschild. Cotiued o page 23 Society for the Exploratio of Psychotherapy Itegratio 22

23 The Itegrative Therapist Volume 2, Issue 4 October 2016 SEPI Regioal Network at the Uiversity of Michiga Psychological Cliic RN Coordiator: Todd Favorite, tfavor@umich.edu A Arbor, Michiga, USA Type: Ope to all metal health professioals The Michiga group (i collaboratio with the Mary A. Rackham Istitute at the Uiversity of Michiga) sposors ogoig psychotherapy traiig through iterships ad post-doctoral fellowships, a ivited lecture series, semiars, ad workshops. They have also offered peer supervisio for 3 years i specific methods of psychotherapy itegratio. I the future, they hope to develop research collaboratios, a relatioship with the Michiga Psychological Society, ad explore the possibility of hostig a coferece. Texas SEPI Regioal Network RN Coordiator: Jeff Harris, jharris18@twu.edu Deto, Texas, USA Type: Ope to all metal health professioals The Texas group is just gettig started, ad has ot yet held meetigs. They pla to get together at the aual Texas Psychological Associatio covetio. Washigto DC Area Regioal Network RN Coordiator: Tom Holma, tom@tomholma.com Gaithersburg, Marylad, USA Type: Ope to all metal health professioals The DC-area group has bee meetig sice the sprig of 2013, ad meetigs have primarily ivolved presetatios ad discussio. I the last 2 years, topics have icluded therapeutic imagery (Tom Holma), teachig psychotherapy itegratio (Lida Moore), iterpersoal recostructive therapy (Ke Critchfield), practicig empirically supported CBT withi a psychoaalytically iformed model (Steve Hollad, with discussio by Roger Segalla), ad most recetly research o meaig i life (Clara Hill). For a more detailed summary about this Regioal Network, see the Jauary 2016 article o pp of The Itegrative Therapist: SOUTH AMERICA Argetie Network of Itegrative Psychotherapies RN Coordiator: Beatriz Gomez, beatrizgomez@fibertel.com.ar Bueos Aires, Argetia Type: Ope to all metal health professioals The Argetie group is very active, sposorig semiars at the Aiglé Foudatio with iteratioal speakers o topics such as supervisio (Rodey Goodyear ad Carol Faleder), the itegrative therapist (Sergi Corbella), the therapeutic alliace ad cultural factors (María del Pilar Grazioso), ad emotio focused therapy (Lye Agus). They coduct a graduate traiig program i eight cities i Argetia ad i Paraguay, offer courses i psychological itervetios at a Childre s Hospital, provide itership supervisio at hospitals, ad developed a multidiscipliary program ad semiar o LGTB patiets. Additioally, they have orgaized a coferece o Psychotherapy i the XXI Cetury: Cotributios of Itegrative Models at the Belgrao Uiversity. The group is orgaizig the 2016 Coferece of the Lati America Associatio of Itegrative Psychotherapies (ALAPSI) i Bueos Aires, with Paul Wachtel as ivited speaker ad Elle Wachtel presetig her ew book. Cotiued o page 24 Society for the Exploratio of Psychotherapy Itegratio 23

24 The Itegrative Therapist Volume 2, Issue 4 October 2016 Chilea Istitute of Itegrative Psychotherapy (ICPSI) RN Coordiator: Roberto Opazo, icpsi@icpsi.cl Satiago, Chile Website: icpsi.cl Type: ICPSI is the RN i Chile, ad the Istitute is coected with may groups Amog the may activities of the Chilea group are ivited speakers (recetly Louis Castoguay ad Edward Craighead) ad atioal workshops (o subjects such as meditatio, family violece, homosexuality, ad cultural iflueces). Sice 2002, the Istitute has offered a Master s program i Itegrative Psychotherapy, sposored by the Uiversidad Adolfo Ibañez. This program icludes courses taught by the Istitute as well as supervised cliical traiig, ad a similar program is beig developed i Bolivia. Fially, faculty ad studets pursue research o the Supraparadigmatic Itegrative Model ad preset at cofereces i other Lati America coutries as well as at ALAPSI. Ecuador SEPI Regioal Network RN Coordiator: Lucio Balarezo, luciobalarezo@hotmail.com Quito, Ecuador Type: Curretly itegrated with the Ecuadoria Society of Couselig ad Itegrative Psychotherapy, SEAPSI ad may expad to other metal health professioals i the future. I the past 2 years, the group i Ecuador has sposored several cofereces (Fifth Lati America meetig of Itegrative psychotherapy; Fifth Ecuadoria meetig of Itegrative psychotherapy), as well as a course o addictios ad semiar o europsychological ad psychological evaluatio. Additioally, they have itegrated several supervisio groups of itegrative psychotherapists i several Ecuadora cities ad brought together groups of researchers. Fially, they have traied itegrative psychotherapists i the city of Loja-Ecuador. Uruguay SEPI Regioal Network RN Coordiator: Margarita Dubourdieu, margadub@gmail.com Motevideo, Uruguay Type: Primarily members of their traiig ceter, but ope to o-members The Cetro Humaa de psicoterapia itegrativa (Itegrative Psychotherapy/Humae Ceter) of SUPNIE (Sociedad Uruguaya de Psicoeuroimuoedocriología) is a traiig ceter that offers uiversity programs ad idividual courses, as well as a 2-year traiig curriculum that icludes childre s ad adult hospital psychotherapy practice ad that ca lead to Certificatio as a itegrative psychotherapist. The ceter also sposors presetatios ad discussios, workshops, study groups, supervisio, ad semiars with ivited speakers. For a more detailed summary about this Regioal Network, see the April 2016 article o pp of The Itegrative Therapist: SEPI Aouces: UPDATED LISTING OF INTEGRATIVE TRAINING PROGRAMS WORLDWIDE The SEPI leadership has completed a survey to idetify itegrative traiig programs ad gather pertiet data about each. The list, ow coverig over 60 programs is available o the SEPI website at the followig address: SEPI Society for the Exploratio of Psychotherapy Itegratio Society for the Exploratio of Psychotherapy Itegratio 24

25 The Itegrative Therapist Volume 2, Issue 4 October 2016 SEPI Society for the Exploratio of Psychotherapy Itegratio SEPI XXXIII ANNUAL MEETING Dever, Colorado, USA May 18-21, 2017 Cliical Decisios at Work Navigatig the Psychotherapy Itegratio Maze Friday, May 19 - Suday, May 21 with pre-coferece workshops o Thursday, May 18 CALL FOR SUBMISSIONS The Society for the Exploratio of Psychotherapy Itegratio (SEPI) ivites submissios for the 33rd Aual Coferece to be held i Dever, Colorado USA (with precoferece workshops o May 18th). The coferece site will be the Sherato Dever Dowtow. Please view the Sherato s website at: for more iformatio about the hotel, dowtow Dever, or to make room reservatios. SEPI is a iteratioal, iterdiscipliary orgaizatio of practitioers ad scholars explorig the limitatios of a sigle-school perspective ad promotig alterative ways of meetig the eeds of our cliets. SEPI also advaces the itegratio of practice ad research. DEADLINE FOR SUBMISSIONS The submissio deadlie is December 18, Submit olie through the SEPI Coferece submissio portal at Submissio guidelies ca also be foud there. The program committee will sed otices of acceptace by February 10, Simultaeous traslatio will ot be available at this coferece; the coferece laguage is Eglish. CONFERENCE THEME Cliical Decisios at Work Navigatig the Psychotherapy Itegratio Maze Cotiuig SEPI s goal to promote psychotherapy itegratio i ew frotiers, the theme for our 2017 meetig is Cliical Decisios at Work. Cliical judgmet is what all cliicias face ad may well be the ultimate practice-relevat research. Cliical judgmets refer to decisios made by the therapist about the cliet ad the case durig the therapy process. Errors i cliical judgmet are rarely shared or discussed. Research could thus focus o the processes through which judgmets are made, the impact of these judgmets o subsequet therapist behaviors, ad ultimately cliet outcomes. Despite the cetrality of cliical judgmet, psychotherapists are less likely tha other health care professioals to explicitly frame their work, traiig, ad research i terms of decisios. Emphasizig cliical decisio-makig ecourages a deliberate, reflective stace toward psychotherapy itegratio. SEPI will cotiue explorig differet cliical approaches, how these are similar ad differet, ad how ca they be itegrated. This coferece will focus o decisio research i geeral, ad cliical decisios i particular. We expect to have practitioers ad researchers ivolved i critical dialogues, i additio to videotaped examples, case formulatios, assessmet istrumets, research scales, ad decisio-makig tools. Cotiued o page 26 Society for the Exploratio of Psychotherapy Itegratio 25

26 The Itegrative Therapist Volume 2, Issue 4 October 2016 To stimulate your participatio, we put forward a set of 10 theory, practice, traiig, ad research questios that emerge from the iterestig itersectio of decisios ad itegratio: 1. Navigatio systems or frameworks for the practitioer are of tremedous importace i cliical decisio-makig. Which itegrative metatheoretical frameworks bled key isights from the major paradigms? 2. How do patiets ifluece cliical decisios? Itegratig differet ways of usig cliet s voice ad feedback i co-creatig cliical decisios. 3. What are the distictive markers or patiet characteristics of psychotherapy models? What are the distictive tasks or itervetios of a approach? How trasdiagostic or trastheoretical are these? 4. What cliical support tools ca aid the therapist or the supervisor i decisio-makig? Heuristic strategies, set of priciples or rules or visual tools like maps, figures, tables, graphs, diagrams, flowcharts where have all the tools goe? 5. Whe facig difficult momets or several markers or choice-poits, how does a therapist decide? What is similar ad differet i decisio-makig i differet therapeutic approaches or career phases? 6. What traiig eable traiees to build self-reflective awareess regardig their ow cliical decisios? What biases ad traps do they typically fall ito? 7. How do psychotherapy research methods apply to traiig ad supervisio research? 8. How ca itegrative decisio makig be stregtheed at aother level of traiig of a itegrative approach? 9. How does techology (audio/video/web) ifluece decisio-makig i sessio ad i traiig? 10. What ca decisio sciece lear from cliicias ad vice versa? What cogitive, emotioal, cotextual, ad motivatioal coditios lead therapists to base their judgmets? The goal of the coferece is to help cliicias ad researchers atted to ad improve their cliical decisios. Cliical decisio-makig ca be approached from may agles. Although we ecourage submissios that speak especially to this theme, we will accept other submissios that will broade our kowledge of psychotherapy itegratio. PROGRAM FORMAT We ecourage the participatio of practitioers ad scholars from all psychotherapy traditios ad disciplies to atted our 2017 coferece. While some may ot ecessarily idetify themselves as itegrative, we welcome the participatio of all itrigued by the discussio of psychotherapy itegratio, pro or co. The program will cosist of symposia/paels, discussio groups, mii-workshops, idividual papers, ad posters that address themes related to psychotherapy itegratio. There will be keyote speakers ad pleary paels featurig ivited participats. We wish to uderscore that: SEPI is particularly devoted to facilitatig dialogue amog participats. As such, all presetatios should allocate ample time for audiece participatio ad discussio. We ecourage the use of videotaped sessios, verbatim trascriptios, demostratios, case presetatios, or other methods that groud the dialogue, clarify practical cosideratios, ad demostrate cliical applicatio. (Please be sure to secure cliet s iformed coset for the ethical use of sessio material.) TYPES OF PRESENTATIONS POSTERS Posters are graphic represetatios of the results of studies or tools to help i decisio-makig. Iterested attedees have oe-o-oe discussios with the preseter whose work is displayed. Poster dimesios should approximate 91 x 122 cm (or 36 x 48 iches). May attedees appreciate receivig a hadout that summarizes a poster s fidigs. Poster Awards are preseted i recogitio of outstadig poster presetatios at the meetig. SYMPOSIA/DISCUSSION GROUPS (90 miutes) A pael/symposium is a formal presetatio that icludes 2 5 preseters, icludig discussat. Each pael must have a chairperso who will itroduce the preseters ad topics, moitor time allotmets, ad guide audiece participatio. A lik i the submissio portal provides a example ad istructios o how to group papers together i a pael/symposium submissio. Alteratively a discussio group may be scheduled. Please ote that the chairperso of a discussio group is resposible for cofirmig at least two other idividuals participatio ad for orgaizig all aspects of the presetatio. Film, videotape, music, artwork, or other forms of media ca also be used to stimulate discussio. MINI-WORKSHOPS (90 miutes) Mii-workshops are desiged primarily for practitioer audieces ad focus o skill developmet or experietial ivolvemet. A workshop summary sheet (overview of the topic) ad hadouts (if applicable) should be available to participats. Oly a limited umber of mii-workshops will be possible durig the coferece. Due to the short ature of these workshops, a poited focus is desirable. INDIVIDUAL PAPERS (15-20 miutes) Research, theoretical, ad cliical papers are formal oral presetatios. A paper may or may ot be part of a pael. Papers that are ot part of a pael will be assiged a specific slot by the program committee. We recommed that istead of submittig brief papers you try to create paels. Creatig a cohesive pael, recruitig a discussat, ad submittig for CE credits ca prove fu ad improve the quality of a pael. You ca use the SEPI listserv or Facebook to fid other people doig similar work. Cotiued o page 27 Society for the Exploratio of Psychotherapy Itegratio 26

27 The Itegrative Therapist Volume 2, Issue 4 October 2016 CONTINUING EDUCATION There will be cotiuig educatio for psychologists offered at the Dever meetig through the Society for the Advacemet of Psychotherapy (Divisio 29 of the America Psychological Associatio/APA). The Society for the Advacemet of Psychotherapy is approved by the APA to offer cotiuig educatio for psychologists, but the Society maitais resposibility for the program. We strogly ecourage all preseters (except those submittig posters or idividual papers) to apply for CE approval. To make your sessio CE eligible, follow the APA CE guidelies: provide complete CVs for all first authors ad provide learig objectives (at least oe per submissio, or at least oe per hour if ay sigle submissio is loger tha oe hour). You will do this through the submissio portal whe you submit your coferece proposal. For iformatio about CE ad writig learig objectives, please visit here: CONFERENCE LANGUAGE Please ote that presetatios must be give i Eglish. Please rest assured, however, that perfect grammatical Eglish is NOT a requiremet, but beig uderstadable to Eglish speakers is required for presetatios. No traslatio services will be available. SUBMISSION GUIDELINES Follow the istructios at the SEPI website posted at REVIEW CRITERIA All submissios are rated for importace, rigor (scietific, cliical or theoretical), scope of coverage, relevace to psychotherapy itegratio, ad cosistecy with the meetig theme. Mii-workshops are additioally rated for preseter qualificatios ad usefuless of the traiig objectives. Proposals must be sufficietly detailed to allow evaluatio of these criteria. STUDENT STIPENDS AND SEPI MEMBERSHIP A limited umber of stipeds are available to defray costs for studets presetig at the coferece. To qualify for a stiped, studets must be the first author ad preseter of a paper/poster ad must be SEPI members. If you or a member of your pael wishes to be cosidered for such a stiped, cotact SEPI Treasurer Dr. Steve Sobelma at steve@drstevesobelma.com. For membership iformatio, go olie or cotact Membership Committee Chair Dr. Paul Wachtel. paul.wachtel@gmail.com LIMITS ON FIRST AUTHORSHIPS There is a limit of two first- authorship presetatios at the coferece; however, there is o limit o other forms of participatio, such as discussat, chair/moderator or secod authorship. All preseters will be subject to the usual registratio fee for the coferece. PROGRAM COMMITTEE Nuo Coceição, PhD Program Chair, 2017 Coferece Tracey Marti, Coferece Coordiator ad Admiistrative Officer Beatriz Gómez, PhD, Past Program Chair Staley Messer, PhD, 2017 Presidet-Elect Daiel Fishma, PhD, Future Program Chair Marvi Goldfried, PhD, Chair of Commuicatios & Publicatios Committee Shigeru Iwakabe, PhD, Member of Educatio ad Traiig Committee Atoio Vasco, PhD, Member of Research Committee Ke Critchfield, PhD, Member of Executive Committee LOCAL ORGANIZING COMMITTEE Lyett Hederso Metzger, PsyD Uiversity of Dever Lavita Nadkari, PhD Uiversity of Dever Society for the Exploratio SEPI of Psychotherapy Itegratio Society for the Exploratio of Psychotherapy Itegratio 27