josh.spurlock

CEU TRAINING: INFIDELITY INTAKES

DATE:03-13-19

TIME:11:00-1:00 PM CT

OUTSIDE STUDY:1 Hour

DIDACTIC PRESENTATION:2 Hours

EDUCATOR:Shaun Lotter MA, LPC #200631338

SOURCES: 

NLT study Bible (2nd ed.). (2008). Carol Stream, Ill.: Tyndale House.

Affair Recovery Center – web published materials

Helping Couples Get Past the Affair – Baucom, D.H., Gordon, K.C. & Snyder, D.K. (2009). New York, NY.: The Guilford Press.

The Journey – Melissa Haas (2013)

Building for Freedom – Troy Haas (2012)

DESCRIPTION:

The training is targeted at assisting mental and behavioral health professionals to grow in their understanding and counseling of Christian clients. Counselors will be taught how to conduct individual sessions with betraying and betrayed spouses.  Additionally, therapists will learn how to conduct a full disclosure session.  Therapists will also integrate theological/faith components on such matters critical to the Judeo-Christian client population while integrating sound clinical skills.

OUTLINE:

• Betraying Spouse Individual Session
• Betrayed Spouse Individual Session
• Full Disclosure Couple’s Session

CLICK HERE for link to material in BOX Research Library

Sessions 2 & 3: Individual Full Disclosure Prep Sessions

• BETRAYING SPOUSE INDIVIDUAL SESSION OUTLINE (90 minutes):

1. Establish an understanding of the client’s history, beginning with childhood.  This is important to complete, as you will need to understand your client’s background to aid in putting the pieces of their story together.  Complete this step unless the client is resistant and does not have a sexual addiction.  In these cases, attempting to explore a more extensive understanding of their past can cause a level of frustration which may lead to termination of therapy, or, significantly hinder buy-in on the therapy process.  In sex addiction cases, getting a history is critical and cannot be skipped.  CLICK HERE for history questions.
   1. You are trying to identify the betraying spouse’s wounds and vulnerabilities, leaving them at risk for infidelity.  As you are talking through their history, it is important for you to be making observations, later being able to use these to make relevant connections to the present.
2. Have the client read their disclosure out loud to you.  Now you will go through the disclosure with the client, listening to determine how well they have completed the task and for any needed corrections.  Often times it is useful to give them a pen and clipboard to take notes if they have a physical copy of the disclosure, their devices if it is a digital copy, or have them send you a digital copy to use to share screen with them on ZOOM to make corrections with them as they go.   It will be important you listen for the following:
   1. Adequate level of detail.  You want to be sure to have the client remove graphic detail (the kind of detail that paints a vivid mental picture.  Example: I met with the affair partner at the hotel and she was wearing . . . lingerie and we had sex in these positions. . . Also, it is critical you listen for broad brush levels of detail.  The client is very vague about what they have done, speaking about it in a more general, even theoretical sense.  This is often due to shame and resistance.  Example: I saw my first Playboy at the age of 11 and have struggled ever since.  
   2. Blaming or justifications. The client has been operating in a great deal of self-deceit.  They are simply not capable of being completely honest without help.  As such, they may intentionally or unintentionally blame others (including the affair partner or their spouse) or make justifications for what they have done.  You will be helping them recognize these.  In the event they are highly resistant, you will likely be pausing to process the resistance, not simply the content needing correction.
   3. Just not doing it. In some cases, a client simply will not complete a written disclosure.  In these cases, we process the resistance.  The client may say they went ahead and shared with their spouse.  Again, process the resistance.  You will likely need to take time with the betrayed spouse to strengthen them in asking for what they want and need, rather than what the betraying spouse would prefer.  This kind of response is common in a relationship where there is a substantial power differential and the betraying spouse is accustomed to doing what they want.
3. Outline client’s plan for self-care and being compassionate with spouse following disclosure. It is helpful to point out to the betraying spouse how their partner is likely to feel and respond following disclosure.  Also, they will need to be intentional about how they will take care of themselves.  Here are some important points:
   1. You will likely feel significant relief following disclosure, your spouse will not.  As the betraying spouse, off-loading what you have been keeping hidden is a great feeling, even if it is painful.  However, it will be like you are backing up a dump truck and unloading a massive load all over your spouse.  They want the truth, but for them, the initial phase is going to be shocking and overwhelming, not relieving.  You may also feel closer to your spouse than you have in a long time, due to being honest with them.  Understand, they may not share this feeling.  You may have a strong desire to connect with them, even sexually, but they may be very closed off to this.
   2. Self-Care.  You need to proactively have a plan in place for how you are going to take care of yourself following disclosure.  This plan should include how you will care for yourself physically, emotionally, spiritually, and mentally.  As a part of this plan, you need to identify safe, supportive, same-gender individuals to be a support to you.  Your spouse is not going to be in a position to provide the support you might like, and you need another outlet.
   3. Drive & Sleep Separately.  It is usually a good idea to drive separately from your spouse to disclosure, as car rides following can be quite challenging.  Additionally, it is often wise to plan on one of you spending the night at a different location than the other spouse.
   4. Be ready to ask what is helpful. Your spouse is going to be in shock and overwhelmed.  It is important you are supportive and not a hindrance.  A simple way to do this is to ask what would be helpful for them rather than trying to guess.  Here are some examples:
      1. Would it be helpful for you to have time out by yourself or with your supports?
      2. Would it be helpful for me to listen to how you are feeling and what you are thinking?
      3. Would it be helpful to ask me questions, even if these are repeat questions?
      4. Would it be helpful for me to hug or hold you?
      5. Would it be helpful for me to share what I am feeling and thinking?
      6. Would it be helpful for me to reaffirm my commitment to our relationship?

BETRAYED SPOUSE INDIVIDUAL SESSION OUTLINE (90 minutes if possible):

1. Normalize and validate.  The betrayed spouse has never been in this position before and is uncertain.  Ask them how their heart is doing.  Be sure to reflect back to them and add where you can what would be normal.  Your goal is to hear them say, “Yes, that’s exactly how I feel right now.”  This assists in building rapport and them seeing your ability to help them.
2. We are going to take history but in a different order.  You want to walk through the history of the marriage relationship first, not childhood.  This is because the client is focused on the current issue.  If we begin in childhood, they may feel lost and struggle to see the relevance.  If we start with the marriage and the issue at hand, we can then move back to childhood, having already established relevance.  You can make this transition by letting them know it would be helpful for you in assisting them to know them and now that you know about the marriage, you want to understand their past.
3. Prepping for disclosure.  Now we are going to talk about getting ready for disclosure session and the days following.  Here are the points we want to make:
   1. What questions do you have and what clarifications do you need?  We are going to encourage the client to take time to write out questions they have any specific areas needing clarification.  Tell the client to write out any and all questions they can think of.  Then, take some time away from this list.  Come back to the list and ask the following about each question, “Will knowing the answer to this question help me heal or cause more injury?”  Any questions which would be helpful in healing are kept while the others are crossed out.  This list is then brought to disclosure.
   2. Identify and prep your support people. The client needs to identify at least one supportive, safe, same-gender person who can be a support to them.  The client will tell them what has happened in their life.  The client will also share the plan to complete full disclosure.  They will arrange to meet up with their support person following disclosure.  This time can be used to process, vent, cry, or just sit quietly.
   3. Drive & Sleep Separately.  It is usually a good idea to drive separately from your spouse to disclosure, as car rides following can be quite challenging.  Additionally, it is often wise to plan on one of you spending the night at a different location than the other spouse.
   4. You need to proactively have a plan in place for how you are going to take care of yourself following disclosure.  This plan should include how you will care for yourself physically, emotionally, spiritually, and mentally.
   5. Give yourself permission to ask for what would be helpful to you. Normalize for the client the reality they and their spouse will feel very differently following disclosure.  Again, their spouse will feel significant relief while they will feel shocked, numb, and overwhelmed.  They will feel burdened while their spouse feels unburdened.  As a result, the client may vary day to day or even moment to moment on what they need.  Encourage the client to see this is normal and to give themselves permission to ask for what they need.  Let them know, desiring closeness with their betraying spouse is not weakness, while at other moments, wanting space is not mean.

Session 4 or Later: Full Disclosure Couple’s Session

Now preparations have been made, we can move into the full disclosure couple’s session.  This is a 90 minute session with both spouse’s present. The session structure is as follows:

1. Welcome couple and outline structure. “I want to take a few moments at the beginning of our time to outline the structure of the session today.  Our purpose in meeting is full disclosure as the first step in all 3 of our recovery areas, your individual recovery (to the betrayed spouse), your individual recovery (to the betraying spouse), and the marriage’s recovery (to both).  I am going to have (betrayed spouse’s name) read through the disclosure they have prepared in its entirety.  As they read through their disclosure, (betrayed spouse’s name) I am going to ask you to have your list of questions and clarifications out.  I will give you a clipboard and pen.  As your spouse reads their disclosure, please make note of any additional questions which arise in your mind while they are sharing.  When they are finished sharing, you will go through all the questions and clarifications from your list which have not been fully addressed, including any new questions you have written down as they shared.  While we are going through your questions, I may present some of my own, as well.  Additionally, if I hear you asking a question which I believe may be harmful to you rather than helpful, I will pause you and ask about what would be helpful about know the answer to this.  I will not tell you what you ultimately can know the answer to.  If you decide you want to know the answer to that question even after we have explored your thoughts, you are welcome to ask it.  With any time remaining, I will dismiss you (to the betraying spouse) and use the remainder of our time to process with your spouse (to the betrayed spouse).  Do you have any questions with what I have outlined?” After answering questions, go ahead and set up follow-up individual or couple’s sessions rather than waiting until the end of session.
2. Walk through the session.
   1. Betraying spouse reads their letter.
   2. Betrayed spouse and therapist ask questions.
   3. Remaining time is spent processing with the betrayed spouse after dismissing betraying spouse (if any time remains).

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Practice Management:

We have updated our TIME OFF FORM (CLICK HERE) to include calculating client hours missed.  As a practice, our time is our inventory, meaning it is what we provide to the clients we serve.  Like any organization, we need to track our resources, and our time is one of those resources.  It enables us to plan as a practice if we are able to see how much clinician time is going to be available in a given month.

So, when you take time off, what you will do is calculate how many of the hours you normally keep available for clients you will be missing.  For example, if you normally have 32 hours on your schedule to see clients but will be missing a few days and keeping 10 hours of client availability that week, then you would enter 22 hours as the number of client hours missed.

Please be sure to click the link above to view the new form and copy it to your HR file, deleting the old time off form.

• Introduction
• Review of Common Unsafe Behaviors
• Identifying Safe Behaviors to Aid in Recovery

For notes CLICK HERE 

CEU TRAINING: Schema Therapy Interventions – Dependence/Incompetence & Enmeshment/Undeveloped Self Schemas

DATE: 12-05-18

TIME: 11:00-1:00 PM CT

OUTSIDE STUDY: 1 Hour

DIDACTIC PRESENTATION: 2 Hours

EDUCATOR: Shaun Lotter MA, LPC #200631338

SOURCES: 

NLT study Bible (2nd ed.). (2008). Carol Stream, Ill.: Tyndale House.

Schema Therapy– Young, Klosko & Weishaar, The Guilford Press, New York 2003

DESCRIPTION:

The training is targeted at assisting mental and behavioral health professionals to grow in their understanding and counseling of Christian clients. Counselors will be taught the Schema Therapy conceptualization and treatment of clients who have dependence/incompetence & enmeshment/undeveloped self schemas. Therapists will also integrate theological/faith components on such matters critical to the Judeo-Christian client population while integrating sound clinical skills.

OUTLINE:

•  Introduction
•  Review of Impaired Autonomy & Performance Domain
•  Dependence/Incompetence Schema Treatment Goals & Interventions
•  Enmeshment/Undeveloped Self Schema Treatment Goals & Interventions

IMPAIRED AUTONOMY & PERFORMANCE DOMAIN (a quick review)

Expectations about oneself and the environment that interfere with one’s perceived ability to separate, survive, function independently, or perform successfully.  Typical family origin is enmeshed, undermining of the child’s confidence, overprotective, or failing to reinforce child for performing competently outside the family.

DEPENDENCE/INCOMPETENCE SCHEMA:

It is not uncommon to encounter clients in the Impaired Autonomy & Performance Domain.  These individuals present as childlike and helpless.  They see themselves as unable to take care of themselves on their own and experience life as overwhelming.  Life seems so tough and they are inadequate to the challenge.  There are 2 components to this particular schema:

1. Incompetence – these individuals lack faith in their decisions and judgements about everyday life.  They hate fear and facing change alone.  They feel unable to face new tasks on their own and believe they need someone to show them what to do.  These fears can range in severity from mild to severe, in which case the individual may not even believe they will be able to feed, clothe, and shelter themselves apart from a support figure (this individual is in a kind of parent role for the client).
2. Dependence – this feature flows naturally out of the first, incompetence.   Since the individual is unable to function on their own, their only options are to find others to take care of them or to not function at all.  These caretakers are usually parents or substitute parents such as partners, siblings, friends, bosses, even therapists.

These clients do not typically come into therapy looking to work on this schema.  Instead, they present as seeking advice from an expert who can tell them what to do in life.  Their symptoms are often anxious or depressive, and they identify these as needing work.  Although, these symptoms often stem from the schema, such as a wife who is anxious and depressed because she is unable to consider setting boundaries with or leaving a controlling/abusive spouse.  Such clients exhibit behaviors like:

• asking others for help
• constantly asking questions as they work on new tasks
• repeatedly seeking advice about decisions
• having difficulty traveling alone
• having difficulty managing finances on their own
• giving up easily
• refusing additional responsibilities (like a promotion at work)

*Please be aware, a small percentage of these individuals will overcompensate by becoming non-dependent, doing everything on their own and shunning any kind of support as a means of distancing themselves from the struggle.  

Treatment Goals:

• Increasing client’s sense of competence and decreasing dependence on other people.
• Build self-confidence via identity work and increasing skill level in managing life challenges.
• Recognition of avoidance behaviors and processing fear & other emotions underneath, which may be connected to childhood.
• Deliberately engaging in life challenges, managing the frustration this creates without giving up.
• Understanding mistakes and failures as an acceptable part of learning.

Cognitive Strategies:

It is the goal of the cognitive strategies to begin to ask the client to challenge their current perceptions of themselves and the benefits of their behaviors.  The cognitive portion of work is identified by schema researchers as particularly important with this schema, as the client struggles with deeply entrenched ways of thinking which highlight the benefits and safety of their dependence/incompetence while minimizing the costs.  Instead, therapists should challenge this thinking, pointing out the limitations of this way of operating, such as unfulfilled emotional needs, a lack of autonomy, and no self-expression.  Additionally, the clients must learn to question their struggle with identifying anxiety as a bad thing, not to be tolerated.

Behavioral:

This intervention is critical if the client is going to gain enough real evidence to refute the schema.  They must confront the anxiety producing situations in order to grow.  Therapist and patient work to assign managing daily life challenges, starting with the easiest, so anxiety can be brought up and managed, while the client has success in mastering tasks.  Role play with the therapist and problem solving are useful.  Additionally, the therapist equips the client with anxiety management techniques – such as flash cards, breathing exercises, relaxation techniques, and rational responding.  Finally, successes should be celebrated by the therapist, who also encourages the client to reward themselves outside of session.

Experiential:

This kind of work may be more limited with this client.  It is valuable to examine origin of the schema and address abuse, trauma, or simply poor parenting which resulted in the struggle.  Be aware you may find a significant trauma history, though not always.  Be aware, if there is trauma, it is important to begin stabilization work, including DBT, rather than moving strongly into working on the dependence/incompetence schema.

ENMESHMENT/UNDEVELOPED SELF SCHEMA:

These clients are often fused with a significant other, leaving difficulty seeing where the client’s identity begins and the enmeshed other ends.  This person is usually a parent or parental figure, such as a partner, sibling, boss, or best friend.  Clients feel an extreme emotional involvement and closeness with the parental figure, at the expense of fun individuation and normal social development.  There is often the sense that neither the client nor the enmeshed other could survive or function without the other.  Additionally, these clients struggle to have a sense of self, which they will often describe as a feeling of emptiness.  They have often surrendered their identity in order to maintain their connection to the parental figure.  It is possible for a client to have one of the traits, enmeshment or undeveloped self, without the other.  For example, a client who had very dominant parents may never have developed a sense of self but is not enmeshed.  However, a client with an enmeshed parent almost always lacks a sense of self.  Struggles with this schema may present as:

• copying the behaviors of the parental figure
• talking about or thinking about him/her
• staying in constant contact with the parental figure
• suppressing all thoughts, feelings, and behaviors that are discrepant from the parental figure
• feeling overcome with guilt in any attempts to separate from the parental figure, including having boundaries

Cognitive:

These strategies work to challenge the client’s view that it is preferable to be enmeshed with the parent figure than to have an identity of one’s own.  Therapist and client explore the advantages and disadvantages of developing a separate sense of self.  Clients identify how they are similar and different from the parental figure.  Identifying similarities is important, as it is unhelpful for the client to go to the extreme and deny any likeness to the parental figure, creating fantasy preferences which are simply opposition to them.  Finally, the client can conduct dialogue between the enmeshed part of self that wants to stay in this kind of relationship with the parental figure and the healthy side who sees value in having a sense of self.

Experiential:

Clients visualize separating from the parental figure in imagery.  For example, clients relive moments in childhood when they disagreed with or felt different from the parent.  They imagine saying what they truly felt and doing what they truly wanted to do.  They imagine telling past and current parental figures how they are different, and how they are alike.  They imagine setting boundaries with past and current parental figures, such as refusing to divulge information or to spend more time together.  The Healthy Adult, played first by the therapist and then by the patient, helps the enmeshed child accomplish the separation.

Behavioral:

These strategies emphasize the client finding their own preferences and natural inclinations.  The client begins to list experiences they find inherently enjoyable.  They may be asked to list their favorite music, movies, books, restaurants, etc.  Clients list what they like & dislike about the significant others.  Behavioral strategies include asserting oneself in the relationship with the parental other.  In the case of this person being the spouse, understand that these individuals often choose a very dominant spouse and become immersed in the spouse’s world.  As such, learning how to be fully themselves in the relationship, including expressing preferences and setting boundaries is critical.