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Guildford BABCP conference: the four main areas I want to use clinically after this conference (eighth post)

I've already written a series of seven blog posts on this year's BABCP conference.  What are the key points I want to take away? I think they centre around four areas. Most important for me is what's been triggered by Michael Lambert's presentation on "Supershrinks and pseudoshrinks" . Secondly, a major theme (more so than at any other conference I've been to) was couple therapy. I spent a lot of time listening to a whole series of couples experts - what do I want to do with this information now? Thirdly there are the implications from the Dodo bird panel on depression treatments. Lastly there's a bits and bobs category.

Taking these in reverse order:

  1. Bits & bobs: There was an avalanche of information (as there always is) at this annual BABCP conference.  If you want to get a better idea of the richness on offer, try browsing through the 102 page "Conference abstracts book".  For example, I went to the "Symposium on cognitive factors that maintain GAD and worry" and it gave me another push towards increased use of reappraisal interventions.  As someone who took on board pretty quickly, in years gone by, that Behavioural Activation is as effective as full Cognitive-Behavioural Therapy for depression, I became pretty dismissive of "swatting the NATs" (disputing Negative Automatic Thoughts) with all the paraphenalia of thought records and forms of "thinking error".  However I'm now increasingly revisiting this "verbal challenging of beliefs" territory from a somewhat different angle.  This seminar's conclusion (in an analogue study) that verbal "positive processing" of worry is as or more effective than "positive" and "negative" imagery strategies underlines the value of the well-supported emotional regulation strategy of reappraisal - see the post "Reappraising reappraisal" or Barlow's simpler variant on this described in "Unified protocol - emotional awareness & cognitive reappraisal" with its focus just on challenging overestimation of occurence probability and severity.  I also enjoyed Susan Bogels take on evolutionary psychology and the particular importance of the father's role in helping children evaluate potential threat & opportunity in the external environment.  Lastly - and most importantly - in this "Bits & bobs" section, I want to celebrate the Ehlers, Clark & colleagues' carefully developed approaches for PTSD, for social anxiety, and for panic disorder.  I intend to continue to "expose myself" to their teaching when possible.  They ain't going to be around for ever ...

  2. The Dodo bird panel on depression treatments:  Well, what to do about this symposium underlining the very similar results obtained with any of the major psychotherapy approaches for depression?  I'd like to consider implications for my own practice of Pim Cuijpers et al's "Stepped care for depression in primary care: what should be offered and how?".  More specifically this suggests that I should check out more thoroughly what's available online and in book form that I could use for guided self-help.  I should also consider a pretty focused one-to-one brief therapy intervention for some people who don't do well enough with guided self-help.  Only then maybe should I be looking at full - 12 to 20 session - one-to-one psychotherapy.  It makes good sense for me to track how I'm doing (sharing this information with the client) and, if there isn't adequate predicted improvement in the first three or so sessions, I should be reviewing the possibility of additional/alternative interventions such as a different slant on the CBT, and/or couple work, and/or antidepressants.

  3. New information on couple therapy:  I want to chew more at this.  What are the indications I want to look out for that couple therapy could usefully be considered?  Well clearly there are the times when a couple contacts me directly wanting to work on their relationship.  It's worth noting as well the encouraging results reported in the paper on "The PREP program for individuals and couples: can interventions with one spouse help the relationship?" suggesting that " ... therapists can effectively work with only one partner "in the room" if they have a couples perspective as they conduct ... therapy".  Obviously there is the NICE guideline recommendation that "behavioural couples therapy should be considered for people who have a regular partner and where the relationship may contribute to the development or maintenance of depression, or where involving the partner is considered to be of potential therapeutic benefit."  I note that their suggestion "an adequate course of therapy should be 15 to 20 sessions over 5 to 6 months" is pretty time-consuming and expensive.  I want to read more and clarify in my own mind when it makes sense to offer a couple based intervention for other disorders like OCD, agoraphobia, GAD, addictions and so on.  I have access to a wealth of couple therapy books (some ordered because of suggestions from the conference).  There is a movement to try to integrate the well-supported couple interventions.  I intend to consider what this might best involve, with "Integrative couple therapy" as a fall-back preference.  Finally I intend to chase up some specific couple therapy supervision.   

  4. Supershrinks & pseudoshrinks:  OK, I'm quite fast out of the blocks on this one.  After the conference I got myself copies of the key papers "Using formal client feedback to improve retention and outcomes", "Using client feedback to improve couple therapy outcomes: a randomized clinical trial in a naturalistic setting", "Does a continuous feedback system improve psychotherapy outcome?" & "Effect of client feedback on couple psychotherapy outcomes".  I've joined the Center for Clinical Excellence and I've booked myself into a two day workshop in Copenhagen in mid-September to hear Scott Miller present on "The heart and soul of change" - a workshop on how to implement simple session-by-session client feedback on therapeutic progress and the therapeutic alliance.  Meanwhile I've downloaded and begun to experiment with the quick four item "Outcome Rating Scale (ORS) & Session Rating Scale (SRS)".

A couple of final comments I would make.  One is that, in a conference with so many parallel streams of information on offer (often eighteen at a time), it would be very possible for ten different attendees to have ten dramatically different experiences.  This series of eight posts on the BABCP conference is a very personal journey as I've picked my way through the many options on offer.  The second point I want to comment on is that it's very easy, in a busy life, to come away from this kind of experience and find that in a few months the insights, intentions & new knowledge have evaporated through lack of attention ... a bit like dead houseplants that haven't been adequately watered.  A challenge, planting the ideas that have most struck me over the days of the conference and trying to grow them into genuine improvements in how well I can help those coming to see me.  A very worthwhile challenge!  I hope some of the points I've made in these eight conference blogs will prove useful for you, the reader, as well.

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