Master Clinician Seminar 5 - Using CBT to Address Treatment Refusal: A Family Consultation Approach
Saturday, November 18, 2023
11:00 AM – 1:00 PM PST
Location: Queets (505), Level 5
Earn 2 Credit
Keywords: Families, Motivation, Adherence Level of Familiarity: Moderate Recommended Readings: Swift, J.K., Greenberg, R.P., Tompkins, K.A., & Parkin, S. (2017). Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and
their combination: A meta-analysis of head-to-head comparisons. Psychotherapy, 54, 47-57., VanDyke, M., Pollard, C.A., Harper, J., & Conlon, K.E. (2015). Brief Family Consultation to families of treatment-refusers with symptoms of Obsessive-
Compulsive Disorder: Does it impact family accommodation and quality of life? Psychology, 6, 1553-1561., Johnco, C. (2016). Managing family accommodation of OCD in the context of adolescent treatment-refusal: A case example. Journal of Clinical
Psychology, 72, 1129-1138., ,
Professor Emeritus Saint Louis University St. Louis, Missouri
Treatment-refusal is a significant healthcare problem. Untreated psychiatric disorders often lead to a lifetime of distress and disability, and not just for the diagnosed individual. Impairment in one person can jeopardize the physical health, psychological well-being, and socioeconomic stability of the entire family. For most people, hope rests on the promise of getting help, but even evidence-based treatment can’t help someone who never receives it. When families reach out to healthcare professionals, they are told nothing can be done. In this seminar, I will describe something that can be done, an intervention called Family Well-Being Consultation (FWBC), a result of 3 decades of clinical development and research. FWBC uses established cognitive and behavioral principles and focuses on the well-being of the entire family. Families are taught how to shape recovery-compatible behavior in the treatment-refuser and how to reduce conflict and stress within the family. The seminar will include lecture, video, and demonstration of technique.
Outline
I. The Nature of Recovery Avoidance 1. Definition and Features 2. Common Misunderstandings 3. Contributing Factors
II. The Family’s Response 1. Accommodating 2. Minimizing
III. Development of the Family Trap 1. Early Stages 2. Advanced Stages
IV. 5 Steps of the Family Well-Being Intervention 1. Prepare for Crises 2. Redefine the Problem 3. Embrace Valued Activity 4. Ease Family Distress 5. Create a Recovery-Friendly Environment
Learning Objectives:
At the end of the session, the learner will be able to:
Identify 4 cognitive behavioral factors that contribute to treatment-refusal and other forms of recovery avoidance.
Describe how family accommodations reinforce recovery avoidance.
Define the term "minimization" and articulate how it exacerbates recovery avoidance.
Describe the 5 steps of Family Well-Being Consultation.
Develop/implement interventions to help families manage crises commonly associated with treatment-refusal.
Develop/implement interventions to help families reduce accommodations and expressed hostility.
Teach families how to use contingencies to shape recovery-compatible behavior in treatment-refusers.
Long-term Goal: Expand and diversify the patient populations they serve.
Long-term Goal: Promote the emotional well-being of family members other than the identified patient.