Special Institute Presentations

SI-1. Treating Insecure Attachment in Group Psychotherapy

Instructor: Aaron Black, PhD, CGP, FAGPA

Attachment Theory concepts are highly applicable to group psychotherapy. In this Special Institute, Dr. Black will explore essential components  of attachment in childhood and within the therapy group.  The process of mentalization will be explained and used to inform interventions for the individual, subgroup, and group-as-a-whole. Specifically, the Institute will address how mentalization deteriorates into identifiable, primitive mental states that shape both client resistances to relational contact and immediacy as well as group leader countertransference.  Dr. Black will describe how awareness of, and sensitivity to, these primitive mental states (rather than general attachment styles) can enhance the leader's ability to locate, and intervene with, insecure attachment.  Instead of encouraging secure attachment within the group, developmentally appropriate intervention strategies will be explored that aim to remove barriers to the expression of this innate, biological capacity. 

Dr. Aaron Black holds a Ph.D. in Clinical Psychology, a CGP, and is in private practice in Rochester, New York, where he works clinically with individuals, couples and groups. Dr. Black is a faculty member of the Center for Group Studies in New York City and a Board member of AGPA.

Learning Objectives:
The attendee will be able to:
1. Define the concept of the secure base in attachment theory. 
2. Describe the secure base functions which facilitate emotional self-regulation. 
3. Define epistemic trust and epistemic vigilance. 
4. Provide an example of how resistance facilitates emotional self-regulation in group therapy. 
5. Describe the qualities of a successful attachment-focused intervention. 
6. Distinguish between effective vs. impaired mentalization.

References:

1. Black, A.E. (2019). Treating insecure attachment in group therapy: Attachment theory meets modern psychoanalytic technique. International Journal of Group Psychotherapy, 69(3), 259-286.
2. Flores, P. J. (2017). Attachment theory and group psychotherapy. International Journal of Group Psychotherapy, 67(Sup 1), S50-S59.
3. Fonagy, P., Campbell, C., & Bateman, A. (2017). Mentalizing, attachment, and epistemic trust in group therapy. International Journal of Group Psychotherapy, 67(2), 176-201.
4. Levine, R. (2011). Progressing while regressing in relationships. International Journal of Group Psychotherapy, 61(4), 621-643.
5. Zeisel, E. M. (2009). Affect education and the development of the interpersonal ego in modern group psychoanalysis. International Journal of Group Psychotherapy, 59 (3), 421-432.

SI-2: Mindfulness-Based Cognitive Therapy: Distinct and Overlapping Elements of Group Delivery of Mindfulness Meditation

 Instructor: Zindel Segal, PhD

This Special Institute will be an interactive learning experience combining didactic instruction with experiential exercises to teach the key aspects of mindfulness-based cognitive therapy (MBCT).  MBCT, originally developed as a group intervention, integrates techniques from mindfulness-based stress reduction with cognitive therapy for depression to teach individuals who have recovered from depression new skills to help prevent future relapses.  Key themes include experiential learning and the development of an open and acceptant mode of response, in which one intentionally faces behavioral difficulties and affective discomfort.  Increased mindfulness allows early detection of relapse-related patterns of negative thinking, feelings, and body sensations, allowing them to be "nipped in the bud" at a stage when this may be much easier than if such warning signs are not noticed or are ignored.  Formulation of specific relapse/recurrence prevention strategies are included in the later stages of treatment.

Dr. Zindel Segal is a clinical psychologist whose research examines the use of mindfulness meditation in promoting affect regulation skills in people suffering from a depressive and anxiety based disorder. His research program has two broad thrusts involving 1) the use of brain imaging to identify neural markers of depressive relapse or resilience associated with long-term practice of mindfulness meditation and 2) evaluating the efficacy of mindfulness-based clinical interventions delivered via online or mobile platforms as a means of increasing access to care.

Learning Objectives:
The attendee will be able to:
1. Outline the empirical rationale for providing patients with a mood disorder training in mindfulness meditation
2. Describe group practice of three of the core mindfulness meditations in MBCT
3. Discuss outcome of dyad based teaching of mindfulness practice and provide feedback.

References:
1. Farb, N., Anderson, A., Ravindran, A., Hawley, L., Irving, J., Mancuso, E., Gulamani, T., Williams, G., Ferguson, A., & Segal, Z. (2018). Comparison of Mindfulness-Based Cognitive Therapy or Group Cognitive Therapy for the Prevention of Relapse/Recurrence in Major Depressive Disorder. Journal of Consulting and Clinical Psychology, 86:200-204.
2. Goldstein, M.R., Turner, A.D., Dawson, S.C., Segal, Z.V., et al. (2019). Increased high-frequency NREM EEG power associated with mindfulness-based interventions for chronic insomnia: Preliminary findings from spectral analysis. Journal of Psychosomatic Research,  120:12-19.
3. Pahlevan, T., Ung, C., & Segal, Z. (2020). Cost-utility analysis of mindfulness-based cognitive therapy versus antidepressant pharmacotherapy for prevention of depressive relapse in a Canadian context. Canadian Journal of Psychiatry, 65:568-576.
4. Segal, Z., Dimidjian, S., Beck, A., Boggs, J., Vanderkruik, R., Metcalf, C., Gallop, R., Felder, J., & Levy (2020).  Outcomes of online mindfulness-based cognitive therapy for patients with residual depressive symptoms: A randomized clinical trial. JAMA Psychiatry, 77:563-573.
5. Segal, Z.V., Anderson, A.K., Gulamani, T., et al. (2019). Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy. Journal of Consulting Clinical Psychology, 87:161-170.