Symptom Media New Releases

In this video, Ray fails to adequately explain Sonya’s rights over her personal health information. Sonya is upset that Ray provided a diagnosis without telling her, and is concerned that this could prevent her from obtaining custody for her son. Ray dismisses her concerns, saying he only provided the diagnosis for insurance billing purposes. He also confuses Sonya by saying he could change the diagnosis if she’s upset about it. By failing to explain how he diagnoses and how he safeguards his client’s information, Ray breaches his client’s trust and undermines the therapeutic relationship.

Ethical Standard:

Primary: APA Ethics Code 10.01 Informed Consent to Therapy; ACA Code E.5 Diagnosis of Mental Disorders; APNA Code Standard 2 Diagnosis

Secondary: APA Ethics Code 4.01 Maintaining Confidentiality, 4.05 Disclosures; ACA Code B.3 Information Shared with Others; APNA Code Standard 9 Communication

Teaching Points:

Assigning a mental health diagnosis is not merely a routine standard of daily practice; it’s a tremendous responsibility. Clinicians must consider a diagnosis’ validity (is the diagnosis useful and accurate?) and reliability (would another clinician reach the same conclusion?). Historically, the consequences of a diagnosis ranged from involuntary commitment to forced sterilization. Today, it could still result in clients losing their jobs, contact with their families, or the right to care for their children. Given these risks, clinicians must communicate clearly with their clients when they determine a diagnosis. Practitioners should be especially cautious about how third party contractors protect client information or address data breaches, especially in light of their potential economic interests. Ethical practitioners must reduce the risks inherent in assigning a mental health diagnosis and in protecting the confidentiality of this information.  Learn more.

In this video, Ray uses his expertise inappropriately. When his client Oscar expresses doubt over how helpful a specific modality is for him, Ray refuses to listen to or discuss his concerns. Instead, Ray reiterates how helpful these techniques are for others, and insists that Oscar should trust him because he is the expert. By weaponizing his knowledge on the subject, Ray fails to help Oscar explore his own unique experience, which undermines his autonomy in making decisions about his treatment.

Ethical Standard:

Primary: APA Ethics Code 2.01 Boundaries of Competence; ACA Code C.2 Professional Competence; APNA Code Standard 4 Planning

Secondary: APA Ethics Code 10.01 Informed Consent for Therapy; Nursing Code 3 Outcome Identification; APNA Code Standard 8 Cultural Humility

Teaching Points:

Therapists rarely ask for blind trust from their clients. Therapists must instead foster trust by being clear about the limits of their own competence and demonstrating it through their professional behavior. Asking clients to suspend their judgements about a therapist’s approach undermines their critical thinking skills, and encourages a mystical view of the therapeutic process. Sheldon Kopp, an Existential Psychologist, advises that as soon as a person finds the “solution” to their problems embodied in the therapist, they should find a new therapist. This is because therapists who promote blind trust risk being seen as gurus or healers. Therapists should instead encourage their clients to attune to their own experience of the therapy, monitor progress, and pivot accordingly.  Learn more.

In this video, Ray fails to center his client Oscar’s experience by interrupting him and insisting on bad advice. When Oscar explains how his attempt to talk to his boss about a work conflict backfired, Ray doesn’t listen to him. Instead, he blames Oscar for not employing his advice effectively, and recommends he tries the same strategy again. Ray also fails to notice Oscar’s discomfort with his suggestions, instilling doubt and controlling Oscar rather than providing any kind of therapeutic interaction.    Learn more.

In this video, Ray crosses a professional boundary by pushing Henry to take a specific course of action. Rather than elicit Henry’s thoughts and feelings about his challenge communicating with his romantic partner, Ray imposes his point of view on the issue. Moreover, he shares a personal anecdote that implies not taking his advice would result in Henry remaining alone forever. This undermines Henry’s personal autonomy, and shifts focus away from his own experience.    Learn more.

In this video, Ray harms the relationship with his client by responding judgmentally when Henry shares that taking his advice backfired. Rather than take responsibility for providing a vague and unclear suggestion, Ray instead blames the outcome on Henry. He questions Henry’s judgment and insists that he didn’t employ his advice well. By insisting that his advice was well intentioned, Ray causes Henry to lose trust in him altogether.    Learn more.

In this video, Ray fails to connect with his client Sonya by rigidly recommending a strategy that isn’t working for her. Sonya describes how difficult it is for her to engage in behavioral activation, and expresses doubt about this strategy working for her. Rather than listen to her and being curious about what’s making this difficult, Ray insists that she try the strategy again. By citing research and providing a needless self-disclosure, Ray prioritizes his so-called expertise over Sonya’s internal experience, which irritates her and harms their relationship.  Learn more.

Claire takes 5 mg of Lortab, twice a day, sometimes a total of 20mg a day. Claire feels she now takes Lortab more to help deal with stress rather than her neck pain. Claire believes the Lortab prescription has been beneficial to her in making life more manageable, providing her a sense of calm, and increasing her productivity. Claire has been taking Lortab for last six or seven months and admits that the pills are not as effective as when she started the prescription.

When asked whether Claire has requested pills from friends and family, Claire acknowledges requesting pills from her neighbor. Though Claire knows that Lortab is highly addictive, she’s insists she is not susceptible to it. At night, Claire drinks a glass of wine, but she says she does not drink right after top taking her Lortabs but takes her last Lortab pill right before going to bed to help her sleep. When informed of the danger mixing opiates and alcohol, Claire does not agree with the clinician’s warning. Furthermore, Claire reports she does not have withdrawal symptoms during times when she is not taking Lortab.

Continuing the interview, Claire asks the clinician whether he prescribes pain medications, initially hoping to extend her prescription. Recognizing she may have overstepped, Claire quickly attempts to change the conversation to the clinician’s credentials. As the interview examines Claire’s personal life, we learn that it has been three months since Claire stopped working, which she says was a result of her boss being unaccommodating to her pain issues. Claire feels the Lortabs helped her at work. However, when the effects of the Lortab would run out while at work, Claire could become stressed and irritable. Claire claims that the reason for the Lortab ineffectiveness was due to her boss increasing her workload rather than an issue of tolerance to the dosage. Upon further examination, Claire admits she missed appointments because she was squeezing in doctor’s appointments to renew her prescriptions. Presently, Claire has stopped looking for work and her friends are concerned. Yet rather than listen to her friends, Claire has ended those friendships saying she doesn’t need negativity in her life. Instead of having fun, all she does is worry her problems and care for other people.

The purpose of this course is to assist the healthcare professional in identifying insomnia through a client’s nonverbal behaviors.

• Healthcare providers need to possess the knowledge of insomnia symptoms from not just what the person verbalizes, but also from their mannerisms and body language.
• Healthcare providers need to be competent in identifying nonverbal symptoms so they are able to complete a more detailed assessment to diagnose insomnia and/or refer to specialty providers for further assessment and treatment if needed.
• Healthcare providers need to perform appropriate follow up questions based on the nonverbal symptoms a client may present with.

Patients may not verbally discuss their symptoms or experiences with insomnia with their healthcare provider. There are nonverbal symptoms of insomnia that can signal that distress and possibility of a psychiatric condition. Identifying and speaking to these symptoms, may open the door for a conversation about insomnia, healthy sleep and possible health consequences due to sleep deprivation. This conversation can get the client connected to resources, services and treatments that will help.

• Learners will gain knowledge about the nonverbal insomnia symptoms that may be seen in an interview with a client or expressed by a concerned support person.
• Learners will be competent in their ability to identify patients who may be suffering from insomnia.
• Learners will show improved performance in their ability to identify nonverbal symptoms of insomnia and ask appropriate follow up questions to assist in diagnosing this condition.

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The purpose of this course is to assist the healthcare professional in understanding how to diagnose, identify and treat Schizoid personality disorder.

• Healthcare providers need to possess the knowledge to identify Schizoid personality disorder.
• Healthcare providers need to be competent in diagnosing Schizoid personality disorder because symptoms can be difficult to differentiate from other psychiatric conditions.
• Healthcare providers need to perform and provide appropriate education to the client about treatments for Schizoid personality disorder.

Patients may not understand symptoms of a personality disorder and how they can negatively impact their life. Those with Schizoid personality disorder may want help with these symptoms if they feel they are distressing to their life and may seek help from mental health professionals. Knowing the clinical features and suggested treatments for this condition will allow this condition to be appropriately identified and treated.

• Learners will gain knowledge about the characteristics of schizoid personality disorder.
• Learners will be competent in their ability to identify schizoid personality disorder symptoms in patients whom they treat.
• Learners will show improved performance in their ability to choose appropriate treatments for Schizoid personality disorder.

The purpose of this course is to assist the healthcare professional in understanding effective treatments for delusional disorders.

• Healthcare providers need to possess the knowledge to diagnose delusional disorder.
• Healthcare providers need to be competent in treating delusional disorder.
• Healthcare providers need to perform and provide appropriate education to the client about treatments used for this disorder.

Patients may present with symptoms of a delusional disorder, but not have understanding that their thought process is related to a mental health condition. Having a comprehensive understanding of the treatment options available to use for delusional disorder help the healthcare provider treat the patient in a comprehensive approach.

• Learners will gain knowledge about the various interventions used to effectively treat delusional disorder.
• Learners will be competent in their ability to identify treatments that will help clients based on symptoms associated with delusional disorder.
• Learners will show improved performance in their ability to educate patients about risk factors for and  interventions used in delusional disorder.

The purpose of this course is to assist healthcare professionals in building and maintaining a strong therapeutic alliance via telehealth.

• Healthcare workers must possess the knowledge of the therapeutic alliance.
• Healthcare workers need to be competent in the components of the therapeutic alliance.
• Healthcare workers need to accurately engage in behavior to strengthen the therapeutic alliance with telehealth clients.

Telehealth is a widely accepted and utilized platform to deliver mental health services. Many providers fear that telehealth may be a barrier to forming a strong and thriving therapeutic alliance. It is important that healthcare providers gain knowledge and competency about the therapeutic alliance via telehealth, and that they engage in behavior to strengthen and maintain it with their clients.

• Learners will gain knowledge of the therapeutic alliance.
• Learners will feel competent in their ability to identify the aspects specific to telehealth that can improve the alliance.
• Learners will show performance improvement in their ability to build and maintain a strong therapeutic alliance with telehealth clients.

Claire says she has a single glass of wine every night and nothing else. When at a party, however, she may have up to three or four drinks but never six. Claire states she can always stop if she wants to and has not had any poblems with drinking since her children were young. Claire’s never been unable to fulfill an obligation, or wasn’t able to do something because of drinking. Claire never drinks in the morning, which is when she takes her prescription of Lortab. Claire clarifies this statement, adding that she might “indulge” with a glass around midday or brunch but that she never mixes her pills and alcohol. Those times when she does drink during the day do lead to feelings of guilt. During those times which she drinks more heavily at parties, Claire can have hazy memories. Her son, Scotty was injured once as a result of her drinking but, as she says, did not have to go to hospital as a result of the injuries. The incident happened when Scotty, who was staying at a friend’s house, called Claire to pick him up. At that point Claire already had a couple glass of wine and her pills and couldn’t get a hold of her mother or husband and so therefore drove, which led to her “bumping him” with her car. Claire admits that she’s also injured herself when drinking and her mother has expressed concern for her drinking because her father was an alcoholic.

Claire has not been feeling nervous or on edge as her Lortab prescription helps provide her with a sense of calm throughout the day and at night. Recently, Claire has been worried about finding a nursing home for her mother and whether her oldest son can take care of himself while at college. To relax, Claire enjoys her glass of wine in the evening and taking a walk in the park on the weekends. Claire admits to being irritable when she doesn’t take her Lortabs.

Claire does not have any current or prior legal issues or history of incarceration. In the past, Claire received a DUI once and was in an accident earlier this year but the responding officer did not check her sobriety in that incident. Claire admit that one time when she was at her cousin’s house, she stole some Percocet from the medicine cabinet. Claire knows it was wrong to take the Percocet and mix it with her Lortab prescription but she excuses the behavior because it was the week she found out her husband Donny was cheating. Finally, Claire discusses a time when she stole a prescription pad out of her doctor’s desk. Claire thought about using it, but ended up throwing the prescription pad away instead. One holiday weekend, when Claire was completely out of her medication, she called a friend to ask for her pills. Claire knows this was wrong and potentially dangerous, but insists she was desperate. Claire feels these episodes go against her identity. As the interview progresses, it becomes apparent that Claire is using multiple doctors to acquire multiple prescriptions.

Claire describes her mood as decent though lately she feels more overwhelmed than passionate about her work. Claire used to love to read, but she attributes her poor eyesight for not enjoying that activity lately. Becoming tearful, Claire opens up about having spent so much energy being a mother that she’s fearful what her role will be when her kids go to college. Furthermore, her mother’s health is declining and her she worries her husband, who has been spending a lot of time away from home, will leave her. Claire is able to sleep thanks to taking a pill before bed. During the day, she is lacking in energy because her activity level is minimal. Since she’s stopped working and mainly stays home watching television and going on the internet, Claire has gained thirty pounds. Claire’s mom has been critical of her use of Lortabs and drinking alcohol, which Claire believes helps her to hold everything together. By the end of the interview, Claire says she’s tired of letting her family down.

Claire lists using marijuana only once in college, does not regularly use tranquilizers, and only once took Xanax when she found out her husband was cheating on her. Claire has never used any stimulant, cocaine, heroin, or hallucinogens. Currently, Claire is on a prescription for Percocet and Lortabs to treat her headaches. Claire believes she can stop taking the Percocet and Lortabs when she wishes. However, when Claire stopped taking opioids in the past, she became agitated and experienced a return of her headaches and neck pain. Claire describes the pills as giving her control of her life, helping her get through the work day and cope with recent family issues she’s been going through. Claire says her husband does not find her Lortab use problematic but is instead thankful that the pills help. Claire had some recent trouble at work missing appointments and with what she describes as personality conflicts with her boss. Claire feels disappointed that she hasn’t been there for her boys the way she should have been and blames herself for an incident when her aging mother fell down the stairs under her care.

The purpose of this course is to assist the healthcare professional in understanding effective treatments for grief symptoms.

• Healthcare providers need to possess the knowledge to identify normal grief and differentiate it from prolonged grief disorder
• Healthcare providers need to be competent in treating grief symptoms.
• Healthcare providers need to perform and provide appropriate education to the client about treatments used for grief symptoms.

Patients may present with symptoms of a grief and bereavement process to a healthcare professional, and this disturbance may be causing significant distress and impairment in their lives. Having a comprehensive understanding of the treatment options available to use for grief symptoms help the healthcare provider treat the patient with a  comprehensive approach.

• Learners will gain knowledge about the various interventions used to effectively treat grief symptomatology.
• Learners will be competent in their ability to identify treatments that will help clients based on symptoms of their grief process.
• Learners will show improved performance in their ability to educate patients about risk factors for and interventions used in grief.

Learning Objectives

By the end of this course learners will be able to:

1. Review symptom criteria for grief, bereavement and prolonged grief disorder.
2. Discuss risk factors for prolonged grief disorder.
3. Identify non-pharmacological treatments for grief symptoms.
4. Demonstrate understanding of pharmacological interventions used to treat grief symptomatology.

The purpose of this course is to assist the healthcare professional in understanding how to diagnose, identify and treat paranoid personality disorder.

• Healthcare providers need to possess the knowledge to identify paranoid personality disorder.
• Healthcare providers need to be competent in diagnosing paranoid personality disorder because symptoms can be difficult to differentiate from other psychiatric conditions.
• Healthcare providers need to perform and provide appropriate education to the client about treatments for paranoid personality disorder.

Patients may not understand symptoms of a personality disorder and how they can negatively impact their life. Those with paranoid personality disorder may want help with these symptoms if they feel they are distressing to their life and may seek help from mental health professionals. Knowing the clinical features and suggested treatments for this condition will allow this condition to be appropriately identified and treated.

• Learners will gain knowledge about the characteristics of paranoid personality disorder.
• Learners will be competent in their ability to identify paranoid personality disorder symptoms in patients whom they treat.
• Learners will show improved performance in their ability to choose appropriate treatments for paranoid personality disorder.

The purpose of this course is to assist the healthcare professional in identifying trauma and/or stress through a client’s nonverbal behaviors.

• Healthcare providers need to possess the knowledge to identify stress and trauma symptoms from not just what the person verbalizes, but also from their mannerisms and body language.
• Healthcare providers need to be competent in identifying nonverbal symptoms so they are able to complete a more detailed assessment to diagnose an trauma or stressor related disorder and/or refer to specialty providers for further assessment and treatment if needed.
• Healthcare providers need to perform appropriate follow up questions based on the nonverbal symptoms a client may present with.

Patients may not verbally discuss their symptoms or experiences with stressors or traumatic events. There are nonverbal symptoms of trauma and stress that can signal that distress and possibility of a psychiatric condition. Identifying and speaking to these symptoms, may open the door for a conversation about stress and trauma and help the client get connected to resources, services and treatments that will help.

• Learners will gain knowledge about the nonverbal trauma and stress symptoms that may be seen in an interview with a client or expressed by a concerned support person.
• Learners will be competent in their ability to identify patients who may be suffering from a trauma or stressor related disorder.
• Learners will show improved performance in their ability to identify nonverbal symptoms of stress and trauma and ask appropriate follow up questions to assist in diagnosing a trauma or stressor related disorder.

Learning Objectives

By the end of this course learners will be able to:

1. Identify the nonverbal symptoms of trauma and stress common in patients with these conditions.
2. Discuss DSM-5-TR diagnoses that are commonly associated with these symptoms.
3. Describe assessment questions for health professionals to use to further assess patients presenting with nonverbal symptoms of trauma and stress.
4. Review common misconceptions related to symptoms of trauma and stress.

The purpose of this course is to assist the healthcare professional in understanding how to diagnose, identify and treat paranoid personality disorder.

• Healthcare providers need to possess the knowledge to identify paranoid personality disorder.
• Healthcare providers need to be competent in diagnosing paranoid personality disorder because symptoms can be difficult to differentiate from other psychiatric conditions.
• Healthcare providers need to perform and provide appropriate education to the client about treatments for paranoid personality disorder.

Patients may not understand symptoms of a personality disorder and how they can negatively impact their life. Those with paranoid personality disorder may want help with these symptoms if they feel they are distressing to their life and may seek help from mental health professionals. Knowing the clinical features and suggested treatments for this condition will allow this condition to be appropriately identified and treated.

• Learners will gain knowledge about the characteristics of paranoid personality disorder.
• Learners will be competent in their ability to identify paranoid personality disorder symptoms in patients whom they treat.
• Learners will show improved performance in their ability to choose appropriate treatments for paranoid personality disorder.

Learning Objectives

By the end of this course learners will be able to:

1. Define the criteria for a general personality disorder.
2. Define paranoid personality disorder and its diagnostic criteria.
3. Describe the signs, symptoms and common behaviors of paranoid personality disorder.
4. Discuss possible causes of paranoid personality disorder.
5. Identify behaviors that are a risk for harming the self or others.
6. Name evidence-based treatments for paranoid personality disorder.

The purpose of this course is to assist healthcare professionals in learning strategies for minimizing and properly handling technology issues that may arise during teletherapy.

• Healthcare workers must possess the knowledge of how technology issues may impact teletherapy.
• Healthcare workers need to be competent in addressing technology issues.
• Healthcare workers need to accurately identify strategies that can minimize technology issues.

Technology issues are commonly experienced during teletherapy sessions. Given the increased use of telehealth as a mode of treatment, many practitioners struggle with knowing how to handle technology issues as they arise. It is imperative that telehealth providers become familiar with implementing strategies that will increase their ability to appropriately address technology issues if they arise during teletherapy, and how to prevent and minimize future occurrences.

• Learners will gain knowledge of common technology issues that can arise during teletherapy.
• Learners will feel competent in their ability to address technology issues.
• Learners will show performance improvement in their ability to troubleshoot and prevent technology issues.

Learning Objectives

By the end of this course learners will be able to:

1. Identify common technological issues that may arise during teletherapy.
2. Identify strategies that may decrease technology issues in teletherapy.
3. Identify general guidelines to follow when technology issues arise.
4. Define misconceptions about technology issues and telehealth.

In discussing Mr. Barber’s criminal history, we learn the “couple times” that he was in trouble with the law including spousal assault and a fight in a bar. He demonstrates poor insight, claiming that each one of these episodes was not his fault and that other people “accuse him of stuff.” The result of these incidents was to be admitted to jail and then to a “nut house.”

Interviewed by the nurse, Mr. Barber talks about his time in the marines, later his employment as a contractor, and numerous other jobs he has held and lost. Mr. Barber insists that the reason he’s held so many jobs is because “people don’t like to listen.”

When questioned by a nurse as to why he was admitted to the hospital, Mr. Barber discusses the ulcer on his foot and that he is supposed to be on a special diet for his diabetes. However, Mr. Barber refuses to cooperate with any treatment plan and admits that he has been admitted multiple times to the behavioral health unit for his bipolar disorder.

When questioned by a nurse as to why he was admitted to the hospital, Mr. Barber is uncooperative and short, explaining that his children have forced him to be here. He hides the truth in regards to his being non-compliant with his diabetes diet and is adamant that he should not be at the hospital.

When questioned by a nurse as to why he was admitted to the hospital and whether he is compliant with his diabetes diet, Mr. Barber initially withholds the truth. When pressed further, he reluctantly admits that he isn’t adhering to his diet from time to time.

Upon first request, Mr. Barber, who has been standing and in pain because of an ulcer, refuses to get off his feet. In order to get Mr. Barber off his feet the nurse negotiates with the patient: if Mr. Barber sits down, she is willing to discuss his diet with him and find something that he’d like to eat.

When questioned about his current and prior relationships, Mr. Barber discusses his previous marriages, why he is divorced, and his three children. During the interview, Mr. Barber repeatedly insists that the nurse is “checking him out” and is sexually interested in him.

The nurse questions Mr. Barber about his past admittance to behavioral units because of his history of bipolar disorder. When discussing his periods of depression, Mr. Barber denials any thoughts of suicide. He claims he has more highs than lows and details his behavior in his periods of mania.

The nurse questions Mr. Barber as to why he entered a behavioral unit the past. Mr. Barber admits that he’s had suicidal thoughts and made plans to kill himself. When his children took away his gun, Mr. Barber said that he made plans to jump off a bridge. The nurse asks Mr. Barber to enter into a contract for safety. Mr. Barber responds that he will not tell the nurse or anyone if he has suicidal thoughts again.

The purpose of this course is to assist the healthcare professional in understanding how to diagnose, identify and treat dependent personality disorder.

• Healthcare providers need to possess the knowledge to identify dependent personality disorder.
• Healthcare providers need to be competent in diagnosing dependent personality disorder because symptoms can be difficult to differentiate from other psychiatric conditions.
• Healthcare providers need to perform and provide appropriate education to the client about treatments for dependent personality disorder.

Patients may not understand symptoms of a personality disorder and how it can negatively impact their life. Those with dependent personality disorder may want help with these symptoms if they feel they are distressing to their life and may seek help from mental health professionals. Knowing the clinical features and suggested treatments for this condition will allow this condition to be appropriately identified and treated.

• Learners will gain knowledge about the characteristics of dependent personality disorder.
• Learners will be competent in their ability to identify dependent personality disorder symptoms in patients whom they treat.
• Learners will show improved performance in their ability to choose appropriate treatments for dependent personality disorder.

Learning Objectives

By the end of this course learners will be able to:

1. Define the criteria for a general personality disorder.
2. Define dependent personality disorder and its diagnostic criteria.
3. Describe the signs, symptoms and common behaviors of dependent personality disorder.
4. Discuss possible causes of dependent personality disorder.
5. Identify behaviors that are a risk for harming the self or others.
6. Name evidence-based treatments for dependent personality disorder.

The purpose of this course is to assist the healthcare professional in understanding how to identify delusional disorder and important aspects of patient education to provide to those suffering with this condition.

• Healthcare providers need to possess the knowledge to diagnose delusional disorder and differentiate this condition from other health concerns.
• Healthcare providers need to be competent in diagnosing delusional disorder.
• Healthcare providers need to perform and provide appropriate education to the client about this condition.

Patients may not understand or know they have a delusional disorder or how it is impacting their life. Having a comprehensive understanding of delusional disorder, will help the healthcare professional identify this disorder from other conditions and better provide appropriate care for individuals who have consistent delusions.

• Learners will gain knowledge about the criteria for delusional disorder.
• Learners will be competent in their ability to identify patients who suffer from delusional disorder.
• Learners will show improved performance in their ability to educate patients about some of the misconceptions related to delusional disorder.

Learning Objectives

By the end of this course learners will be able to:

1. Define symptom criteria for delusional disorder.
2. Differentiate delusional disorder from disorders with similar presentation.
3. Identify diagnoses that commonly co-occur with delusional disorder.
4. Demonstrate understanding of common misconceptions related to delusional disorder.

The purpose of this course is to assist the healthcare professional in identifying depression through a client’s nonverbal behaviors.

• Healthcare providers need to possess the knowledge to identify depression symptoms from not just what the person verbalizes, but also from their mannerisms and body language.
• Healthcare providers need to be competent in identifying nonverbal symptoms so they are able to complete a more detailed assessment to diagnose major depression and/or refer to specialty providers for assessment and treatment.
• Healthcare providers need to perform appropriate follow up questions based on the nonverbal symptoms a client may present with.

Patients often do not discuss their feelings of depression due to stigma. They may deny when asked in an interview, but for many clients who experience depression there will be nonverbal symptoms expressed when they meet with healthcare professionals. Identifying and speaking to these symptoms, may open the door for a conversation about depression and help the client get connected to resources, services and treatments that will help.

• Learners will gain knowledge about the nonverbal depression symptoms that may be seen in an interview with a client or expressed by a concerned support person.
• Learners will be competent in their ability to identify patients who may be suffering from depression
• Learners will show improved performance in their ability identify nonverbal symptoms of depression and ask appropriate follow up questions to assist in diagnosing depression.

Learning Objectives

By the end of this course learners will be able to:

1. Identify depression and nonverbal symptoms common in patients with this condition.
2. Discuss DSM-5-TR diagnoses that are commonly associated with these symptoms.
3. Describe assessment questions for health professionals to use to further assess patients presenting with nonverbal  depressive symptoms.
4. Review common misconceptions related to symptoms of depression.

The purpose of this course is to assist the psychiatric provider in understanding treatment of schizophrenia with long acting injectable antipsychotics and how this treatment option can be valuable in a patient plan of care.

• Healthcare providers need to possess the knowledge of long acting injectable antipsychotics.
• Healthcare providers need to be competent in using these medications in schizophrenia treatment.
• Healthcare providers need to perform appropriate education to the client and family member(s) about this treatment option.

Individuals may present with limited treatment of their current antipsychotic regimen due to issues with limited insight and adherence. Long acting injectable antipsychotic medications have benefits to help patients function optimally but due to some of the challenges related to patient fear, lack of patient education and the option not being offered, many patients are not prescribed LAI antipsychotics. It is imperative that psychiatric providers have knowledge regarding these valuable treatments that can limit hospitalizations and improve overall outcomes in schizophrenia.

• Learners will gain knowledge about long acting injectable antipsychotics and the different types available.
• Learners will be competent in their ability to identify patients who would benefit from treatment with long acting injectable antipsychotic medications
• Learners will show improved performance in their ability to educate patients and families about the treatment option of long acting injectables and choosing an appropriate long acting injectable based on patient needs.

Learning Objectives

By the end of this course learners will be able to:

1. Define long acting injectables.
2. Describe the benefits of long acting injectables in Schizophrenia.
3. Identify the challenges prescribing long acting injectables.
4. Differentiate between the types of LAI.

The therapist welcomes Oscar to the session and remarks that he seems to be feeling tired. Oscar explains that his neighbors made loud noises until late into the night and did not allow him to sleep. He further shares that this and other grievances occur often, like those neighbors throwing trash and being rude to them, which Oscar believes may in part be due to them being black. The therapist points out that race is one among many sources of cultural differences that could result in him not getting along with his neighbors, and helps Oscar consider possible avenues to manage this conflict. Oscar determines he cannot move because rent is too costly elsewhere, and expresses a reticence to get to know his neighbors. The therapist then engages Oscar in discussing how feeling like a situation is beyond his control is impacting his wellbeing.

Oscar begins the session by sharing his anger over continually not being paid by his employer. He explains that he and his coworkers have had to beg to be paid on time, yet his employer continues to be excessively late in paying them because they are undocumented. The therapist validates Oscar’s reaction, and explains that although he is undocumented, he has a right to his earned wages and there are advocacy groups she could refer him to for help. She then asks about Oscar’s experience working in Guatemala, and he shares many details about learning carpentry from his father and taking pride in his work. Oscar then indicates his interest in getting help with his garnered wages, as long as he can remain anonymous.

Oscar starts the session by sharing a story about receiving a call from his son’s school and being unable to communicate with the person over the phone in English. He expresses being frustrated by the situation, feeling helpless, and doubting that the therapist could understand his situation. The therapist acknowledges that she cannot know what it feels like without having the same experience, but assures Oscar that she’s trying her hardest to understand what he’s saying. She then explains to Oscar that he has a right to an interpreter in his son’s school as well as other agencies, and orients his attention to the virtues that he models for his children, which are deserving of respect.

The therapist welcomes Oscar to the session. Although Oscar indicates that he prefers handling his troubles independently at first, the therapist’s validation of his choices allows him to open up. Oscar shares that he’s missing his home country of Guatemala due to the holidays, especially the food and festivities that he has not experienced since moving to the U.S. The therapist validates Oscar’s nostalgia as normal to many immigrants, and asks how Oscar maintains his connection to home. Oscar shares the many ways in which he does this, including regular calls and messages with his extended family, especially his cousin who he considers close. The therapist frames Oscar’s experience as a loss, and Oscar shares more about how being physically far from his family has affected his mood and thoughts.

The therapist welcomes Oscar into the session and asks about how things are going at home. Oscar says things are okay with his wife, and emphasizes that he sees her as a good wife and mother because she fulfills her duties at home. He describes having conflicts with his wife when she expressed a desire to have a job to earn extra income, and Oscar contrasts his view with that of most American families. The therapist asks Oscar about his parents’ way of managing his household growing up, and normalizes that he developed this view given his upbringing. She also explains the circumstances that led American families to develop different expectations around women working, and orients Oscar to think about what he wants for his family.

The therapist starts the session by asking Oscar about his wife and how their relationship is going. Oscar describes as a good mother because she fulfills her duty of cleaning and cooking, which he points out may be difficult for the therapist to understand because she’s American. The therapist reflects Oscar’s concern about not being understood, as well as being made to feel alienated by other people he’s met in the U.S. She further explains that a therapist’s job is to validate people’s experiences, not judge them, but nevertheless assures Oscar that he could seek a male therapist if he’s more comfortable. Oscar explains that he’d be more comfortable with a male therapist, but he’s willing to try continuing sessions with this one as long as she indicates that she respects Oscar’s decisions for what he considers is best for his family.

The therapist welcomes Oscar into the session and shares a bit about her background, including where she’s from, and how she learned Spanish. She then asks what brings Oscar to therapy, and he indicates that conflicts with his wife are what most troubles him currently. The therapist then orients Oscar to the therapy space by emphasizing that he’s the expert on his own experience, while she’s an expert in mental health. She also explains the different ways in which people can become therapists in the U.S., and answers Oscar’s questions about logistics (whether he should come alone or with his wife, take medication, and the like).

The therapist welcomes Oscar into the session and introduces herself briefly before asking Oscar if he’s ever been to therapy before. Oscar indicates that he’s been to family sessions with a counselor at his son’s school before, but they were not helpful and he prefers going to work instead, because he’s not “crazy”. The therapist asks Oscar to elaborate on what he means by crazy, and what brings him to therapy since he’s not very willing. Oscar describes the conflicts he has with his wife at home, and indicates that he doesn’t need therapy. The therapist validates Oscar’s perspective and assures him that after a few sessions, if he doesn’t find their time together helpful, they can stop meeting.

The purpose of this course is to assist the healthcare professional in identifying mania through a client’s nonverbal behaviors.

• Healthcare providers need to possess the knowledge to identify mania symptoms not just what the person verbalizes, but also from their mannerisms and body language.
• Healthcare providers need to be competent in identifying nonverbal symptoms so they are able to complete a more detailed assessment to diagnose a mental health condition and/or refer to specialty providers for further assessment and treatment.
• Healthcare providers need to perform appropriate follow up questions based on the nonverbal symptoms a client may present with.

Patients may not verbally discuss their symptoms or experiences with mania. This is due to the fact that in many cases the person has poor insight into these symptoms. There are nonverbal symptoms of mania that can signal that the person is experiencing mania and may have certain mental health conditions.  Identifying and speaking to these symptoms, may open the door for a conversation about their mania and help the client get connected to resources, services and treatments that will help.

• Learners will gain knowledge about the nonverbal mania symptoms that may be seen in an interview with a client or expressed by a concerned support person.
• Learners will be competent in their ability to identify patients who may be suffering from mania and require further treatment.
• Learners will show improved performance in their ability to identify nonverbal symptoms of mania and ask appropriate follow up questions to assist in diagnosing a mental health condition, such as bipolar disorder.

Learning Objectives

By the end of this course learners will be able to:

1. Define mania and identify the non-verbal symptoms common in patients with this condition.
2. Discuss DSM-5-TR diagnoses that are commonly associated with these symptoms.
3. Describe assessment questions for health professionals to use to further assess patients presenting with non-verbal  mania symptoms.
4. Review common misconceptions related to mania.

The purpose of this course is to assist the healthcare professional in identifying substance related disorders through a client’s nonverbal behaviors.

• Healthcare providers need to possess the knowledge to identify substance related disorder symptoms from not just what the person verbalizes, but also from their nonverbal signs and symptoms.
• Healthcare providers need to be competent in identifying nonverbal symptoms so they are able to complete a more detailed assessment to diagnose substance related disorders and/or refer to specialty providers for further assessment and treatment if needed.
• Healthcare providers need to perform appropriate follow up questions based on the nonverbal symptoms a client may present with.

Patients may not verbally discuss their symptoms or experiences related to substance use with their healthcare provider.. There are nonverbal symptoms of substance related disorders  that can signal that distress and possibility of a psychiatric condition. Identifying and speaking to these symptoms, may open the door for a conversation about substance related conditions. This conversation can get the client connected to resources, services and treatments that will help.

• Learners will gain knowledge about the nonverbal substance related disorder symptoms that may be seen in an interview with a client or expressed by a concerned support person.
• Learners will be competent in their ability to identify patients who may be suffering from a substance related disorder.
• Learners will show improved performance in their ability to identify nonverbal symptoms of substance related disorders and ask appropriate follow up questions to assist in diagnosing these conditions.

The purpose of this course is to assist the healthcare professional in understanding how to diagnose, identify and treat avoidant personality disorder.

• Healthcare providers need to possess the knowledge to identify avoidant personality disorder.
• Healthcare providers need to be competent in diagnosing avoidant personality disorder because symptoms can be difficult to differentiate from other psychiatric conditions.
• Healthcare providers need to perform and provide appropriate education to the client about treatments for avoidant personality disorder.

Patients may not understand symptoms of a personality disorder and how it can negatively impact their life. Those with avoidant personality disorder may want help with these symptoms if they feel they are distressing to their life and may seek help from mental health professionals. Knowing the clinical features and suggested treatments for this condition will allow this condition to be appropriately identified and treated.

• Learners will gain knowledge about the characteristics of avoidant personality disorder.
• Learners will be competent in their ability to identify avoidant personality disorder symptoms in patients whom they treat.
• Learners will show improved performance in their ability to choose appropriate treatments for avoidant personality disorder.

Learning Objectives

By the end of this course learners will be able to:

1. Define the criteria for a general personality disorder.
2. Define avoidant personality disorder and its diagnostic criteria.
3. Describe the signs, symptoms and common behaviors of avoidant personality disorder.
4. Discuss possible causes of avoidant personality disorder.
5. Identify behaviors that are a risk for harming the self or others.
6. Name evidence-based treatments for avoidant personality disorder.

The purpose of this course is to assist healthcare professionals in building strong rapport with their teletherapy patients for the purposes of effective treatment.

• Healthcare workers must possess the knowledge of the importance of rapport with teletherapy patients.
• Healthcare workers need to be competent in engaging in behavior conducive with building rapport.
• Healthcare workers need to accurately identify techniques and strategies that will improve rapport.

Research has shown that rapport is essential to patient satisfaction, treatment adherence, and treatment outcomes. Given the increased use of telehealth as a mode of treatment, many practitioners struggle with knowing how to foster the same level of rapport as they had during in-person settings. It is imperative that telehealth providers become familiar with implementing strategies that will increase rapport with new telehealth patients, as it will lead to better treatment outcomes.

•  Learners will gain knowledge of rapport and its importance.
• Learners will feel competent in their ability to identify strategies to build rapport.
• Learners will show performance improvement in their ability to form a strong professional relationship with new teletherapy patients due to increased rapport.

Learning Objectives

By the end of this course learners will be able to:

1. Identify rapport.
2. Differentiate strategies that may hinder rapport from those that will bolster it.
3. Identify general guidelines to follow when working with new teletherapy patients.
4. Define misconceptions about rapport and telehealth.

Chase’s eyes are unfocused, staring into space, his movements are slow and his affect is flat. Chase looks off to the side of the room, staring intensely at something that is not actually there. He often has difficulty concentrating and occasionally becomes unfocused from the conversation. Chase feels like something bad will happen, but doesn’t know what. During the interview Chase experiences both auditory hallucinations (a voice in his head) and a visual hallucination (he sees someone in the room, a shadows, but only out the side of his eye). Chase says that sometimes he sees God and that this vision comes to him as a feeling. Chase describes the voice in his head, a woman, who irritates him, bosses him around, and sometimes tells him to hurt himself. However, Chase refuses the commands of the voice.

During the conversation with the clinician, Chase rocks back and forth in self-stimulatory behavior. Chase interrupts the clinician upon hearing the voice of a woman (an auditory hallucination). Chase doesn’t know this woman but he’s heard her before. The woman tells Chase he’s stupid and shouldn’t be talking to the interviewer. Chase insists that his college RA and professor built a laser in his dorm and that Chase can’t ignore the woman because she never shuts up. The woman doesn’t control Chase’s thoughts but she is always bossing him around. The RA is trying to hurt Chase because Chase knows about her secret. This voice talks to chase all the time, always telling him to do things. When asked what the voice is telling him, Chase responds that she’s currently telling him to “sit up straight” and “stop talking with you.” Chase sometimes acts on these commands from the voice, but only when it’s ok. Sometimes the voice tells Chase to hurt himself but he refuses.

Chase is having a conversation when he suddenly hears something in the next room, which triggers a heightened sense of paranoia. Chase believes the people talking in the next room is the sound of “them” building a laser. The clinician reveals to Chase that the noise is actually the humming of the air conditioner but Chase is adamant people are in the next room and they’re talking about him. Chase does not believe the people in the next room are controlling his mind or hearing his thoughts, but that they know where he is and might be interested in hurting him.

Chase is having a conversation when he suddenly hears his RA and professor in the next room, and believes that they followed him here to the hospital. The clinician tells Chase that there are in fact voices in the next room but it is from a meeting of hospital staff, not his RA and professor. Chase accuses the clinician of letting the RA and professor into the hospital, that they building a laser and following him because he found out about their plans.

While Chase talks to the interviewer he occasionally bursts out laughing and smiling. When asked why he’s laughing and smiling Chase says it’s because of his “fans” who are telling him he’s doing a good job. Chase’s enjoys the voices as they cheer him on and say things like “you can do it,” and “put your mind to it.” The voices encourage Chase to play his music, saying he could be Metallica and “he’s right on beat.” Chase loves the voices, his fans, which are around when he plays his music, when he talks to people, help him.

Chase is non-responsive at the start of the interview, eyes roving and fearful. Chase says that the woman in his head won’t shut up. He doesn’t know this woman, but it’s a voice he’s heard before. This woman is telling Chase to hurt himself and to kill himself. She says that Chase is stupid, that he’s going to die. Chase sometimes believes this voice though he doesn’t want to hurt or kill himself. Chase says the voice tells him how to kill himself: to jump of f the roof at the dorm. He tries not to listen to her but she once made him go to he roof to see how tall it is. She says 12 stories is enough. Other times she says jump in front of the bus, and he says no. Chase thinks that the voice could control him and has no idea what to do if she tells him to jump.

As the interview begins, Chase appears engaged in another, internal conversation. When questioned about the voice, Chase says it’s a woman who won’t stop talking. This woman’s voice says that Chase is stupid, worthless and he should stop talking right now. Chase doesn’t know who this woman is, but she does talk to him frequently. She tells Chase to hurt himself, but he’s never acted on those commands and often tells the woman he won’t. Presently, the woman is telling Chase to kill himself by jumping off the roof of the dorm. Other times, she tells him to jump in front of a bus but in each instance Chase doesn’t do what she says. In order to drown out the voice, Chase listens to heavy metal and draws, which helps make the voice go away for a little bit.

Chase looks all around the room, tracking something, and says that his professor is building lasers on the second floor. Chase insists he doesn’t imagine things, that this laser is real real, and that he hears the voice of G-d and a woman. Chase doesn’t believe the voices can hear his thoughts or control him though she frequently tells him what to do. Chase thinks the woman on the second floor could hurt him because he knows about the lasers. Chase doesn’t feel like he has special powers despite his ability to speak to G-d.

Post medicating, Chase appears more subdued and calm. Chase has not been hearing any voices or seeing any shadows. Chase feels terrible about his recent schizophrenic episode when he hurt his RA. During his arrest, the police violently wrestled Chase to the floor. Chase has nightmares and flashbacks about what happened and expresses considerable guilt at having punched his RA. Chase’s nightmares also include his arrival at the hospital, being poked with needles and strapped down to a bed. Chase worries that he’ll relapse and start hearing voices again and that those voices will make hurt someone. However, the current medications keep Chase in control.

Chase is looking around the room and tells the interviewer that he is currently seeing dogs made of shadows out of the corner of his eye and that when he turns to look at them they’re not there. The shadow dogs remind Chase of his neighbor’s dog that he once hit with his hand because it wouldn’t stop barking. Chase describes the dog shadows as big and always knowing where Chase is.

Chase is looking around the room and tells the interviewer that he is currently seeing dogs made of shadows out of the corner of his eye. He sees these dogs everywhere, including presently in the room. These shadows dogs simply stare at him and make it difficult for him to concentrate during the interview. Chase describes the dog as a mother that has lots of puppies, and that this dog knows Chase hurts her kind. Chase relates that his neighbor had a dog that he once hit with his fist because “she wouldn’t shut up.” Chase never saw that dog again. Chase says that these shadow dogs know that Chase hit his neighbor’s dog. When he tries to turns and look at them, they disappear. Chase further describes that these dogs sometimes show their teeth and he is afraid the dogs, which communicate with one another, might come after him.

Chase slowly shifts his eyes from one corner of the room to the other before indicating that he sees a dog in the room. Chase describes the dog as a big mutt that is licking the interviewer’s leg. Chase is baffled that the interviewer cannot see the dog. When questioned further, Chase indicates that he sees this dog in many other places, such as in the bank and supermarket. Chase can’t understand the visual hallucination, which makes him feel like he’s dreaming and wonder whether he is awake or asleep.

Erika starts the session by sharing with the therapist that she got a promotion at work, which will allow her to move into an apartment. The therapist shares in Erika’s joy, then updates her about a routine call that the clinic will make of all the clients. Erika becomes upset by the call relating to her method of payment, and yells at the therapist for asking for money just as she got a raise. The therapist reflects her emotional experience, and leads her through a progressive muscle relaxation exercise to release the tension she’s feeling. She then processes the exercise with Erika, and discusses how the issue of money is triggering for Erika.

Erika starts the session by sharing with the therapist that she got a promotion at work, which will allow her to move into an apartment. The therapist shares in Erika’s joy, then updates her about a routine call that the clinic will make of all the clients. Erika becomes very upset at the therapist for asking her about money. The therapist leads Erika through a belly breathing exercise to help her de-escalate, and processes the exercise with Erika. Erika expresses some insight into what was triggering about discussing money, and the therapist points out how Erika was able to calm herself. She also points out how she could frame the conversation differently next time.

The therapist welcomes Erika into their first session and asks whether she’s had any prior experience with therapy. Erika explains that she didn’t like the first therapist she had because he kept questioning whether she was sure she wanted to transition, and she continued services with him because she wanted to get a letter for gender-affirming hormones. The therapist validates her experience and shares a bit about her background and experience working with people in the queer community. She then asks Erika what made her want to come back to therapy, and Erika responds that she’s looking for a listening ear. The therapist then engages Erika in discussing her hopes and dreams for the future.

The therapist welcomes Erika into their first session and asks whether she’s had any prior experience with therapy. Erika explains that she didn’t like the first therapist she had because he kept questioning whether she was sure she wanted to transition, and she continued services with him because she wanted to get a letter for gender-affirming hormones. The therapist validates her experience and asks Erika what they could do differently in their work together. Erika indicates that what she wants most is to be understood, and asks what the therapist would know about the needs of the trans community. The therapist shares about her personal and professional background, while affirming that Erika is an expert on her own life experiences. Erika pushes back against the idea that the therapist might understand what she’s been through and the therapist assures Erika that they could look for a trans therapist if that’s what she wants. Erika declines because she doesn’t want to get on a waitlist again, and wants to try with her.

Erika begins the session being upset because the clinic’s system addresses her as “Jake”, a name she no longer goes by. The therapist apologizes to Erika for the error, and asks Erika if she’d be okay if she advocates on her behalf. Erika expresses sadness over having to constantly fight for what she believes should be a simple matter, and the therapist validates Erika’s sadness and disappointment with having to fix this mistake that continually occurs. The therapist also provides Erika with some options with how they can collaborate to fix it, whether it’s the therapist working on it independently or the two of them working together. The therapist then thanks Erika for her candid feedback and engages her in discussing how administrative issues like these are affecting her life.

Erika begins the session being upset because the clinic’s system addresses her as “Jake”, a name she no longer goes by. The therapist apologizes to Erika for the error, and acknowledges that the work they are doing to build trust in therapy is invalidated by her seeing her dead-name on the screen. Erika indicates that she’s confident the therapist can help her fix this mistake, but also shares that she’s been “double-crossed” before. The therapist validates Erika’s challenges in advocating for herself given her priorities for finding physical safety, and suggests referring Erika to an advocate who can help her change her name and gender on official documentation. Erika agrees, as she’d feel like she has a bit more freedom if her name was legally changed.

Erika starts the session by asking the therapist how her weekend was, and insisting on knowing when the therapist doesn’t answer specifically. The therapist tracks Erika’s interest and wonders what she’s so curious about. Erika shares that she hasn’t been going out as much to save money, as she used to go to drag shows, then asks the therapist if she’s ever been to one. The therapist again focuses on what Erika would get out of knowing this, and wonders if Erika’s isolation is making her so curious. Erika acknowledges this, and also shares that she’s not sure if the therapist is a true ally. The therapist answers that she’s been to a drag show before, but more importantly, if Erika doesn’t feel comfortable, they can explore finding a trans therapist for her. She then engages Erika in a discussion of what she can do to feel less isolated, even while on a budget.

Erika starts the session by asking the therapist how her weekend was, and insisting on knowing when the therapist doesn’t answer specifically. The therapist tracks Erika’s interest and wonders what she’s so curious about. Erika says she wants to connect with the therapist, and the therapist differentiates between how they can connect and the ways in which Erika can connect with a friend. She then emphasizes that the focus of therapy should be on Erika, and thanks her for coming to the session and working hard to maintain that focus.

Erika starts the session by sharing with the therapist that she lost her job and was evicted from her apartment. The therapist asks some questions to ensure that Erika has a safe place to stay, then points out how committed Erika is to therapy to still have attended. Erika expresses hopelessness about how her living situation is making it impossible for her to move forward, and that every time she gets back up, she gets knocked down again. The therapist reflects Erika’s feeling of lack of control in her life, and asks her to think about what is within her control. When Erika has trouble identifying anything she’s in control of, the therapist points out how resourceful she is in choosing people in her life who help her, and in focusing on her mental health. Lastly, she provides Erika with the option of talking to a case manager at their clinic.

The purpose of this course is to assist healthcare professionals in properly assessing for and challenging trauma-related beliefs among trauma-exposed patients while conducting teletherapy for the purposes of effective treatment.

• Healthcare workers must possess the knowledge of trauma-related beliefs among trauma-exposed patients.
• Healthcare workers need to be competent in identifying trauma-related beliefs among trauma-exposed patients.
• Healthcare workers need to accurately challenge trauma-related beliefs with evidence-based techniques.

Many trauma-exposed patients (particularly those with PTSD) report negative trauma-related beliefs about themselves, others, the future, and the world. They may also report trauma-related beliefs about what caused their trauma to happen or the consequences of their trauma. If the provider is unable to identify a patient whose worldview was significantly impacted and changed by their trauma, the patient’s symptoms will likely maintain and may potentially worsen. It is important that healthcare providers be able to accurately identify cand challenge cognitions pertaining to trauma among trauma-exposed patients to effectively treat their symptoms.

• Learners will gain knowledge of trauma-related beliefs.
• Learners will feel competent in their ability to identify trauma-related beliefs.
• Learners will show performance improvement in their ability to challenge trauma-related beliefs.

Learning Objectives

By the end of this course learners will be able to:

1. Identify trauma-related beliefs according to DSM-5-TR criterion D.2.
2. Identify trauma-related beliefs according to DSM-5-TR criterion D.3.
3. Differentiate examples of trauma-related beliefs.
4. Define misconceptions about trauma-related beliefs.

The purpose of this course is to assist healthcare professionals in properly identifying, engaging in, and communicating confidentiality with teletherapy patients.

• Healthcare workers must possess the knowledge of confidentiality among teletherapy patients.
• Healthcare workers need to be competent in communicating confidentiality among teletherapy patients.
• Healthcare workers need to accurately address confidentiality issues and risks among teletherapy patients.

Since the COVID-19 pandemic, telehealth has become a widely used platform for mental health treatment. While beneficial in many ways, it does pose unique risks to confidentiality with regard to therapy treatment. It is imperative that telehealth providers are aware of these risks and are confident in their ability to identify, communicate and mitigate them.

• Learners will gain knowledge of confidentiality.
• Learners will feel competent in their ability to communicate confidentiality with teletherapy patients.
• Learners will show performance improvement in their ability to maintain high standards of confidentiality with teletherapy patients.

Learning Objectives

By the end of this course learners will be able to:

1. Define confidentiality in the therapy setting.
2. Identify risks to client confidentiality via telehealth.
3. Assess best practices and behaviors to avoid regarding confidentiality in the telehealth setting.
4. Describe misconceptions about confidentiality and telehealth.

The purpose of this course is to assist healthcare professionals in properly identifying trauma-related avoidance among teletherapy patients for the purposes of effective treatment.

• Healthcare workers must possess the knowledge of trauma-related avoidance among trauma-exposed teletherapy patients.
• Healthcare workers need to be competent in differentiating types of trauma-related avoidance among trauma-exposed teletherapy patients.
• Healthcare workers need to accurately treat trauma-related avoidance with evidence-based techniques.

Many trauma-exposed patients engage in trauma-related avoidance behaviors. If the provider is unable to identify a patient who is engaging in trauma-related avoidance, and/or if the provider does not possess the knowledge/competence to differentiate it from adaptive avoidance, the patient’s symptoms will likely maintain and may potentially worsen. It is important that healthcare providers be able to accurately identify and differentiate types of external and internal trauma-related avoidance to effectively treat their symptoms.

• Learners will gain knowledge of trauma-related avoidance.
• Learners will feel competent in their ability to identify trauma-related avoidance.
• Learners will show performance improvement in their ability to differentiate external and internal trauma-related avoidance.

Learning Objectives

By the end of this course learners will be able to:

1. Identify trauma-related avoidance.
2. Differentiate external and internal trauma-related avoidance.
3. Identify general guidelines to follow when determining whether a patient is engaging in trauma-related avoidance.
4. Define misconceptions about trauma-related avoidance.

Natalie describes the relationship with her mother as good, distant in a way, and gentle. Natalie’s relationship with her father isn’t close but he pushes her to do her best in school and can be hard on her. Natalie admits that her father’s “encouragement” is often critical and he’s verbally abusive, primarily when he’s been drinking. During those episodes when he’s been drinking, which happen regularly, he will call her “worthless” and “a waste of space.” These comments make Natalie feel small and cause her to shut down. Natalie’s mom tries to stay out of the middle and has never interrupted her father’s verbal abuse of Natalie. According to Natalie, her mother isn’t strong and never stands up to her father. Natalie’s relationship with her brother, who has recently moved home, is further strained. Natalie’s brother sometimes gets physical with her, but she claims it’s just wrestling or “playing.” These physical alterations with her brother have resulted in some bruising. Though Natalie doesn’t find the wrestling fun, she says it’s not horrible either.  Learn more.

Natalie talks about her father’s drinking habits – he drinks every day and more when he doesn’t have to work the next day. When he drinks, her father’s personality changes, becoming more aggressive. He has never hurt Natalie physically but sometimes hurt her feelings by making comments such as that Natalie doesn’t have friends, needs to lose weight, that she’s a joke, or should be more like her brother. Natalie excuses this behavior from her father as constructive criticism. Natalie stays clear of her brother because he’s a “little rough” physically. Sometimes her brother wrestles with Natalie, which has resulted in injuries – bruises and drawing blood. Natalie claims her brother is allowed to do whatever he wants and their mother has never intervened on her behalf. When asked about the relationship between her father and mother, Natalie becomes evasive, eventually excusing her father’s behavior toward her mom, as “it’s what guys do.” Natalie believes this is how most families function. When Natalie was younger, she recalls that her father was abusive toward her brother, but thinks it was just to toughen him up. Natalie realizes that the abuse she’s suffered from her brother was because her father abused her brother. However, Natalie excuses the abuse because that’s what Natalie’s mother does.  Learn more.

Natalie’s father is a drinker and is pretty harsh with his words when drunk. Her father will often tell Natalie that she needs to get friends, lose weight, that she’s worthless etc. Though Natalie attempts to excuse this behavior, it does have an effect on her. Natalie feels that she doesn’t live up to her father’s standards and doesn’t know how to please him, or be the girl he wants her to be. Though Natalie’s father has never hurt her physically, he is aggressive with her brother, but only, as Natalie says to get her brother to be more masculine. Natalie says her brother is a lot like her father, verbally ridiculing her, but also in being rough with her physically. Natalie admits that her brother will punch her every now in order to get her to do something. As a result of her brother, Natalie has experienced bruising and a couple of scars on her arm from him scratching her. Meanwhile, Natalie’s mother does not intervene on Natalie’s behalf either to stop her father or brother. Natalie’s father has never been physically aggressive with her mother, but they do argue. Natalie feels this behavior is acceptable because it is all to teach a lesson.  Learn more.

Natalie’s appetite and eating behavior has become inconsistent lately. Some days she doesn’t eat a meal and some days she’ll eat a full day’s food in one sitting. When she eats enough food for one sitting, she feels relief and then regret. Overall, she’s lost a few pounds over the last few months. However, before this period, Natalie was eating regularly, breakfast, lunch and dinner normally.  Learn more.

Natalie’s interest level is non-existent right; she hasn’t found anything exciting or pleasurable recently. She enjoys being alone, being on her phone or taking long showers; she feels distracted in a good way when she’s doing these activities. Before these depressed feelings began, Natalie played tennis every day, hung out with friends, went to the movies, was in all AP classes, and now she doesn’t know why she liked doing all of these things and more broadly doesn’t see a point in anything. In the past, Natalie did find pleasure when engaging in these activities. However, this loss in pleasure began gradually, around the time when her brother moved home and she had to move back into her old room. It’s been four or five months since Natalie lost interest in friends and in her class work, and she even though she’s considered being more engaged, she continues to have a strong desire to be alone.  Learn more.

In describing her mood, Natalie has been feeling down, but says she would settle for being neutral or in the middle, which would be an improvement to her current mood. These down feelings have been persistent over the last five or six months, starting when her older brother moved home (forcing her to move back into her old, smaller room), and around the time when her father lost his job. After losing his job, Natalie’s father began drinking more. Natalie describes having nothing to do but sit in her room. Her thoughts often dwell on the negative, that she has no friends; she’s fat, etc. and is made worse when her brother yells at her and says she’s just isolating herself. Natalie gets a lot of anxiety when she thinks about the future and admits that she’s had thoughts about killing herself. Natalie has considered many different suicidal plans, “A through Z,” and provides a detailed example of one. Natalie feels that after she kills herself, all her negative thoughts would go blank, but doesn’t know it would make her feel better.  Learn more.

In the past, Natalie had many close relationships but currently feels that she has no one she could consider a friend. Natalie stopped hanging out with her classmates and so they stopped inviting her. Natalie’s social interactions at school, even small ones, are minimal. When she does initiate contact with others, she describes feelings anxious and not wanting to say anything wrong. Though Natalie cannot describe an interaction in which she “said the wrong thing,” she describes seeing the judgment on other people’s face. At home, Natalie has stopped engaging in conversation. Natalie’s mom tries to give her pep talks, encourage her to go outside, and feels that if Natalie just does some things, that she’ll feel better. On the other hand, Natalie’s dad just yells at her, especially when she doesn’t respond. Natalie used to have a good relationship with her father before but since he lost his job and started drinking more she tries to stay away from him as much as possible. Natalie just wants to be alone and for her parents to stop suggesting things.  Learn more.

Natalie sleeps a lot and takes naps throughout the day. Yet no matter how much she sleeps, Natalie just feels tired. At night, it’s hard for Natalie to fall asleep when she has thoughts racing through her head. Once she gets to sleep, she wakes periodically throughout the night. In the morning, Natalie feels unrested, has to force herself to get moving and feels like a zombie throughout the school day. On weekends, Natalie sleeps for as long as she can yet still doesn’t feel rested.  Learn more.

Natalie doesn’t drink alcohol and doesn’t have any interest in drinking because of the way her father behaves when he drinks. Natalie considered taking her mom’s sleeping pills but didn’t as she sleeps enough as is. When asked about using other drugs, Natalie doesn’t even know where she would get street drugs. She did try her brother’s marijuana for a time but the pot only made her feel worse. The last time Natalie smoked was a couple of weeks ago but claims that stopping hasn’t improved her mood.  Learn more.

The purpose of this activity is to increase the learner’s overall knowledge of benzodiazepine overuse among older adults.

• Clinicians need to improve assessment competency for benzodiazepine overuse among older adults.
• Clinicians need to be prepared to assess for benzodiazepine overuse among older adults.
• Clinicians need to be competent in assisting older adults with benzodiazepine misuse.

Technology issues are commonly experienced during teletherapy sessions. Given the increased use of telehealth as a mode of treatment, many practitioners struggle with knowing how to handle technology issues as they arise. It is imperative that telehealth providers become familiar with implementing strategies that will increase their ability to appropriately address technology issues if they arise during teletherapy, and how to prevent and minimize future occurrences.

• Define older adults.
• Define benzodiazepines, as well as the risks associated with their use.
• Identify statistics of benzodiazepine use among U.S. adults and older individuals.
• Comprehend dangers of benzodiazepine use among older patients.
• Identify an approach to treatment.

Learning Objectives

By the end of this course learners will be able to:

1. Define older adults.
2. Define benzodiazepines, as well as the risks associated with their use.
3. Identify statistics of benzodiazepine use among U.S. adults and older individuals.
4. Comprehend dangers of benzodiazepine use among older patients.
5. Identify an approach to treatment.

The purpose of this course is to assist healthcare professionals in properly identifying and assessing for Major Depressive Disorder for the purposes of providing effective resources and treatment recommendations.

• Healthcare workers must possess the knowledge of symptoms pertaining to Major Depressive Disorder among teletherapy patients.
• Healthcare workers need to be competent in identifying Major Depressive Disorder among teletherapy patients.
• Healthcare workers need to provide appropriate resources and treatment recommendations for teletherapy patients experiencing Major Depressive Disorder.

Symptoms of Major Depressive Disorder are prevalent and can lead to an array of mental and physical health consequences. It is imperative that providers are able to identify symptoms of Major Depressive Disorder among teletherapy patients and approach them in a culturally competent manner. Being able to identify symptoms of MDD will lead to appropriate evaluation and treatment recommendations.

• Learners will gain knowledge of Major Depressive Disorder.
• Learners will feel competent in their ability to identify Major Depressive Disorder.
• Learners will show performance improvement in their ability to assess for Major Depressive Disorder.

Learning Objectives

By the end of this course learners will be able to:

1. Identify Major Depressive Disorder.
2. Assess for Major Depressive Disorder.
3. Identify general guidelines to follow when working with a teletherapy patient reporting symptoms of Major Depressive Disorder.
4. Describe misconceptions about Major Depressive Disorder.

The purpose of this course is to assist healthcare professionals in properly assessing for and identifying trauma-related beliefs among trauma-exposed patients while conducting teletherapy for the purposes of effective treatment.

• Healthcare workers must possess the knowledge of trauma-related beliefs among trauma-exposed patients.
• Healthcare workers need to be competent in identifying trauma-related beliefs among trauma-exposed patients.
• Healthcare workers need to accurately treat trauma-related beliefs with evidence-based techniques.

Many trauma-exposed patients (particularly those with PTSD) report negative trauma-related beliefs about themselves, others, the future, and the world. They may also report trauma-related beliefs about what caused their trauma to happen or the consequences of their trauma. If the provider is unable to identify a patient whose worldview was significantly impacted and changed by their trauma, the patient’s symptoms will likely maintain and may potentially worsen. It is important that healthcare providers be able to accurately identify cognitions pertaining to trauma among trauma-exposed patients to effectively treat their symptoms.

• Learners will gain knowledge of trauma-related beliefs.
• Learners will feel competent in their ability to identify trauma-related beliefs.
• Learners will show performance improvement in their ability to differentiate trauma-related beliefs about oneself, others, and the world.

Learning Objectives

By the end of this course learners will be able to:

1. Identify trauma-related beliefs according to DSM-5-TR criterion D.2.
2. Identify trauma-related beliefs according to DSM-5-TR criterion D.3.
3. Differentiate examples of trauma-related beliefs.
4. Define misconceptions about trauma-related beliefs.

The purpose of this activity is to increase the learner’s overall knowledge of the relationship between PTSD and TBI among military personnel.

• Clinicians need to improve assessment competency for PTSD among military personnel.
• Clinicians need to be prepared to assess for comorbid TBI among military personnel.
• Clinicians need to be competent in assisting military personnel with comorbid PTSD and TBI diagnoses with the proper referrals and treatment.

U.S. veterans are at significantly increased risk of experiencing a TBI due to the nature of their job. They are also at higher risk of developing PTSD. Research has indicated that TBI itself is a significant risk factor for the development of PTSD.  It is imperative that healthcare providers are able to understand the relationship between PTSD and TBI among military personnel to ensure proper prevention and intervention methods.

• Define PTSD and traumatic brain injury (TBI).
• Identify risk factors for comorbid PTSD and TBI among military personnel.
• Comprehend the relationship between comorbid PTSD and TBI.
• Identify treatments for PTSD and TBI.

Learning Objectives

By the end of this course learners will be able to:

1. Define PTSD and traumatic brain injury (TBI).
2. Identify risk factors for comorbid PTSD and TBI among military personnel.
3. Comprehend the relationship between comorbid PTSD and TBI.
4. Identify treatments for PTSD and TBI.

The purpose of this activity is to increase the learner’s overall knowledge of the relationship between opioid use disorder and homelessness.

• Clinicians need to improve assessment competency for opioid abuse among homeless populations.
• Clinicians need to be prepared to assess for homelessness and ability to live independently.
• Clinicians need to be competent in assisting homeless patients with opioid use disorders.

Homelessness and opioid abuse are a public health crisis in the United States. Statistics show that homeless individuals are at higher risk of overdose from opioids. It is imperative that healthcare providers are able to understand the relationship between opioid abuse and homelessness and that they are able to provide those who are at-risk of, or currently experiencing, homelessness the proper resources.

• Define homelessness and its types.
• Identify the relationship between homelessness and opioid abuse.
• Identify risk factors for opioid abuse and homelessness.
• Performance improvement in the ability to provide resources for homeless individuals who abuse opioids.

Learning Objectives

By the end of this course learners will be able to:

1. Define homelessness and its types.
2. Identify statistics for homelessness.
3. Define criteria for opioid use disorder.
4. Comprehend risk factors for homelessness and opioid abuse.
5. Identify the association between homelessness and opioid abuse.
6. Identify programs and resources for homelessness.

The purpose of this course is to assist healthcare professionals in properly identifying and assessing for elder abuse among teletherapy patients.

• Healthcare workers must possess the knowledge of abuse among elderly teletherapy patients.
• Healthcare workers need to be competent in identifying elder abuse among teletherapy patients.
• Healthcare workers need to accurately address abuse among elderly teletherapy patients.

It is imperative that healthcare providers are confident in their ability to identify and assess for abuse among elderly teletherapy patients. Moreover, it is important for healthcare workers to discern situations that might require mandated reporting relating to elder abuse, as there are often serious ramifications for not doing so.

• Learners will gain knowledge of elder abuse.
• Learners will feel competent in their ability to identify types and signs of elder abuse.
• Learners will show performance improvement in their ability to address elder abuse.

Learning Objectives

By the end of this course learners will be able to:

1. Define elder abuse.
2. Identify types of elder abuse.
3. Identify risk factors and signs for elder abuse.
4. Define misconceptions about elder abuse.

The therapist welcomes Olivia to the session and asks her how she’s doing, noting that she’s visibly sad. Olivia shares that it’s the one year anniversary of her cousin Gabby’s death. The therapist asks what Gabby was like, and Olivia shares details of how they spent time together. The therapist validates how important Gabby was to her, and asks if there’s anything she’d like to do to honor her memory. Olivia says she attended a vigil for her when she first passed, but is now feeling numb towards them as they happen in her community so often. The therapist normalizes that this may be a response to protect her from the trauma of the loss, and asks if Olivia would like to process this in therapy. The therapist outlines options Olivia has, like doing narrative therapy, art therapy, or joining a grief group. Olivia expresses some interest in joining the grief group, and the therapist provides more details about what joining it might be like.

The therapist welcomes Olivia to the session and asks how she has been doing with her friends. Olivia shares what she’s been doing with her friend Melanie, but is initially hesitant to talk about how things are going at school. With some prompting from the therapist, she shares that other students at school are making up rumors about her, and calling her “schizo” behind her back. The therapist reflects how Olivia has some support at school, and discusses options for how she might seek support from school administrators for this problem. Olivia indicates that she’d be embarrassed to “tell on” the people posting about her to her principal, but expresses some interest in sharing the story of her mental health struggles to people to quiet the rumors. The therapist remarks on how this is an indicator of Olivia’s progress, and helps her think through various options for how to convey this story to people at school.

The therapist welcomes Olivia to the session and asks how her follow up appointment with her psychiatrist went. Olivia angrily describes how she felt she was being talked down to, as if she were stupid, and the therapist engages Olivia in a breathing exercise to de-escalate her anger. She then asks Olivia some clarifying questions about the appointment, and expresses how sorry she is that her family went through that. Olivia assumes that she and her family were talked down to because they’re black, although she says she’s not certain. The therapist acknowledges that many white doctors have a tendency to focus on their expertise rather than a family’s needs, and asks Olivia what she’d like to do to advocate on her behalf. She then gives Olivia two options, and Olivia says she would prefer that the therapist talks to the doctor separately to tell him that he’s been insensitive. The therapist assures Olivia that she’ll talk to him and inform Olivia of his response, and thanks her for sharing about the appointment.

The therapist welcomes Olivia to the session and asks how her transition back home and to her faith community are going. Olivia shares that she started a youth group with a pastor who she likes, especially because he’s been kind to her about the voices she hears. The therapist asks Olivia what she thinks of the messages she’s getting from the voices, and Olivia attributes meaning to it as part of her mission in the world. Olivia adds that she’s starting to think about how bible study and prayer might be more important than therapy. The therapist asks Olivia how she thinks she’s special even without the voices, and Olivia clarifies that while she feels she’ll always have the messages she got from them with her, she doesn’t want them to come back. The therapist then differentiates between medical, scientific knowledge about her voices, religious messages that she has gotten about the voices, and how important it will be for Olivia to take in both and determine what she thinks about the voices.

The therapist welcomes Olivia to the session and asks how her transition back home has been going. Olivia shares that going back to church with her family has been “weird”, and how the people there think that they can pray any problem away, while she doesn’t think what she went through could be resolved with prayer. Olivia adds that the people at church make her feel like something’s wrong with her for not healing by praying. The therapist normalizes how hard it must be to hear that, and asks if Olivia’s parents think the same. Olivia shares that they used to say those things aloud, and while they no longer say them, she believes they still do because they’re making her go to church. The therapist comforts Olivia and asks what it’s been like to feel forced to go to church. Olivia describes some of the strategies she’s used to convey to her parents that she doesn’t want to go, but hasn’t expressed it outright with them. The therapist asks whether Olivia thinks it would be helpful to bring her parents in so she can talk to them about how she’s feeling, and Olivia is willing to try despite being afraid that they might make her stop therapy. The therapist then engages Olivia in planning for how that session with her parents would go.

The therapist welcomes Olivia to the session and asks her to share how her prior experience with therapy in the group home where she was living had gone. Olivia says it wasn’t that helpful, and the therapist asks if it would be helpful to talk about her background. The therapist talks about her identities and asks Olivia what it might be like to share her personal experiences with someone who is different from her, and this makes Olivia uncomfortable. The therapist points this out, then asks Olivia if she could reflect on what about the last therapist she didn’t like. Olivia says her family doesn’t trust doctors, and she was uncomfortable because all the doctors she worked with previously were white. The therapist acknowledges that there’s been a lot of harm done to people by the medical and mental health professions, which are dominated by white people, and that she’s going to check in with Olivia periodically whether anything she says or does is harmful to her. The therapist then emphasizes that Olivia is the expert on herself while she’s the expert on mental health, and that their work will be collaborative as opposed to prescriptive.

The therapist welcomes Olivia to the session and asks her to share how her prior experience with therapy in the group home where she was living had gone. Olivia says it wasn’t that helpful, specifically because she is Christian, but that therapist did not find prayer or her faith important. This therapist clarifies that therapists ought to incorporate whatever wisdom and practices their clients bring, then asks more about how prayer helps Olivia. She then provides Olivia with the option of seeking pastoral counseling, and explains how her role is different from that. The therapist asks Olivia if she’d like an example, and the therapist outlines how she might help Olivia handle a difficult situation such as hearing hurtful language from a peer in school. Finally, she emphasizes that while she’s an expert on mental health, the most important part of their work is their relationship, and that they can check at the end of their third session whether Olivia is comfortable with her and whether she’d like to continue.

The purpose of this course is to assist healthcare professionals in properly identifying trauma-related hypervigilance among teletherapy patients for the purposes of effective treatment.

• Healthcare workers must possess the knowledge of trauma-related hypervigilance among trauma-exposed teletherapy patients.
• Healthcare workers need to be competent in differentiating adaptive safety behavior from trauma-related avoidance among trauma-exposed teletherapy patients.
• Healthcare workers need to accurately treat trauma-related hypervigilance with evidence-based techniques.

Many trauma-exposed patients engage in trauma-related hypervigilance, which can lead to avoidant behaviors. If the provider is unable to identify a patient who is engaging in trauma-related hypervigilance, and/or if the provider does not possess the knowledge/competence to differentiate it from adaptive safety behavior, the patient’s symptoms will likely maintain and may potentially worsen. It is important that healthcare providers be able to accurately identify and treat trauma-related hypervigilance with evidence-based techniques.

• Learners will gain knowledge of trauma-related hypervigilance.
• Learners will feel competent in their ability to identify trauma-related hypervigilance.
• Learners will show performance improvement in their ability to differentiate adaptive safety behavior and clinically significant trauma-related hypervigilance.

Learning Objectives

By the end of this course learners will be able to:

1. Identify trauma-related hypervigilance.
2. Differentiate adaptive safety behavior from trauma-related hypervigilance.
3. Identify general guidelines to follow when determining whether a patient is engaging in trauma-related hypervigilance.
4. Analyze misconceptions about trauma-related hypervigilance.