CBT for Complex Cases


October 22 - 23, 2012

Presented by

mark freeston

Mark Freeston


Workshop application

Workshop prices


Day 1 - CBT for complex cases: Looking for patterns and developing treatment-guiding hypotheses

Relevant Background

In CBT we have a number of different ways of representing client presentations that have different uses, strengths, and limitations. These include problem lists, “hot cross buns”, formulations representing both longitudinal and cross-sectional hypotheses, and highly individualized representations based on theoretical models. It is proposed that all of these may struggle a times to generate helpful hypotheses with complex/comorbid presentations.

With comorbid cases, these familiar types of representations may interfere with recognition of important functional relationships between different parts of the presenting problems that have potential implications for effective treatment.  It is argued that these functional relationships may become more obvious at an intermediate level of specification. It is proposed that comorbid/complex cases will vary infinitely at a highly detailed and individualized level, but they may fit a finite number of patterns (and large number of combination of patterns) at an intermediate level.

Identifying these basic patterns provides a way into complex and comorbid cases. The first day focuses on recognizing these patterns, developing hypotheses and planning treatment based on them.


Day 2 - CBT for complex cases: Thinking about technical difficulty, chronicity, barriers to change, and common processes

Relevant Background

First, some cases that are “hard to treat” may be so because of specific features of the presentation rather than their complexity.  What makes such cases “hard to treat”?  We will consider the differences between a case that is technically difficult and one that is truly complex. Such cases may require careful thinking and even greater adherence to models (and flexible/creative use of them) to find the way in rather than a “if it’s not working, try something else” approach.

Second, chronicity and severity are often associated with complexity. In some cases they may have prognostic implication; in others they may not.  Why may this be so? There are a number of different ways that severity, complexity and chronicity may interact that have differential implications for treatment; in some cases a broad-based approach may be essential, in others a very focused approach (in the right area) may have the greatest pay-off.  Developing differential hypotheses about these patterns can guide treatment: Do we need to put lots of things in place to enable change? Or does focusing in on specific aspects offer the best possibility of helping the person become unstuck?

In both cases, how does the change process then need to be managed?  Finally, there is great interest in trans-diagnostic approaches.  There are different ways of thinking about trans-diagnostic issues; being clear about what we mean can help therapists access the right parts of the evidence base in ways that have clear treatment implications.

These implications can perhaps lead to balance between what is common or shared between problems or diagnoses and the tailoring the intervention to particular features of the different parts of complex presentations.

Key learning objectives

By the end of the workshop participants will have

  1. become familiar with some of the more common types of pattern of associations between disorders and their implications,
  2. increased familiarity with some of the limited evidence base,
  3. reflected on how the evidence base can guide decisions and how we can make reasonable extrapolations from it,
  4. considered different types of complexity and hard to treat cases, and
  5. will have practiced an approach for generating treatment guiding hypotheses when new and complex presentations are encountered.

Training Modalities

Methods will include brief didactic presentations, working in pairs or small groups with particular types of presentation, interactive plenary sessions, and question and answer sessions.

Required Background

The workshop assumes a degree of familiarity with diagnostic systems (ICD and/or DSM) as a helpful shorthand to describe symptom patterns and syndromes and access the evidence base, but will consider the types of psychological links that may be present in complex and comorbid presentations. It also assumes familiarity with standard models and approaches for anxiety disorders, depression, and other disorders with a CBT evidence-base, for both the models and the treatment.

Implications for everyday clinical practice of CBT

This workshop considers a number of possible types of relationship between axis I disorders (such as anxiety disorders and depressive disorders), and between axis I and axis II disorders (i.e. personality traits and disorders) as well as the various relationships between complexity, severity, chronicity and technical difficulty. In the face of inevitable comorbidity and complexity, this way of approaching cases can help clinicians generate face-valid hypotheses that can guide treatment in a variety of ways such as i) where to start, ii) when and how to adapt standard approaches in the face of complexity, iii) how to sequence or combine interventions based on or drawn from evidenced based therapeutic approaches; they can thus also iv) anticipate and avoid possible difficulties and v) recognize pitfalls and find possible solutions.

Workshop costs

There are early bird prices which are available till about 6 weeks before the workshops. But we suggest you don’t leave it to the last minute – our 2009, 2010 and 2011 workshops have been full for some weeks before. For early bird prices, please note that application forms must have arrived at UCRH (fax/email accepted) by these dates.

Please note: our workshop prices include morning and afternoon teas (always very good!) - but do not include lunch for two reasons:

  1. To keep prices down. We hope you’ll agree that the prices are pretty good compared with what most people are charging.
  2. Because our experience is that its good for people to get out of the building and into Byron Bay at lunchtime; a walk on the beach, a café lunch, whatever

CBT for Complex Cases - October 22 - 23, 2012

2 day workshop earlybird price - $520 - $580 Full Price

*Double Discount - Book two consecutive workshops and receive a further $100 off the total price


Workshop location

All workshops will be held in Byron Bay in the NSW Northern Rivers region. Byron Bay is a world renowned tourist mecca and will provide a magnificent backdrop for our workshop program.

Southern Cross University
Byron Bay Community and Cultural Centre
Level 1
69 Jonson St
Byron Bay NSW 2481

Workshop times

Registration & tea/coffee will be from 8.30am. The workshops will start at 9.00. There will be morning and afternoon tea breaks, and a lunchbreak around 12.30. Workshops finish at 4.30

Registration & tea/coffee will be from 1:00pm on 18th with the workshop starting at 1:30pm and an afternoon tea break around 3pm. Tea/coffee will be from 8:30am on 19th with the workshop starting at 9:00am and with morning and afternoon tea breaks, and a lunchbreak around 12.30. Workshop finishes at 4:30pm.

Getting to Byron Bay and accommodation

For information on travelling to Byron and accommodation please click here.

Workshop registration

You can register for week long programs at discounted prices. Head to our Workshop Application page where you can download and fax/post us your application.


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