2023 Annual Yellowbrick Conference

Michael McClam, MD, FAPA
Medical Director, Youth Division
President of Medical Staff

Summary:
In the therapeutic hospital, we treat many patients with comorbid primary psychiatric (axis one under the old rubric) and personality disorders (axis two). From one perspective, the “axis one” symptoms merely represent the tip of the iceberg in that longstanding personality dynamics drive the interpersonal and intrapsychic conflict which underlie the apparent psychiatric symptoms. Immersion into a hospital that focuses on the interpersonal dynamics between the patient and the treatment team create a situation where the patient’s typical pattern of interactions and defense mechanisms will manifest during treatment and can be explored and analyzed as tolerated by the patient. One of the more common defense mechanisms that treatment teams face is splitting, or, in other words, “all or none” or “black and white” thinking.

Learning Objectives:

1. 1. Understand the psychological antecedents of splitting and why and in what context in which it commonly arises
   2. Learn how treatment teams can learn to expect and use the affects that arise in the patient-treatment team relationship to provide a corrective experience
   3. Learn about the factors that can provide hope for healing in the patient’s subsequent relationships

Summary:
Personality has been long thought to be permanent. New research shows that personality is more flexible and adaptive than previously thought and that individuals can transition from using maladaptive behaviors to more adaptive mechanisms. This is especially true for people with personality disorders. Join Drs. Francis and Stoeckel from Huntsman Mental Health Institute’s Young Adult Comprehensive Assessment and Treatment (CAT) Program at the University of Utah as they explore personality development throughout the lifespan and exciting research updates. Together they will highlight several in vivo cases in which environment and feedback were repeatedly used in treatment settings to modify maladaptive personality patterns.

Learning Objectives:

1. 1. Identify modifiable features of personality of the lifespan and recognize those that are less adaptable over time
   2. Build on clinical repertoire with targeted techniques to aid in shaping behaviors in persons with identified personality disorders
   3. Gain clinical confidence in EBM behavioral techniques that improve outcomes for patients over time

Summary:
This presentation utilizes psychoanalytic theories to formulate the stages of treatment of young adults in residential therapeutic programs. A longitudinal model is theorized that includes 5 distinct stages with accompanying examination of the following aspects of each stage:

1. The phase of treatment
2. Emotional, cognitive, behavioral, and interpersonal manifestations
3. Unconscious psychodynamics
4. Therapeutic considerations

Learning Objectives:

1. 1. Identify some of the unconscious dynamics that emerge during the phases of residential therapeutic treatment
   2. Explore psychotherapeutic interventions that can be used to achieve a successful residential treatment experience
   3. Explore a treatment model that can be extrapolated to other modalities

Summary:
Check back soon for description.

Learning Objectives: Check back soon.

Summary:
Intensive treatment in an open therapeutic community with an integrated and coherent psychotherapeutic model of treatment is both an opportunity for intensive immersion in potentially deep relationships with peers and staff, and must tolerate a hovering level of “messy” and disruptive experiences, in order to be effective. The availability of information from behavioral communications to the individual—and sometimes group–psychotherapy provides an opportunity for a technique that is far less accessible in an outpatient practice, that of the therapist introducing behavioral information which the patient may not have chosen to discuss, or about which they may not even be conscious in the moment. This talk will attempt to integrate some of the sources of this access from many aspects of the intensive treatment setting, including non-verbal sources, with the psychotherapeutic approach utilized to make sense, and use, of the important information they provide about patients’ often dissociated self-states, using a model of Enactment Theory as the guide for interpreting both what happens in the therapist’s office, and outside of it.

Learning Objectives:

1. 1. Participants will have a working understanding of the structure and process of Yellowbrick, an intensive psychiatric treatment program for Emerging Adults
   2. Participants will be familiar with the specific approach of bringing behavioral information from outside the usual boundaries of outpatient psychotherapy, into its internal process
   3. Participants will gain further understanding of Enactment Theory, a neurobiologically-based model of intersubjective emotional experience and its interpretation as part of the process, to attempt help patients integrate dissociated and potentially dangerous self-states