Shifting the Paradigm A Revolutionary Framework for Effective

Gray Otis, Ph. D, LCMHC, CCMHC, DCMHS-T AMHCA Diplomate, Clinical Mental Health Specialist in

Presentation Contributors Gray Otis, Ph. D, LCMHC, CCMHC, DCMHS-T q AMHCA Diplomate, Clinical Mental

The AMHCA Initiatives AMHCA Disassociation from ACA © 2018 KEY CORE BELIEFS. ALL RIGHTS

Clinical Mental Health Counselor Initiatives q CMHC Marketing Package – Video, Brochures, Bookmarks, etc.

CMHC Marketing Package q Video – What is a Clinical Mental Health Counselor? q

Clinical Mental Health Counselor Initiatives: q CMHC Marketing Package – Video, Information Brochures, Bookmarks,

Licensure portability q Coalition with ACES, NBCC, AASCB q Currently – drafted requirements q

Standards for the Practice of Clinical Mental Health Counseling: The Standards of Practice established

Clinical Mental Health Counselor declaration q CMHC Declaration – the equivalent of an Hippocratic

Credentialing Certifications: Specialist, Diplomate, Fellow Replaces the Diplomate & Clinical Mental Health Specialist (DCMHS)

Credentialing Certifications: Specialist, Diplomate, Fellow 2. Diplomate in Clinical Mental Health Practice (DCMHP): Earned

Credentialing Certifications: Specialist, Diplomate, Fellow 3. Fellow in Clinical Mental Health Education and Research

Professional Blueprint Career Model A career guide for counselors & a library of the

Medicare Reimbursement: q Congressional bill for Medicare Reimbursement introduced again q Mental Health Access

Wrapping it up These are some of the current initiatives for our profession We

Thank you for serving Questions? © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 22

Presentation Outline 1) What Lies Beneath? 2) Core Belief Development 3) Shame vs Guilt

Key Core Beliefs, Unlocking the HEART of Happiness & Health Available on Amazon Written

1) What Lies Beneath? © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 26

Key Core Beliefs: What Lies Beneath We propose that Negative Core Beliefs are schemas

Key Core Beliefs Defined Powerfully held convictions about self: q Consistent over time q

Identifying Negative Core Beliefs How many of you have heard these comments like these

Key Core Beliefs q q q We accept our Key Core Beliefs as true

2) Core Belief Development © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 31

How Key Core Beliefs act as filters Each event in our lives is influenced

Accumulating Key Core Beliefs Throughout the lifespan, both Positive and Negative Core Beliefs accumulate

Self-Belief Identity Our Self-Belief Identity creates either an antagonistic sense of self or a

Quiz: Negative to Positive Core Beliefs Negative Core Beliefs What would be a alternative

3) Shame vs Guilt © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 39

Shame-Based Negative Core Beliefs Etiology Many Negative Core Beliefs originate from trauma or chronic

Distinguishing Between Guilt and Shame GUILT: “I did something wrong or terrible” Guilt motivates

The Transformation of Shame Self-Beliefs q q q If the beliefs are resolved, the

Exercise: Shame-Based Beliefs Identify possible Shame Based, Negative Core Beliefs Teen-ager who was sexually

Other Shame Related Negative Core Beliefs What is wrong with me? Why can’t I

Another Example: Parental Shame My child is doing poorly. What’s wrong with her? The

Review of Negative Core Beliefs Shame-based Negative Core Beliefs create emotional dysregulation To cope,

How to Change Negative Core Beliefs The therapeutic process to transform any Negative Core

How to Change Negative Core Beliefs The process to transform any Negative Core Belief:

Positive Core Belief Development BECOME AWARE: Identify the Negative Core Belief “I am scared

Assessing the Quality of Your Life Daily estimate the quality of your life on

4) HEART © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 64

HEART: The 5 Essentials of Integrated Well-being Health—physical wellness based on principles of healthy

We All Have Key Core Beliefs Regarding: Health I am healthy I am uncoordinated

KEY CORE BELIEFS: Unlocking the HEART of Happiness & Health The concepts in Key

THANK YOU Questions? © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 70

THANK YOU Gray Otis, Ph. D, LCMHC gray_otis@yahoo. com 801 -885 -8585 © 2018

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Shifting the Paradigm A Revolutionary Framework for Effective Treatment Outcomes H. Gray Otis, Ph. D, LCMHC, DCMHS-Trauma Utah Mental Health Counselors Association Conference – March, 2019

Gray Otis, Ph. D, LCMHC, CCMHC, DCMHS-T AMHCA Diplomate, Clinical Mental Health Specialist in Trauma Current private practice – owner Vanguard Behavioral Health Past clinical director of residential and intensive out patient treatment programs AMHCA Director of Program Coordination AMHCA Liaison to AASCB and ACEs 801 -885 -8585 gray_otis@yahoo. com © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 2

Presentation Contributors Gray Otis, Ph. D, LCMHC, CCMHC, DCMHS-T q AMHCA Diplomate, Clinical Mental Health Specialist in Trauma q He has been the clinical director of residential and intensive out patient treatment programs q Private practice – owner Vanguard Behavioral Health Sandi Williams, MS, MA, LMFT q Specialist in trauma resolution and family counseling q She has co-facilitated a residential treatment program q Private practice – owner of the Meadows Counseling, adjunct professor at Utah Valley University James Messina, Ph. D, Psychologist, CCMHC, DCMHS-T q AMHCA Diplomate, Clinical Mental Health Specialist in Trauma q He has served as a professor at Troy State University q Developed a library of on-line resources available at Coping. US © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 3

Clinical Mental Health Counselor Initiatives q CMHC Marketing Package – Video, Brochures, Bookmarks, etc. q Licensure Portability – Coalition with ACES, NBCC, AASCB q AMHCA Standards for the Practice of Clinical Mental Health Counseling q CMHC Declaration – Hippocratic Oath, a first in mental health q Credentialing Certifications: Clinical Specialist, Diplomate, Fellow q CMHC Professional Blueprint Career Model q Medicare Reimbursement © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 5

CMHC Marketing Package q Video – What is a Clinical Mental Health Counselor? q Printed marketing materials: n. Information Brochures n. Bookmarks n. Handouts q Downloaded and available without cost © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 6

Clinical Mental Health Counselor Initiatives: q CMHC Marketing Package – Video, Information Brochures, Bookmarks, etc. q Licensure Portability – Coalition with ACES, NBCC, AASCB q AMHCA Standards for the Practice of Clinical Mental Health Counseling q CMHC Declaration – Hippocratic Oath, a first in mental health q Credentialing Certifications: Clinical Specialist, Diplomate, Fellow q CMHC Professional Blueprint Career Model q Medicare Reimbursement © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 7

Licensure portability q Coalition with ACES, NBCC, AASCB q Currently – drafted requirements q Intended to be compatible with state compacts q One size does not fit all states © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 8

Standards for the Practice of Clinical Mental Health Counseling: The Standards of Practice established in 1979 and updated ever since Used by the Institute of Medicine to justify federal hiring and reimbursement Includes: q Scope of Practice and Standards of Practice and Research q Clinical Practice Standards q Recommend AMHCA Training in the Knowledge and Skills: Biological Bases of Behavior Substance Use Disorders & Co-occurring Disorders Specialized Clinical Assessment Trauma Informed Care Technology Assisted Counseling (TAC) Integrated Behavioral Health Care Aging and Older Adults Standards and Competencies Child and Adolescent Standards and Competencies New standards proposed for Military Counseling, Couples & Family, etc. . © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 10

Clinical Mental Health Counselor declaration q CMHC Declaration – the equivalent of an Hippocratic Oath q Recently approved by the Board of Directors q Voluntary q A public statement regarding professional ethics q Published in the latest AMHCA Advocate q May be downloaded without cost q Suitable for framing © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 12

Credentialing Certifications: Specialist, Diplomate, Fellow Replaces the Diplomate & Clinical Mental Health Specialist (DCMHS) 1. Clinical Mental Health Counseling Specialist (CMHCS) in: Couples or Family Counseling Integrated Behavioral Health Care Counseling Substance Abuse and Co-occurring Disorders Developmental Disability Counseling Trauma Counseling Child and Adolescent Counseling Geriatric Counseling Military Counseling Each specialist credential requires training, supervision, & experience © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 14

Credentialing Certifications: Specialist, Diplomate, Fellow 2. Diplomate in Clinical Mental Health Practice (DCMHP): Earned by those who wish to be recognized Advanced Practice Establishes requirements and standards for counselors who have been fully licensed for at least 7 years and served the profession in positions of leadership, education, promotion of public mental health, etc. © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 15

Credentialing Certifications: Specialist, Diplomate, Fellow 3. Fellow in Clinical Mental Health Education and Research (FCMHER): Earned recognition in Advanced Education and Research Establishes requirements and standards for Counselor Educators who have been fully licensed for at least 7 years and served in education and research positions. © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 16

Professional Blueprint Career Model A career guide for counselors & a library of the profession’s pertinent documentation including: q History q Code of Ethics & CMHC Declaration q The Standards of Practice q Professional Development Guidance q Advanced Credentialing Certifications Under current development with a publication date of this year © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 18

Medicare Reimbursement: q Congressional bill for Medicare Reimbursement introduced again q Mental Health Access Improvement Act (S. 286) was re-introduced by Senator Barrasso (R-WY) and Senator Stabenow (D-MI) q Will allow counselors to bill Medicare for treating older adults with mental health conditions. q Both ACA and AMHCA support this legislative initiative q Still a concern regarding Congressional Budget Office accounting q Political winds are changing and Medicare Reimbursement will be enacted © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 20

Wrapping it up These are some of the current initiatives for our profession We have distinct advantages with respect to other mental health professions because of our focus on holistic health, strengths, and resilience The future looks very promising © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 21

Key Core Beliefs, Unlocking the HEART of Happiness & Health Available on Amazon Written for the public Includes workbook & online resources (Key. Core. Beliefs. org) Appendix for clinicians Can be used as an adjunct to therapy © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 24

Key Core Beliefs: What Lies Beneath We propose that Negative Core Beliefs are schemas that lie at the genesis of nearly all mental health disorders. Through the transformation of these injurious beliefs to Positive Core Beliefs, depression, anxiety, and trauma will be resolved with lasting results. © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 27

Key Core Beliefs Defined Powerfully held convictions about self: q Consistent over time q Can be either conscious or subconscious Based on prior experiences in childhood, adolescence, and adulthood q q Strongly linked to who we are – our unique sense of self q Can often be expressed as “I am. . . ” Statements (e. g. “I am a competitive person. . . I am competitive”) © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 28

Key Core Beliefs q q q We accept our Key Core Beliefs as true – but – many are mistaken Based on our experiences, we continually create self-beliefs – constructed reality of the self Ø Negative Core Beliefs generally arise out of personally adverse interactions (“My friends don’t want to spend time with me. . . I am unattractive. ”) Each self-belief is either a Negative Core Belief or Positive Core Belief Ø q These self-beliefs filter our perceptions, thoughts, emotions, and actions. Positive Core Beliefs arise out of personally affirmative interactions (“My teacher thinks I good at math. I must be pretty smart. . . I am smart. ”) q The accumulation of Key Core Beliefs develops our Self-Belief Identity 30 © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED.

How Key Core Beliefs act as filters Each event in our lives is influenced by our previous Key Core Beliefs and the emotions related to these deeply held convictions. As we perceive a new experience, our Key Core Beliefs immediately filter and influence our perceptions of the event. To illustrate: © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 32

Accumulating Key Core Beliefs Throughout the lifespan, both Positive and Negative Core Beliefs accumulate Self. Belief Identity © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. If Positive Core Beliefs predominate, the individual generally develops a constructive Self-Belief Identity 34

Accumulating Key Core Beliefs Throughout the lifespan, both Positive and Negative Core Beliefs accumulate Self. Belief Identity If Positive Core Beliefs predominate, the individual generally develops a constructive Self-Belief Identity However, if Negative Core Beliefs prevail, how would the individual be likely to perceive his or her Self-Belief Identity? © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 35

Self-Belief Identity Our Self-Belief Identity creates either an antagonistic sense of self or a beneficial sense self: I am diabetic, I am sick – or – I have diabetes but I am tough and pretty healthy Self. Belief Identity I am fat, I am ugly – or – I am healthy but I could lose some weight” Skilled therapists can help individuals develop added Positive Core Beliefs and a stronger, more constructive Self-Belief Identity © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 36

Quiz: Negative to Positive Core Beliefs Negative Core Beliefs What would be a alternative I am alone. I am hopeless. I am depressed. I am angry. I am critical. I am addicted. I am ashamed. I am lazy. I am unlovable. © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. Positive Core Belief? 37

Quiz: Negative to Positive Core Beliefs Negative Core Beliefs What would be a alternative Positive Core Belief? I am alone. I am friendly. I am hopeless. I am hopeful. I am depressed. I am optimistic. I am angry. I am calm. I am critical. I am accepting. I am addicted. I am healthy. I am ashamed. I am okay. I am lazy. I am conscientious. I am unlovable. I am worthy to be loved. These are deeply held beliefs – not just positive affirmations © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 38

Shame-Based Negative Core Beliefs Etiology Many Negative Core Beliefs originate from trauma or chronic distress q For example – use of the Adverse Childhood Experience questions: “Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? ” q Individuals suffer loss of attachment, low-grade anxiety, cultural conflicts, etc. q Deep seated emotions associated with shame may be manifested in any DSM disorder or medical condition (e. g. “I was often put down. . . I am worthless. ”) q By attempting to numb severe negative emotions and shame, individuals simultaneously numb out joy and love q ©Often, there is a horrifying 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. sense of isolation & helplessness 40

Distinguishing Between Guilt and Shame GUILT: “I did something wrong or terrible” Guilt motivates us to change SHAME: “There is something wrong with me – I am terrible” Shame beliefs lead us to believe that we cannot change To resolve mental health disorders, mental health counselors must be skilled in helping individuals transform shame-based Negative Core Beliefs © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 41

The Transformation of Shame Self-Beliefs q q q If the beliefs are resolved, the symptoms resolve All of these disorders have coupled, shame-based, Negative Core Beliefs Outcome research shows that addressing underlying shame is highly effective in treating many DSM disorders including anxiety, PTSD, depression, addictions, and compulsive behaviors. Shame self-beliefs can be transformed into constructive, POSITIVE SELF- BELIEFS Mental health counselors need evidenced-based approaches to treat the underlying basis of cooccurring disorders 42 © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED.

Exercise: Shame-Based Beliefs Identify possible Shame Based, Negative Core Beliefs Teen-ager who was sexually abused in childhood I am dirty, disgusting, undeserving, contemptible, etc. Veteran whose close friend died in combat I am cowardly, deserve to die, disloyal, etc. Woman who was emotionally devastated by divorce © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 47

Other Shame Related Negative Core Beliefs What is wrong with me? Why can’t I ______? Primary fear – inherent shame-based Negative Core Belief: ‘There is something fundamentally wrong with me’ ‘I can’t change – I am just an angry person’ 51 © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED.

Another Example: Parental Shame My child is doing poorly. What’s wrong with her? The parental shame self-belief is often subconscious: ‘There is something wrong with my parenting’ ‘I am a failure and I cannot change. I’m just a bad parent’ 53 © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED.

Review of Negative Core Beliefs Shame-based Negative Core Beliefs create emotional dysregulation To cope, clients turn to alcohol, drugs, work, exercise, religion, politics, or any of a multitude highly creative compulsive behaviors q Negative Core Beliefs eclipse everything else mentally & emotionally q We must go beyond treating symptoms q No counselor can create Positive Core Beliefs q However, we can create the conditions to transform Negative Core Beliefs into Positive Self-Beliefs © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 55

How to Change Negative Core Beliefs The therapeutic process to transform any Negative Core Belief: 1. BECOME AWARE: Identify the Negative Core Belief. 2. CREATE: Devise an alternative, desired Positive Core Belief. 3. ACT: Foster behaviors that reinforce the Positive Core Belief. 4. PRACTICE: Consistently act to strengthen the Positive Core Belief. © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 56

How to Change Negative Core Beliefs The process to transform any Negative Core Belief: 1. BECOME AWARE: Identify the Negative Core Belief. 2. CREATE: Devise an alternative, desired Positive Core Belief. 3. ACT: Foster behaviors that reinforce the Positive Core Belief. 4. PRACTICE: Consistently act to strengthen the Positive Core Belief. © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 60

How to Change Negative Core Beliefs The process to transform any Negative Core Belief: 1. BECOME AWARE: Identify the Negative Core Belief. 2. CREATE: Devise an alternative, desired Positive Core Belief. 3. ACT: Foster behaviors that reinforce the Positive Core Belief. 4. PRACTICE: Consistently act to strengthen the Positive Core Beliefs are methodically developed by applying this process. Therapists can expedite this process by employing CBT, CPT, ACT, EMDR, etc. © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 61

Positive Core Belief Development BECOME AWARE: Identify the Negative Core Belief “I am scared around all strangers. ” My Core Belief is: “I am fearful. ” CREATE: Devise an alternative, desired Positive Core Belief “I want to be self-confident. ” My Core Belief will be: “I am confident. ” ACT: Foster behaviors that reinforce the Positive Core Belief “From now on, when someone greets me I will say, Hi. ” PRACTICE: Consistently act to strengthen the Positive Core Belief. “I will make a habit of this even if I feel anxious. ” © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 62

Assessing the Quality of Your Life Daily estimate the quality of your life on a scale of 1 to 7 by how much you live with empathy, caring, and connection. Shame, Fear, Isolation Connection Empathy, Caring, Fear of self and self-beliefs has an effective anecdote. This builds Positive Core Beliefs: I am empathetic and caring © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 63

HEART: The 5 Essentials of Integrated Well-being Health—physical wellness based on principles of healthy living Emotions—emotional balance through self-understanding Awareness—conscious use of our mental abilities Relationships—caring and satisfying connections with others Transcendence—enrichment through inspiring influences These five essentials construct our sense of Self-Belief Identity © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 65

We All Have Key Core Beliefs Regarding: Health I am healthy I am uncoordinated Emotions I am coolheaded I am resentful Awareness I am intelligent I am not musical Relationship I am kind I am dishonest Transcendence I am spiritual I am uninspired © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 67

KEY CORE BELIEFS: Unlocking the HEART of Happiness & Health The concepts in Key Core Beliefs can be highly therapeutic. For more information, please refer to Appendix D, "Notes for Mental Health Professionals. " © 2018 KEY CORE BELIEFS. ALL RIGHTS RESERVED. 69