Trainer, Briana Pfeuffer, LCSW is a clinical social worker with nearly a decade of experience working with children, teens, and families. Briana specializes in clients- child and adult alike- with complex trauma, OCD, and anxiety disorders. In her previous position she was team lead for a community mental health service that provided on-going therapy and crisis care to clients. Briana has additionally facilitated several therapy groups, including an art-based coping skills group for teens, and a support group for family members of clients with severe and complex trauma.

• (15 Min)- Introduction of trainer. If appropriate size, introduction of participants. 

• (out loud or in virtual chat) Why is this topic important? Why is it hard for clinicians to follow through with ERP? Why did participants sign up for this course/what do they hope to learn?

• Start with Lesson/presentation  

• (20 min) Topic on Screening for ERP- the type of diagnosis ERP is helpful for, and who it may not be helpful for. It is the gold standard of OCD and Anxiety. Consider if Trauma and other diagnoses make it inappropriate. Developmental age considerations. Anxiety vs. OCD. 

• (10 min) Group discussion (out loud or in virtual chat): Most of us probably learned about ERP in Graduate school- what is our initial impression? What are our barriers to using it. 

• Trainer shares her initial barrier was not wanting to feel mean or push clients too much. Worried about backlash in rapport. 

• Getting clinicians to buy into it being an effective model AND that it can be done in a kind way that still saves rapport. 

• (15 min) Topic on Anxiety cycle and ERP Review: Short review on the Anxiety cycle. How avoidance only strengthens anxiety, and how facing it is important. Anxiety traps clients and this helps them become free in small manageable steps that build their confidence for the long-term. Anxiety is often a lack of feeling capable of handling a “bad thing”. Review of how to use ERP appropriately and effectively. 

• (10 min) Bathroom break- 1 hour mark 

• Break out rooms: Case Study- Trainer will bounce between virtual rooms

• (10 min) Introductions to group members and read through case study example to brainstorm. 

• (20 min) Formulate how to talk to a case study client about engaging in ERP therapy. Consider age, Motivational Interviewing techniques, and explaining the anxiety cycle and ERP in an age appropriate way. 

• (20 min) Role play for a larger group. Volunteers from the breakout rooms share their summary. Trainer engages in a role play of how she would explain it to clients of different developmental ages so clinicians can observe options. 

• See handouts of Fear “staircase”, MI questions, How to involve play. Emotion Thermometer, etc. 

• (10 min Bathroom Break)- 2 hour mark 

• (20 min)Topic on Fear Ladder technique: Staff reviews how to brainstorm a fear ladder with clients. In a kind way- getting their buy in on wanting the change in their life. Staff provides research of why including parents for children or teens if appropriate. Imaginal, in-vivo exposures. Exposures in session vs. in real life. Accidental parent anxiety reinforcement at home. 

• Break out rooms (same group, same case study): 

• (15 min) Clinicians practice building a fear ladder or “fear staircase” for case study clients, and discuss whether to involve parents or not. 

• (15 min): Trainer leads final group demonstration for larger group of follow up after a fear ladder has been established, and how to “graduate” young clients from their ERP work.