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

2. Gray Otis, PhD, 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

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

4. AMHCA Disassociation from ACA
The AMHCA Initiatives
AMHCA Disassociation from ACA

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

6. CMHC Marketing Package
Video – What is a Clinical Mental Health Counselor?
Printed marketing materials:
Information Brochures
Bookmarks
Handouts
Downloaded and available without cost

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

8. Licensure portability
Coalition with ACES, NBCC, AASCB
Currently – drafted requirements
Intended to be compatible with state compacts
One size does not fit all states

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

10. 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:
Scope of Practice and Standards of Practice and Research
Clinical Practice Standards
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..

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

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

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

14. 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

15. 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.

16. 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.

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

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

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

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

21. 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

22. Thank you for serving
Questions?

23. Presentation Outline 1) What Lies Beneath
Presentation Outline 1) What Lies Beneath? 2) Core Belief Development 3) Shame vs Guilt 4) HEART

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

25. Presentation Outline 1) What Lies Beneath
Presentation Outline 1) What Lies Beneath? 2) Core Belief Development 3) Shame vs Guilt 4) HEART

26. 1) What Lies Beneath?

27. 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.

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

29. Identifying Negative Core Beliefs

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

31. 2) Core Belief Development

32. 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:

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

34. Accumulating Key Core Beliefs
Throughout the lifespan, both Positive and Negative Core Beliefs accumulate
If Positive Core Beliefs predominate, the individual generally develops a constructive Self-Belief Identity
Self-Belief Identity

35. Accumulating Key Core Beliefs
Throughout the lifespan, both Positive and Negative Core Beliefs accumulate
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?
Self-Belief Identity

36. 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
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
Self-Belief Identity

37. Quiz: Negative to Positive Core Beliefs
Negative Core Beliefs What would be a alternative Positive Core Belief?
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.

38. 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

39. 3) Shame vs Guilt

40. Shame-Based Negative Core Beliefs Etiology
Many Negative Core Beliefs originate from trauma or chronic distress
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?” 
Individuals suffer loss of attachment, low-grade anxiety, cultural conflicts, etc.
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.”)
By attempting to numb severe negative emotions and shame, individuals simultaneously numb out joy and love
Often, there is a horrifying sense of isolation & helplessness

41. 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
into Positive Core Beliefs

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

43. Exercise: Shame-Based Beliefs
Identify possible Shame Based, Negative Core Beliefs Teen-ager who was sexually abused in childhood

44. 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.

45. 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

46. 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.

47. 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

48. 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 I am unattractive, a failure, broken, etc.

49. 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 I am unattractive, a failure, broken, etc. An adult who was extensively criticized as a child

50. 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 I am unattractive, a failure, broken, etc. An adult who was extensively criticized as a child I am stupid, a mess, disappointing, etc.

51. 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’

52. 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’
Perhaps the most important shame self-belief –
‘Who could love an angry person? I’m unworthy to be loved’

53. 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’

54. 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’
The parent now has additional evidence that
‘Who could love a bad parent? I’m unworthy to be loved’

55. 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
Negative Core Beliefs eclipse everything else mentally & emotionally
We must go beyond treating symptoms
No counselor can create Positive Core Beliefs
However, we can create the conditions to transform Negative Core Beliefs into Positive Self-Beliefs

56. How to Change Negative Core Beliefs
The therapeutic process to transform any Negative Core Belief:
BECOME AWARE: Identify the Negative Core Belief.
CREATE: Devise an alternative, desired Positive Core Belief.
ACT: Foster behaviors that reinforce the Positive Core Belief.
PRACTICE: Consistently act to strengthen the Positive Core Belief.

57. How to Change Negative Core Beliefs
The process to transform any Negative Core Belief:
BECOME AWARE: Identify the Negative Core Belief.

58. How to Change Negative Core Beliefs
The process to transform any Negative Core Belief:
BECOME AWARE: Identify the Negative Core Belief.
CREATE: Devise an alternative, desired Positive Core Belief.

59. How to Change Negative Core Beliefs
The process to transform any Negative Core Belief:
BECOME AWARE: Identify the Negative Core Belief.
CREATE: Devise an alternative, desired Positive Core Belief.
ACT: Foster behaviors that reinforce the Positive Core Belief.

60. How to Change Negative Core Beliefs
The process to transform any Negative Core Belief:
BECOME AWARE: Identify the Negative Core Belief.
CREATE: Devise an alternative, desired Positive Core Belief.
ACT: Foster behaviors that reinforce the Positive Core Belief.
PRACTICE: Consistently act to strengthen the Positive Core Belief.

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

62. 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.”

63. 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 Empathy, Caring, Connection
Fear of self and self-beliefs has an effective anecdote.
This builds Positive Core Beliefs: I am empathetic and caring

64. 4) HEART

65. 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

66. 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

67. 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

68. 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 The five essentials are Key Core Beliefs

69. 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."

70. Questions?

71. Gray Otis, PhD, LCMHC