Advanced CBT
Overcoming Resistance and Treating Complex Cases

Clinicians familiar with standard CBT can still feel stuck when clients present with co-occurring conditions, longstanding problems, rigid thinking, intense emotions, impulsive behavior, limited insight, or recurring therapy-interfering patterns. These cases can make it difficult to know where to begin, how to respond to resistance, or how to judge meaningful progress.
Although CBT is sometimes reduced to coping skills or surface-level symptom management, cognitive approaches can also address deeper beliefs and more complex presentations. For behavioral health professionals, the challenge is not simply choosing another technique; it is adapting formulation, pacing, communication, expectations, and the use of the therapeutic relationship to the needs of the case.

"Advanced CBT: Overcoming Resistance and Treating Complex Cases" is one of three courses that comprise the Cognitive Behavioral Therapy Training Certificate (CBTTC). Enroll in the full program and earn 15 total CEs and the CBTTC.

Jeff Riggenbach, PhD, trained at The Beck Institute for Cognitive Therapy and Research in Philadelphia specifically to help develop a personality disorder treatment program that has treated more than 500 patients with borderline personality disorder and many individuals with other personality disorders across two facilities over a 15-year period. His experience integrating cognitive, dialectical behavior, and schema-informed methods with complex clinical presentations—and training clinicians throughout the United States and internationally—directly informs the practical guidance and case examples in this course.

Even clinicians with a strong foundation in CBT can feel uncertain when clients’ difficulties are longstanding, multifaceted, and slow to respond to standard interventions. Through didactic instruction, clinical examples, case analysis, and humor, Jeff presents an integrated CBT, dialectical behavior therapy, and schema-informed approach to help clinicians better understand what is maintaining the problem, work through resistance, and recognize meaningful progress.

Although CBT is sometimes misunderstood as a brief, surface-level approach, cognitive and schema-informed methods can also address deeply rooted beliefs and complex clinical presentations. Effective work with these cases requires more than choosing another technique; it calls for thoughtful case conceptualization, flexible communication, realistic expectations, and purposeful use of the therapeutic relationship while maintaining structure, accountability, collaboration, and compassion. The approach remains practical and measured, recognizing that no single intervention fits every client and that progress may occur gradually.

Key Takeaways:

• Progress in Smaller Steps: Track changes in frequency, intensity, consequences, and functioning rather than assuming persistent symptoms mean treatment has failed.
• Validation Before Challenge: Respond to pain, history, and perceived injustice with genuine validation before inviting responsibility, reality testing, or behavioral change.
• Preparation for Continued Recovery: Use warning signs, evidence logs, coping plans, booster sessions, and self-therapy to help clients continue practicing skills between and after sessions. 

Why this course?

• A Framework for Clinical Sticking Points: Organize work with resistance, compelling schemas, self-harm, interpersonal escalation, paranoia, and psychotic experiences without reducing clients to labels.
• Tools That Translate to Session: Conceptualization maps, chain analyses, coping cards, behavioral experiments, and carefully chosen language make advanced concepts more usable in practice.
• Experience Grounded in Complex Care: Jeff’s Beck Institute training and years of personality disorder program development connect the material to sustained clinical work with challenging presentations.

Learning Objectives:

• Describe 5 characteristics of a “Complex Case”.
• Analyze 3 types of resistance and utilize appropriate interventions for each.
• Discuss the 5 principles vital for treating clients with challenging conditions.
• Demonstrate 4 module skills training for personality-disordered individuals.
• Utilize a case study to assess the integrated treatment of one client with BPD.
• Compare “befriending” with cognitive-based interventions for individuals with psychosis and explain the indications for the usage of each.

Enroll today to strengthen your ability to conceptualize complex cases, respond to resistance with greater clarity, and apply schema-informed CBT strategies to borderline personality disorder, paranoia, psychosis, and other challenging presentations. The course offers a practical framework for supporting realistic progress while helping clients build skills they can continue using beyond regular treatment.