The 38th Door County Summer Institute

The 38th Door County Summer Institute is organized by Medical College of Wisconsin (MCW) and will be held from Jul 21 - Aug 08, 2025 at Landmark Resort, Door County, Egg Harbor, Wisconsin, United States of America.

Session 1: Developing Advancement Skills Via Medical Improvisation
July 21- 25, 2025 9:00 am – 12:15 pm

Course Description:
Health care involves constant adaptation to unexpected challenges. Recently a movement spearheaded at Northwestern University’s Feinberg School of Medicine has begun using improvisational acting exercises to teach physicians, psychotherapists, nurses, and pharmacists the ability to respond flexibly in the face of change. This movement, called medical improvisation, has shown promise in promoting a wide variety of communication skills, including empathy, affirmation, collaboration, and authenticity. A recent classification of medical improv skills (Fu, 2019) breaks them into three categories. This year’s seminar will focus on the third category, Advancement, which includes skills that enrich self and others through the delivery of ideas (e.g., creativity, spontaneity, modulation of verbal and nonverbal cues). While the effects of practicing medical improv can often be humorous, participants do not need to be “funny” to do it. The leaders of this largely experiential workshop will draw on their close collaboration with Paul Sills, founding director of Chicago’s Second City, who used improvisation to train renowned actors such as Alan Arkin and Alan Alda. After an overview of current research and theory in medical improvisation and advancement skills, the bulk of the week will be devoted to engaging in and discussing a series of simple and entertaining improv exercises in a safe, highly supportive atmosphere. No previous experience with improvisation is required.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Describe the importance of spontaneity and improvisational ability in medicine, psychotherapy, pharmacy, and other health-related fields.
• Identify and explain Fu’s (2019) classification of medical improvisation’s goals and core skills into three categories: (a) Attunement (knowledge of self and others), (b) Affirmation (validation of self and others), and (c) Advancement (enrichment of self and others).
• Analyze research demonstrating the importance of practitioner advancement skills, focusing on the ability to modulate nonverbal cues (e.g., paralinguistic variety, facial expressiveness) to increase message impact and educational effectiveness.
• Demonstrate advancement skills via medical improvisation techniques (e.g., modulation of vocal pitch, volume, speech rate, emphatic accentuation).

Session 2: Bridging the Gap Between Mental Health Providers and Educators to Maximize Student Success and Well-Being
July 21- 22, 2025 8:30 am – 12:35 pm

Course Description:
A large percentage of children and adolescents, due to a variety of factors, are deemed as "high-risk”, calling upon educators, mental health workers, and the like to effectively meet the needs of these students. Despite there being wellestablished evidence-based treatments (EBTs) for child and adolescent mental health conditions, there is a “gap” in service attainability and outcomes between mental health settings and schools. Increased coordination is needed to increase the accessibility and generalization of EBTs. This 2-day workshop is designed to facilitate the collaboration between all school personnel and community-based mental health professionals and to offer ways to integrate efforts to meet the emotional, behavioral, and academic challenges that “high-risk” students present. The focus will be on mental health, behavioral, and developmental conditions that touch both systems, such as addressing the needs of students who have experienced adverse childhood events/trauma, neurodiversity (e.g., ADHD, autism spectrum disorders, or learning disabilities), and/or mental health disorders (e.g., anxiety, depression). We will offer a roadmap as to how educators and mental health workers can collaborate to establish trauma-informed schools, support skill acquisition, facilitate generalization, and bolster resilience. Case examples, group activities, and collaborative problem-solving will be utilized to identify practical solutions to overcome the various challenges and barriers we face integrating across systems.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Describe the “gap” and solutions for overcoming barriers between mental health settings and schools, to effectively address the needs of students.
• Explain components for establishing an integrated mental health support system and ways to address mental health needs in the classroom.
• Specify tools and strategies to build adaptive alternative behaviors and develop emotional regulation skills.
• Indicate how to obtain generalization and bolster resilience.

Session 3: Threat Assessment in 2025 and Beyond: Examining Best Practices in Processing Risk, Addressing Complexities, and Mitigating Workplace Violence
July 21- 22, 2025 8:30 am – 12:35 pm

Course Description:
Whether you work in the community or hospital-based settings, the topic of workplace violence is ubiquitous. When combined with the ongoing issues surrounding mass shootings, the time has never been more germane to examine how threat assessment can combine with typical risk assessment to maximize outcomes. This 2-day session will focus on a myriad of related topics including (but not limited to): Workplace violence in healthcare, domestic violence, linkage (or lack of linkage) between mental health and violent actions, updates on psychopathy, messaging education surrounding mass violence, firearm education as a public health measure, and any pertinent overlaps between homicide and suicide.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Analyze the current state of threat assessment as a best practice in mitigating violence.
• Apply any overlap between mental illness and violence, while also being able to explain any areas of concern.
• Determine the next best steps when evaluating an individual at risk of externalized violence, whether that be as a patient, staff, or community member.
• Identify concrete strategies to use to mitigate risk to themselves (or those they serve) while also proposing proper documentation that assists both medically legally, as well as clinically.

Session 4: Setting Up for A Successful Transition and Start to A New School Year: Key Considerations and Strategies for Fostering Students’ Academic, Emotional, and Behavioral Success
July 24 – 25, 2025 8:30 am – 12:35 pm

Course Description:
The beginning of a new school year can be difficult for students and, in turn, for educators; particularly when students present with social, emotional, behavioral, and/or developmental challenges. It is not uncommon for the initial weeks of an academic year to be “lost” in concern, and in trying to learn more about students, their needs, and how to support them effectively. Much is already known about incoming students and even the best practices to address the anticipated challenges. If the appropriate information is considered in advance, proactive steps can be taken to mitigate difficulties and to set students and educators up for success.

This 2-day summer preparatory workshop is designed specifically for school personnel who will be working with students with autism, ADHD, anxiety, trauma, and/or other disorders this upcoming school year. The focus will be on identifying students’ needs, understanding various mental health and developmental conditions, establishing effective classroom supports and structure, and distinguishing “team-based” approaches to reduce challenging behaviors and increase the demonstration of adaptive alternative behaviors and emotional regulation.

Learning Objectives:

• Indicate key pieces of information to consider/ascertain prior to a transition to a new school year to foster success.
• Specify at least 10 tools/strategies that can be used to facilitate transitional, social, emotional, behavioral, and learning success.
• Explain and identify the role of “TEAM” in developing adaptive alternative behaviors and building generalization.
• Utilize at least 3 techniques to increase positive thinking for children with autism, anxiety, and/or behavioral challenges.

Session 5: Neurology for Non-Neurologists
July 24 – 25, 2025 8:30 am – 12:35 pm

Course Description:
This workshop is designed to present a series of lectures covering common and important diagnoses in neurology that impact the practice of non-neurologists, in particular psychiatrists. The course will cover the neurological examination and discuss neurologic conditions that often intersect with psychiatry. We will also discuss strategies to collaborate with fellow departments like Neurology.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Utilize the neurological examination in the evaluation of complex patients
• Recognize neurologic conditions that are frequently seen by and/or comanaged with psychiatry
• Identify appropriate diagnostic and referral strategies
• Determine strategies for effective collaboration with Neurology in patients with complex neuropsychiatric disorders

Session 6: Awe and Wonder as Pathways to Resilience and Wisdom Through the Mindful Viewing of Film 
July 28 – August 1, 2025 9:00 am – 12:15 pm

Course Description:
"The beginning of awe is wonder, and the beginning of wisdom is awe." —Abraham Heschel 

The meaning of awe is to realize that life takes place under wide horizons, horizons that range beyond the span of an individual life or even the life of a nation, a generation, or an era that goes beyond human comprehension. Wonder is a feeling of curiosity, amazement, or astonishment caused by experiences of mysterious beauty in encountering the unfamiliar. Recent studies and reviews have shown that experiences of awe and wonder can enhance resilient well-being including positive affect and wisdom. Clinician well-being is essential for safe, high-quality patient care. This seminar aims at a mindfulness experience through viewing 4 feature films in which inspiring characters experience awe and wonder as a way to resilient well-being for the purpose of renewing these qualities in the lives of the seminar participants and in our work with patients. In addition, one morning, a pair of creative documentary films will be shown to engage participants directly in the experience of awe and wonder. On each of the 5 mornings, 1 film is shown via Blu-ray video projection and 6 loudspeakers with an introduction and centering process to begin the session and processing after the film focusing on the participant's own experience of the movie including silent reflection, journaling, dyadic sharing, and group discussion. Supplementary optional films (non-CME) will be shown on 2 evenings (Monday and Thursday). Films take on an exquisite cumulative power when shown over 5 days at the DCSI in a group setting that is truly remarkable and unforgettable.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Describe the essential role of experiencing awe and wonder as a way to resilient well-being.
• Identify how film characters experience awe and wonder as a way to resilient well-being so as to identify these strengths in themselves and in their patients.
• Develop skills and practice techniques of viewing films from a mindfulness perspective in which inspiring characters experience awe and wonder as a means to resilient well-being for the purpose of renewing these qualities in their lives.
• Apply ways to help patients view films from a mindfulness perspective in which inspiring characters experience awe and wonder as a means to resilient well-being for the purpose of renewing these qualities in patients’ lives.

Session 7: Strengthening Leadership and Interpersonal Effectiveness
July 28 – 29, 2025 8:30 am – 12:35 pm

Course Description:
In four modules over the two sessions, we will first explore methods for developing influence and enhancing leadership skills. We will then practice established and new approaches to managing change, interpersonal communication, and teams. We will draw from participants' experiences and challenges and provide skills that can be used in the workplace and beyond.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Recognize and appropriate leadership and interpersonal skills
• Utilize the ability to better diagnose and overcome obstacles to change
• Demonstrate ability to communicate more effectively in and out of the workplace
• Utilize more influence and be more effective in team and organizational settings

Session 8: Neurobehavioral Syndromes: Neuroanatomical Correlates and Review of Traumatic Brain Injury from Acute Sequelae to Long-term Outcomes
July 28 – 29, 2025 8:30 am – 12:35 pm

Course Description:
In this workshop, participants will be able to recognize and assess neurobehavioral syndromes. The discussion will include a presentation of both major and focal neurobehavioral syndromes and their neuroanatomical correlates. Participants will be able to recognize current models and cognitive constructs as well as methods of assessment. Case presentations of various syndromes will be included.

The presentation will then include information surrounding TBI characteristics and features that inform injury severity classification (mild, moderate, severe), acute and subacute sequelae of TBI across the injury severity spectrum, and typical recovery/prognosis. Post-injury management and risk factors for prolonged recovery with mTBI will be discussed. This program will review the gradient of injury characteristics, clinical presentation, and biological markers along this mild TBI injury severity spectrum. Current evidence for TBI, sport-related concussion, and repetitive head impact exposure as a risk factor for Alzheimer’s disease and related dementias (ADRDs), as well as moderating factors throughout the lifespan that may attenuate or intensify these associations will be discussed.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Recognize major neurobehavioral syndromes, their neuroanatomical correlates, and how they can be differentiated with cognitive testing.
• Describe models and cognitive constructs underlying the neurobehavioral presentation of these syndromes.
• Recognize methods of assessment relevant to neurobehavioral syndromes.
• Apply this knowledge to case presentations.
• Identify TBI injury severity based on acute injury characteristics and apply this classification to their understanding of patient recovery and prognosis.
• Describe common post-injury sequelae and conventional methods of assessment.
• Discuss various injury-related features across the severity spectrum within the mild traumatic brain injury classification.
• Analyze the adverse long-term outcomes associated with TBI, sport-related concussion, and contact sport exposure, as well as factors that may moderate these associations.

Session 9: Practical Opioid Use Disorder Treatment for Providers
July 31 – August 1, 2025 8:30 am – 12:35 pm

Course Description:
Opioid Use Disorder continues to be a national epidemic with concerning prevalence and mortality. The evolution of illicit synthetic high-potency opiates, including fentanyl and its analogues, has greatly contributed to overall morbidity and mortality in people who use opioids. Because high-potency opioids commonly contaminate supplies of other illicit drugs, opioid-naïve individuals are now experiencing the devastating consequences of these powerful drugs. In response to such concerns, efforts to improve access to first-line medications for opioid use disorder (MOUD), have intensified. In particular, the DATA waiver that previously placed barriers on buprenorphine prescribing has been eliminated, as of January 2023, thereby increasing the potential pool of prescribers to anyone who holds a DEA controlled substance registration. While this progress is encouraging, there are still large numbers of prescribers who still lack the education, practical knowledge, or confidence to begin prescribing these life-saving medications.

This talk will impact a broad audience of anyone working with people exposed to opioids. We will focus especially on effective psychotherapeutic modalities since this population has a high rate of co-occurring mental health conditions. Particular attention will be paid to social (e.g. sober living or peer support) and harm reduction interventions (e.g. needle exchange or naloxone). Finally, prescribers will learn practical lessons on how to integrate prescribing buprenorphine into their clinical practice and meet the DEA requirement for buprenorphine prescribing.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Utilize lessons from the history of opioid addiction in modern treatment & advocacy
• Describe the current epidemiology and underlying neurobiology of opioid use disorder
• Use screening, assessment, and diagnosis of opioid use disorder
• Assess commonly co-occurring conditions (focusing on pain, addictive disorders, and psychiatric conditions)
• Analyze medications for opioid use disorder (MOUD) like buprenorphine, methadone, and naltrexone with psychosocial treatments to optimize recovery outcomes 

Session 10: Interpersonal Psychotherapy (IPT)
July 31 – August 1, 2025 8:30 am – 12:35 pm

Course Description:
Interpersonal psychotherapy (IPT) is an affect-focused, time-limited, evidence-based treatment indicated for treating major depressive disorder, eating disorders, and posttraumatic stress disorder, and as adjunctive treatment for bipolar disorder. It is one of the best-tested psychotherapies. It focuses on the relationship between mood and life events, building interpersonal skills, and mobilizing protective social support. The treatment does not focus on cognitions or transference and does not assign homework. Dr. Markowitz has spent decades testing IPT in comparative trials and teaching this therapist- and patient-friendly approach. The workshop will cover the essentials of IPT and its application to particular patient populations. Participants are encouraged to bring in case material for discussion.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Describe the fundamental principles, elements, and structure of the IPT approach.
• List the four interpersonal problem areas.
• Identify factors such as affect dysregulation and reflective functioning that may contribute to the mechanism of the IPT effect.
• Analyze the evidence supporting the IPT approach.

Session 11: The Art of Suicide Prevention: Innovations in Uncovering Suicidal Ideation, Risk Formulation, and Creating Resiliency 
August 4 – 5, 2025 8:30 am – 12:35 pm

Course Description:
Dr. Shea will delineate the unique challenges facing clinicians when they are trying to uncover suicidal ideation in high-risk clients, who frequently are hesitant to share their method of choice for suicide (MOC) and the intensity of their intent. He will describe and demonstrate how the Chronological Assessment of Suicide Events (CASE Approach) - a flexible and engaging strategy for uncovering a client’s suicidal ideation, planning, and intent - can immediately help a clinician meet these challenges. He will then address how to create a practical formulation of suicide risk, that includes the concepts underlying one of the newest innovations in risk-formulation - Prevention-Oriented Suicide Risk Assessment. Throughout the symposium, Dr. Shea will pull upon the lens of “Matrix Treatment Planning” which emphasizes how to create hope in the hopeless. The techniques described apply to therapists in all clinical settings from community mental health centers, college counseling centers, and private psychotherapy practices to emergency departments and inpatient units.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Describe and apply the principles of “matrix treatment planning” to instill hope and resiliency as a method of suicide prevention
• Utilize seven behaviorally specific interviewing techniques - designed to enhance validity when uncovering sensitive and taboo topics including suicidal ideation and other risk factors/warning signs of suicide (Normalization, Shame Attenuation, the Behavioral Incident, Gentle Assumption, Denial of the Specific, the Catch-All Question, and Symptom Amplification)
• Describe and flexibly utilize the Chronological Assessment of Suicide Events (CASE Approach) to both effectively screen for suicidal ideation, and, if present, to sensitively explore the extent of action taken upon any methods considered by the client including an initially withheld MOC
• Create a sophisticated formulation of risk that creatively integrates the interplay among risk factors, warning signs, protective factors, and available clinical, social, and interpersonal supports

Session 12: 2025 Update on Psychiatric Medication for Mood and Anxiety
August 4 – 5, 2025 8:30 am – 12:35 pm

Course Description:
This workshop presents an update of psychopharmacology focusing on the needs of practicing clinicians by covering medications used to treat the most common psychiatric disorders including unipolar and bipolar disorders, and anxiety disorder. We will focus on indications for the use of medications, side effects, issues around use, and risks, and review both what arewell-known and new findings that will improve outcomes. This workshop is appropriate for all clinicians prescribing psychotropic medications including psychiatrists, primary care physicians, APNPs, nurses, and social workers who work with patients taking psychiatric medications

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Discuss how to collaborate with patients about medication decisions even with patients who are difficult to work with
• Identify when to avoid benzodiazepine prescribing and when appropriate
• Describe lab tests to monitor patients on Lithium, atypical antipsychotics, valproic acid, carbamazepine, and lamotrigine
• Identify how to diagnosis specific anxiety disorders and understand how this impacts treatment decisions.

Session 13: A Primer in Perinatal Mental Health
August 4 – 5, 2025 8:30 am – 12:35 pm

Course Description:
The field of perinatal (or reproductive psychiatry) has been ever-expanding in recent years. Extensive research has been conducted on the impact of psychiatric disorders in the perinatal period and their impact on the fetus, neonate, and child, as well as the parent. Expanding research has been completed in the areas of psychopharmacology in pregnancy and lactation. Unfortunately, while psychiatric disorders are the most common complication of the perinatal period, most providers, including mental health providers, do not feel comfortable with management. These symposia will provide an overview of the assessment and management of common, as well as more complex psychiatric disorders in the perinatal period, including depression, anxiety, bipolar disorder, attention deficit disorder, and opioid use disorder.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Compare differences between perinatal mood and anxiety disorders.
• Identify risks of untreated psychiatric disorders, including substance use disorders, in the perinatal period.
• Explain the risks to the fetus/infant of antidepressant, anxiolytic, mood stabilizer, and stimulant exposure in utero and during lactation.
• Identify the appropriate use of zuranolone.

Session 14: Transformational Moments: How Master Clinicians Think, Talk, and Listen When Facing the Most Challenging of Clinical Tasks 
August 7 – 8, 2025 8:30 am – 12:35 pm

Course Description:
This symposium will offer a variety of innovative strategies and interviewing techniques for transforming many of the most problematic clinical challenges encountered in everyday practice. Traditionally daunting clinical tasks are the focus of this symposium including: rapidly and sensitively engaging clients with borderline and/or narcissistic disorders, exploring incest and domestic violence, uncovering subtly presenting and/or dangerous psychotic processes (demonstrated with vivid videos of actual patient interviews), unraveling diagnostically complex or atypical presentations of anxiety disorders such as OCD, Panic Disorder, and PTSD (also demonstrated with vivid actual client interviews), and transforming angry client encounters or antagonistic client questions. Dr. Shea – with a subtle grace and keen insight – deconstructs these troubling everyday clinical gremlins and re-imagines the situations providing clinicians with new maps for navigating these daunting clinical terrains. By doing so, he not only helps clinicians to more effectively transform these difficult moments but also decreases clinician burn-out by enhancing clinician confidence and increasing fascination with the intricacies of the therapeutic dyad. The techniques described are immediately applicable to therapists in all clinical settings from community mental health centers, college counseling centers, and private psychotherapy practices to emergency departments and inpatient units.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Use specific interviewing techniques and strategies for rapidly engaging clients with borderline and/or narcissistic processes by utilizing an admixture of cognitive-behavioral principles with psychodynamic techniques from schools of thought such as Object Relations and Self-psychology.
• Utilize interviewing techniques for spotting delusional mood, delusional perception, the life-cycle of psychosis, and dangerous psychotic processes including command hallucinations, alien control, psychotic hyper-religiosity, and hidden smoldering paranoia.
• Use interviewing techniques to differentiate the subtle phenomenological presentations and symptoms of both typical and atypical Panic Disorder and OCD (which may have important treatment ramifications) as well as sensitively uncover hidden histories of physical and sexual abuse that may be the etiology of a client’s PTSD.
• Assess and gracefully transform moments of intense disengagement with clients including angry confrontations and awkward client challenges or personal questions to the clinician.

Session 15: Update on Anti-Psychotic Medications: The Old and the New 
August 7 – 8, 2025 8:30 am – 12:35 pm

Course Description:
This workshop will review common and not so common issues in prescribing anti-psychotic, medications, how to increase the effectiveness of anti-psychotic treatment, the place of the newer anti-psychotic medications in the treatment algorithms, and some uses of these medications in non-psychotic conditions.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Compare how to address some of the social aspects of prescribing anti-psychotic medication with the goal of increasing treatment alliance
• Describe the advantages and problems associated with commonly underused anti-psychotic medications including clozapine and long-acting injectable medications
• Analyze the updates in mechanisms of newer non-dopaminergic antipsychotic medications
• Discuss the role of anti-psychotic medications in non-psychotic conditions

Session 16: Ethics for Mental Health Professionals: A Novel Approach to the Issues
August 7 – 8, 2025 8:30 am – 12:35 pm

Course Description:
This seminar will cover professional boundaries, confidentiality, and duty to warn/protect cases, as well as emerging ethical issues concerning electronic health records, interstate licensing requirements, social media, virtual therapy in a virtual world, and legislative updates. Dr. Anderson will review major ethical issues in mental health practice and will lead discussion including cases from participants. Focus will start with ethical principles, and methods for resolution of ethical dilemmas, and then will move to informed consent and to emerging issues in ethics for mental health providers.

Learning Objectives:
Participants who engage in this education intervention will be able to:

• Identify ethical issues including ethical principles, methods for resolution, informed consent, and virtual therapy issues.
• Describe ethical issues in professional boundaries, confidentiality, and duty to warn/ protect cases.
• Discuss emerging ethical issues concerning electronic records, interstate licensing requirements, social media, and legislative updates.
• Discuss ethics cases from participants.