Chapter 5: Beginning treatment/ structuring CBT

Question 1

sequencing of CBT (13)

Answer 1

• usually in the following manner, although movement back and forth across the various phases may occur
  1. assessment
  2. clinical case formulation
  3. feedback to the client and reformulation, as needed
  4. goal setting
  5. psychoeducation
  6. client monitoring of behaviours and emotions
  7. Behavioral interventions
  8. client monitoring of cognitions
  9. cognitive restructuring
  10. reassessment and discussion of schemas
  11. schema monitoring (if needed)
  12. schema change therapy (if needed)\
  13. relapse prevention, maintenance and ending therapy

Question 2

typical structure of one CBT session

Answer 2

1. general check-in, mood or distress rating, comment about or bridge from the previous session
2. agenda setting, including homework review, pressing issues for the current session, setting priorities for the session and approximate time allocated for each topic
3. homework review
4. working on each agenda item
5. summary of the sessions main points
6. Feedback about the session
7. Discussion of the overall homework, including anticipation of problems, practice regarding any concerns, and final homework assignment

Question 3

strategies for in-session structure

Answer 3

1. realistic expectations about amount of work
2. be predictable and a good role model for session structure
3. be collaborative
4. provide regular summaries and reminders of the time
5. more difficult or challenging items near the beginning
6. expect for crises, follow the agenda
7. if client raises important issue near the end: let know that you will make note of this topic and it will be addressed at the beginning of the next session
8. plan sufficient time for discussion of homework

Question 4

psychoeducation

Answer 4

• provision of information about relevant psychological principles and knowledge to a client, e.g., diagnosis, evidence-based treatments, coping strategies, research findings, resources
• used more at the beginning, but can used at any time in therapy

Question 5

important questions for psychoeducation

Answer 5

1. Do the education, language, and literacy levels of the client match the materials?
2. does the client have both the energy and skills required to access the materials? (e.g., computer)
3. Does the client want the information or is he or she likely to be interested in it?
4. Does the client have the resources available to access the information?
5. Is the client worried about privacy if someone else sees the materials? For example, if family members are not aware of the problem, then the client may be reluctant to take written materials home
6. What is the distress level and concentration ability of the client at this point in time? High distress and poor concentration impede the clients ability to engage in psychoeducation
7. Will the client potentially be overwhelmed by the information?
8. Are the materials engaging and go high quality, up to date, accurate and consistent with CBT?

Question 6

why pschoeducation?

Answer 6

• increased collaboration
• greater involvement
• knowledge increases sense of control
• shifts beliefs
• sense of relief that their problems have been written about, researched and discussed: feelings of validation, support and hope
• increased knowledge and skills

Question 7

homework assignments

Answer 7

• essential part of CBT interventions
• crucial for learning and generalising change beyond the therapy sessions
• must be developed collaboratively with the client