CBT Techniques Flashcards
(31 cards)
What is the structure of a CBT session?
Beginning:
- Greet client + establish the relationship
- Collect information to establish the agenda for this particular session
Middle:
- Select one of the topics from the agenda + collect more data on it (specifically relating to the processes in the cognitive model)
- Plan a strategy
- Implement a strategy
- Evaluate effectiveness of chosen strategy
- Ask client to summarise what they have planned/learned - make sure client gets down in writing
- Create an action plan of things collaboratively with client - that they want to do/achieve between this session and the next
End:
- Ask for feedback (e.g. are you happy with the tasks, felt listened to and like the therapist understands your values etc.)
- Make sure the client has a good summary of the session
- Check on homework
What do you do if a client changes the agenda midway through the session?
This is acceptable - but needs to be made clear with the client that this is what has happened/bring it to their awareness that they’ve changed topics
e.g. “I notice we were talking about X but now we’re talking about Y… Which is more important to you?”
The therapist can also change the direction of the consultation too should they feel it more beneficial to discuss one problem over another
What 4 things should you do at the beginning of the session?
Check on clients mood
Make a bridge
Set the agenda
Review the clients action plan
How should you check the clients mood?
Subjective and objective measures e.g. using a depression or anxiety inventory + asking how they feel; allows you to keep track of data/concrete examples of change
How do you make a bridge?
Link previous session with current - “what happened between last session and this one that is important for me to know?”
- Often these responses are negative
Followed up with “can you tell me anything that has happened between the sessions that was more positive for you?”
Should also link to the next session - “is there anything coming up in between this session and the next that I should know about?”
How do you set the agenda?
Will likely be dictated by the content of the bridge i.e. what has happened in the previous week that was challenging, or what is coming up in the week to come that might also be more challenging and warrants actioning
Question you ask needs to be specific, else client can ramble about unrelated things:
“what problem or problems would you like my help in solving today?”
Therapist can also ask to include an item on the agenda that they think would be useful for the client; needs to be okayed by client
How do you review the clients action plan?
3 questions:
- “what did you get done?”
- “what did you learn from that?”
- “is there anything you’ve done this week that would be helpful to continue doing?”
How do you manage a client who just keeps talking and gets off task?
As simple as it sounds:
“Oh Judith can I just interrupt you a second?”
This can feel quite uncomfortable, but stops the session being derailed and unproductive
One way of managing your fears about upsetting a client is to raise this as a likelihood at the beginning of a session:
“I think what you’ll find is I’ll be interrupting you periodically to really get the information I need…. If this becomes a problem, please do let me know”
How do you manage a client who gets annoyed/upset at you interrupting?
You will pick up on this in the session e.g. from their body language or they might tell you directly, you can ask:
“so what was going through your mind right there?” - to encourage that awareness - validate their response
Then you can suggest that for the next period of the session, that you wont interrupt them at all and see if they’d appreciate it
What are the fundamentals of the therapeutic alliance/relationship?
Empathy
Warm, genuine and human interactions
Verbal and non-verbal validation/interest demonstration
Showing you understand e.g. by referring to what you have learned about how their minds work (“given your high expectations you place on yourself, I can see why you now feel disappointed with your grade”)
“what would you like to work on TOGETHER” etc - emphasising that the process is a collaborative one
When you give them something that works
Sometimes a small degree of self-disclosure e.g. “I think that way too sometimes”
Asking for and acting on feedback
The therapeutic relationship is the anaesthesia to surgery - it allows someone to apply specific techniques (Beck)
Why is goal setting important and how should it be done?
Important as it gives a clear outcome for what is hoped to be achieved by the end of the therapy course - will (hopefully) be realistic and achievable, but may need to be reassessed throughout the process as other things emerge or are solved
Should be done in the first session
Often based on “core values”: e.g.
- Relationships
- Family
- Work
- Home
- Physical health
- Mental health
- Spirituality
- Finances
- Other interests/hobbies
- Social justice
How do you use the cognitive model?
Should be applied to any situation your client brings to you; take one at a time and work through the situation
Questions: IN THIS ORDER What was the situation? Or what were you thinking about (remembering, experiencing, predicting)? What went through your mind? What was your reaction? How did you feel emotionally? Did your body react? If so, how? What did you do?
Can literally draw out a diagram in session demonstrating the relationships, can share with client
How do you identify an automatic thought?
Watch for a change in your reaction:
Maybe you start doing a certain set of behaviours
Maybe you’re avoiding doing something
Maybe you notice a strong emotion
Maybe you notice some change in your body
When you notice one of these changes, ask:
“what was just going through my mind?”
This will identify the automatic thought, you’ll know when you think it if it actually was an automatic thought or something else/a distraction
What is the ‘opposite technique’ for identifying automatic thoughts?
A technique for identifying automatic thoughts when you can’t figure out what was going through your mind
Try posing a question to yourself about something that could be the opposite of what you are thinking e.g.
“are you thinking that you are really going to enjoy spending time with your friends?”
This should prompt some kind of aversive reaction in you and you will know that the opposite is actually true
How do you identify a core belief?
The downward arrow technique:
“If your automatic thought were true, what would that mean/what would that mean about who you are?”
- This should point to how they feel about themselves
Formulation:
After hearing a number of situations be talked through/after you’v identified a number of automatic thoughts, you may start to see a theme emerging about how they feel about themselves; look for identifiers of helplessness, unlovabiltiy, worthlessness
Core belief as automatic thought:
Sometimes, some automatic thoughts might be independent of situation e.g. “I’m incompetent” as opposed to “I’m incompetent because of X situational factors”
How do you identify coping strategies?
Formulation:
How has the client coped with their core beliefs throughout their life?
What kind of behavioural strategies have they developed?
What are some consistent patterns of behaviour that are dysfunctional, at least at times?
Ask directly:
“How have you coped throughout life?”
How do you identify assumptions?
Working on coping strategies:
Once you’ve identified coping strategies, you can work backwards to an - “If X then Y” statement e.g.
If I trust people then I get hurt - If I don’t trust/avoid people then I don’t get hurt
Formulation:
Some assumptions are situation specific e.g. “if I talk to my friends about how I’m feeling then they won’t listen to me” - but this relates to the broader assumption mentioned above about trust, therefore if multiple situations yield similar situation-specific assumptions, this might point to an overarching assumption
Provide part of the assumption:
e.g. “How would you fill in this blank? If I were to try something that could be hard for me then _____”
Hypothesise:
“It seems to me that you have some idea about X, do you think that could be true? Do you think that could be something to do with the reason you do Y (examples of behaviours)?”
What are Socratic questions? Why are they used?
Questions with the intent of getting the client to check the evidence for and utility of their automatic thoughts that arise in response to given environmental stimuli
They are important tools because:
- to simply give advice isn’t as powerful as collaboratively working on a solution - its less integrated/believed by the client (violates the principle of collaborative empiricism)
- any advice given might be on the basis of very little evidence if its from your point of view, might falsely reassure/guide
- also teaching someone how to employ the Socratic method themselves allows further development outside of session
“ASK DON’T TELL”
What are some examples of Socratic questions addressing the evidence for a given automatic thought?
What evidence do you have that your thought is true?
Do you have any evidence of the other side?
Is there another way of looking at this situation?
If the worst thing your imagining did happen, how would you cope with that?
What are some examples of Socratic questions addressing alternative possibilities to the automatic thought?
What is the best thing that could happen?
What is the most realistic outcome?
What are some examples of Socratic questions addressing the outcome of an automatic thought?
What is the effect of telling yourself that X?” e.g. ‘people will be critical’
What could be the effect of changing your thinking?
What are some other Socratic questions you might ask?
What would you tell a friend in the same situation?
(finally) Is there any action you wish to take? What would you like to do about it? (or if you want to include an imperative, what should you do next?”
What are behavioural experiments?
Experiences that you help clients set up in session or between, to test the automatic thoughts they have that take the form of negative predictions e.g. if I do X then bad thing Y will happen
Before the experiment, we have to introduce the possibility that it might not go as expected + ask them:
“What would you like to be able to tell yourself if the experiment doesn’t go well?” - get them to write it down, read before, and after experiment if necessary
After the experiment is over, we get clients to write down their conclusions
Can help clients change thinking at both intellectual and emotional levels
What is a credit list?
Getting the client to keep a list of all the small successes they accomplish during the day, in spite of their negative core beliefs
