Level 3 Exam Flashcards
(131 cards)
1
Q
What constitutes an Excellent score on the section of the test entitled “Testing: Review of BMS (pre-session) from current session”?
A
- The therapist displays and interested, warm, open demeanor when asking about BMS
- Reviews specific scores from each symptom section in meaningful way.
- Asks questions about scores/invites patient to discuss symptoms further
2
Q
What constitutes an Excellent score on the section of the test entitled “Testing: Review of BMS and Evaluation of Therapy form from previous session”?
A
- The therapist comments on any pre-post symptom changes on last-session’s BMS
- Comments in an interested/non-defensive manner on Evaluation of Therapy Form
- Invites the patient to discuss symptoms changes and/or Evaluation of Therapy Form
- Shows genuine interest in connecting with patient about this information
3
Q
What constitutes an Excellent score on the section of the test entitled “Empathy: 5 SECRETS OF EFFECTIVE COMMUNICATION w/ ANGRY PT”?
A
- Successful use of each of the 5 secrets: TE/FE, DA, ST, IF, IN
- Appears comfortable with difficult or sensitive topics
- Puts the patient at ease with use of 5 secrets
4
Q
What constitutes an Excellent score on the section of the test entitled “Empathy: 5 SECRETS OF EFFECTIVE COMMUNICATION WHEN PT IS PRESENTING PROBLEM AND WHENEVER NECESSARY DURING SESSION”?
A
a) Successful use of many of the 5 secrets when patient is presenting problem
b) Appears comfortable offering extra empathy when needed/does not rush patient
c) Puts the patient at ease with use of empathy d) Overall excellent listening and reflection skills (TE/FE/DA)
5
Q
What constitutes an Excellent score on the section of the test entitled “Agenda Setting: Invitation”?
A
a) Offers invitation to begin working on problem(s) while sitting with open hands and clearly open to continued empathy only.
b) Moves smoothly to empathy when patient exhibits resistance to agenda setting or to specificity when invitation is accepted.
6
Q
What constitutes an Excellent score on the section of the test entitled “Agenda Setting: Specificity and Conceptualization”?
A
a) Therapist asks pt to describe a specific moment in time/place when s/he was struggling with specified problem.
b) Clear explanation of need for specificity is provided.
c) Conceptualization is clear and logical, helpful in guiding treatment
7
Q
What constitutes and Excellent score on the section of the test entitled “Empathy: Assessing/Addressing Outcome Resistance”?
A
a) Mastery level of paradoxical magic button and magic dial questions used.
b) Clear paradoxical presentation and discussion of outcome resistance following presentation of magic button and before use of magic dial.
8
Q
What constitutes and Excellent score on the section of the test entitled”Methods: Choice of Methods (Use of Recovery Circle/Intro to Failing as Fast as we Can)?
A
a) Generates 15+ appropriate techniques on a Recovery Circle (with minimal or no reliance on the List of 50 Techniques).
b) Demonstrates clear explanation of the purpose of the Recovery Circle to client.
c) Chooses methods squarely applicable to specific problem.
d) Demonstrates comprehensive understanding of all methods chosen.
9
Q
What constitutes and Excellent score on the section of the test entitled”Methods: Presentation and Demonstration of A Few Methods - First Method Chosen by Examinee?
A
a) Thorough ability to explain the purpose of the method.
b) Strong ability to execute the method.
c) Incorporates appropriate empathy and connection.
d) Thoroughly integrates client learning at the end of the method.
10
Q
What constitutes and Excellent score on the section of the test entitled”Methods: Presentation and Demonstration of A Few Methods - Second Method Chosen by Examiner?
A
a) Thorough ability to explain the purpose of the method.
b) Strong ability to execute the method.
c) Incorporates appropriate empathy and connection.
d) Thoroughly integrates client learning at the end of the method.
11
Q
What is the setup for the Feared Fantasy Technique?
A
- Like the Externalization of Voices, this is a two-person technique. You and the other person act out your worst fears, such as being rejected because you aren’t smart enough or good enough. When you face your worst fear, you often gain liberation from it.
- Your worst fears usually don’t turn out to be real monsters, but figments of your imagination that can be defeated with a little logic, compassion, and common sense.
- It is a form of cognitive interpersonal exposure, and designed for interpersonal situations that someone is not likely to confront in reality.
- Patient are invited to enter into a Twilight-Zone world where their worst fears actually spring to life.
- In this world, if you think people are looking down at you, they really are - their thoughts about you are even worse than you would imagine
- People in this world also tell you what they are thinking, no matter how cruel or brutal it may sound.
- One person plays a “character from hell,” some judgmental or critical person the patient is afraid of who tries to rip the other to shreds based on their worst fears.
- The other plays the role of the client.
- After a while ask the client: Who’s being the bigger jerk here?
- Once the patient gets it, you can do a role-reversal, so she or he can do battle with the monster. This will convert intellectual understanding into real change at the gut level.
- In the end, make sure that any insights or positive thoughts it generates are written down in the Daily Mood Log.
12
Q
What is the rationale and setup for the Acceptance Paradox?
A
- The Acceptance Paradox represents the spiritual core of CBT. It can lead to emotional enlightenment, but it’s the most difficult technique for patients and therapists alike to comprehend.
- When you use the Acceptance Paradox, you surrender to your own inner critic.
- It is similar to the Disarming Technique in the Five Secrets
- The Acceptance Paradox is an exception to the rule of moving on to the next technique if this doesn’t work.. If the patient doesn’t see it, you can continue to model it, using frequent role-reversals.
- It can be done in a role-play format like Externalization of Voices, with the emphasis being on the Acceptance Paradigm as opposed to the Self-Defense Paradigm.
- As always, any positive thoughts that are generated can be put back in the Daily Mood Log.
13
Q
What is the rationale and setup for the Individual Downward Arrow Technique?
A
- The Individual Downward Arrow helps patients pinpoint Individual SDBs.
- You ask the patient to select a negative thought on his or her Daily Mood Log and draw a downward arrow underneath it.
- The arrow is a form of shorthand for this type of question: “If this were true, why would it be upsetting to you? What would it mean to you?”
- These questions will trigger a new negative thought that the patient can record directly under the arrow.
- Then you repeat the questions, and the patient will come up with another negative thought.
- Once you’ve done this several times, you can review the list of negative thoughts the patient generated. It will usually
be easy to identify the SDBs at the core of the patient’s suffering. - It is no so much of a method as it is a data-gathering technique.
- You’ve usually completed the Downward Arrow chain when you encounter a thought like one of these: a) That would mean I was worthless; b) That would mean life was not worth livi;ng; and c) Then I could never feel happy again.
- Keep a copy of this Self-Defeating Beliefs List, and hand it to the patient at this point. Patients are usually intrigued by
what we come up with. - Once you’ve identified an SDB, it can be helpful to do an Attitude Cost-Benefit Analysis (CBA).
14
Q
What do I say in Straightforward Agenda Setting?
A
I would say something like this: “John, you’ve mentioned a number of very difficult problems that you have been struggling with, including X, Y, and Z. I’d like to offer you more than just listening and support, as important as that is. I have a number of powerful tools that I believe could help you tremendously. As such, I’m wondering if this would be a good time for us to roll up our sleeves and get to work on one of the problems you’ve described, or if you need more time to talk and have me listen. Listening is important, and I don’t want to jump in prematurely, before you feel ready.”
15
Q
What do I say when I’m doing Paradoxical Agenda Setting?
A
“Mary, you’ve been telling me how frustrated you feel with _________. You’ve mentioned how difficult he /she is to deal with, and so forth. I’m wondering if you want some help with your relationship with this person, or if you mainly just wanted to let me know how difficult and annoying he or she is.”
16
Q
What are the Truth-Based Techniques?
A
They are:
a) Examine the Evidence
b) Experimental Technique
c) Survey Method
d) Reattribution
17
Q
What are the Logic-Based Techniques?
A
They are:
a) Socratic Method
b) Thinking in Shades of Gray
c) Process vs. Outcome
18
Q
What are the Semantic Techniques?
A
These are;
1) Semantic Method
2) Let’s Define Terms;
3) Be Specific
19
Q
What is Empathy, and why is it important?
A
When we’re upset, you need someone to listen and see the world through your eyes without trying to cheer us up, change us, help us, or give us advice. Although this usually won’t cure us, it’s often a necessary first step. It can be a tremendous relief to feel that someone’s listening.Similarly, we can empathize when you’re trying to help a friend or family member who feels upset. Usually, all they really want is for us to be a good listener.
20
Q
What is Agenda Setting, and what is its purpose?
A
Agenda Setting is the most basic and important technique of all. First, try to define a specific problem you want help with. It must be specific as to person, place, and time.
Ask yourself, “What is the specific problem I want help with? What time of day did it happen? Where was I? Who was I interacting with? What was going on?”
Second, ask yourself if you’re motivated and willing to roll up your sleeves and work on it now, rather than just talking about it endlessly. Ask yourself, “What would it be worth to me to solve this problem? How hard would I be willing to work on the solution?”
21
Q
What is the Straightforward Technique?
A
You try to substitute a more positive and realistic thought for each of your Negative Thoughts. Ask yourself, “Is this Negative Thought really true? Do I really believe it? Is there another way to look at the situation?”
22
Q
What is the Experimental Technique?
A
You do an experiment to test the validity of your Negative Thought, in much the same way that a scientist would test a theory. Ask yourself, “How could I test this Negative Thought to find out if it’s really valid?”
23
Q
What is the Survey Technique?
A
You do a survey to find out if your thoughts are realistic. Ask yourself, “How do other people think and feel about this? Could I ask some friends about this to get some feedback?” For example, if you believe that social anxiety is rare or shameful, simply ask several friends if they’ve ever felt that way.
24
Q
What is Reattribution?
A
Instead of blaming yourself entirely for a problem, you can think about the many factors that contributed to it. You can also focus on solving the problem instead of blaming yourself for it. Ask yourself, “What caused this problem? What did I contribute and what did others contribute? What can I learn from the situation?”
25
What is the Socratic Method?
Ask yourself several questions that will lead to the inconsistencies in your Negative Thoughts. For example, you might ask yourself, "When I say that I'm a 'failure at life,' do I mean that I fail at some things some of the time, or all things all of the time?"If you say, "some things some of the time," you can point out that this is true of all human beings. If you say, "all things all of the time," you can point out that this isn't true of anyone, since no one fails at everything.
26
What is Thinking in Shades of Grey?
Instead of thinking about your problems in black-and-white categories, you evaluate them in shades of gray.
When things don't work out as well as you'd hoped, you can think of the experience as a partial success or a learning opportunity. Pinpoint your specific errors instead of writing yourself off as a total failure.
27
What is Process vs. Outcome?
You evaluate your performance based on the process--the effort you put in--rather than the outcome. Your efforts are within your control, but the outcome is not.
28
What is the Semantic Method?
Substitute language that is less colorful and emotionally loaded. Instead of thinking, "I shouldn’t have made that mistake," you can tell yourself, "It would be preferable if I hadn't made that mistake." This method is especially helpful for should statements and labeling.
29
What is "Let's Define Terms?"
When you label yourself as "inferior" or "a fool" or "a loser," ask yourself what those labels mean. You'll see that there's no such thing as a "fool" or a "loser." Foolish behavior exists, but fools and losers do not. Ask yourself, "What's the definition of 'an inferior human being' or 'a loser'? What is my definition of someone who is hopeless? When I say I'm hopeless, what claim am I making?"
30
What is Be Specific?
Stick with reality and avoid judgments about reality. For example, instead of thinking of yourself as totally defective, you can focus on your specific strengths and weaknesses.
31
What is Self-Monitoring?
Keep track of repetitious Negative Thoughts or anxiety-producing fantasies by counting them. You can count your thoughts in a couple of different ways. You can keep a 3x5 card in your wallet or pocket. Each time you have a Negative Thought, put a tick mark on the card. Alternatively, you can use a wrist-counter like the ones golfers wear to keep track of their scores. At the end of the day, record the total on your calendar. Usually, the upsetting thoughts will diminish and disappear after about three weeks of Self-Monitoring.
32
What are the four steps of Agenda Setting?
a) The Invitation; b) Specificity; c) Conceptualization; and d) Methods
33
What are the Compassion-based Techniques?
There is only one: The Double Standard Technique
34
What is Dangling the Carrot?
This is the technique for overcoming resistance.
35
What is Sitting with Open Hands?
This is the technique for overcoming resistance.
36
What is the Magic Dial?
This is another useful tool to melt away Outcome Resistance. You can point out that in many cases, some negative feelings can be healthy and helpful. Here’s the kind of thing you can say to the patient: “If you had a Magic Dial and could adjust your feelings to the ideal levels, what would those levels be? Now you have a therapy goal that won’t threaten the patient. I also reassure patients that if we are too successful, and the anxiety drops below the ideal level (in this case 20%), I will help them generate some anxiety once again so they don’t get too complacent, or too happy. This often triggers some laughter and relief.
37
What is the Fallback Position?
This is a technique
for overcoming resistance.
38
What is the Acid Test?
Most patients will immediately agree to push the Magic Button. It sounds great to have all of your negative feelings suddenly vanish, just by pushing a button. However, the patient hasn’t yet grasped what we’re really offering. We’re offering to help patients feel happy and fulfilled in spite of their problems and shortcomings. We can’t change the facts of any patient’s life in today’s session. We can only help the patient develop greater happiness and self-esteem in spite of those facts. When you do the Acid Test, you make the patient suddenly aware of the implications of pressing the Magic Button.
39
What are the techniques (11) for dealing with Outcome Resistance?
1. Dangling the Carrot
2. Miracle Cure
3. Magic Button
4. Acid Test
5. Positive Reframing
6. Magic Dial
7. Straightforward/Paradoxical Cost-Benefit Analysis
8. Externalization of Resistance
9. Devil's Advocate Technique
10. Sitting with Open Hands
11. Fallback Position
40
What are some reasons someone may NOT want to push the Magic Button?
.This issues vary with regards to the conceptualization of the problem, but in general they involve: a) not deserving the outcome; b) changing
41
What is the Miracle Cure?
This is a technique for targeting Outcome Resistance. It is both a data gathering step as well as a useful Agenda Setting tool that may give you some important insights about why the patient is stuck. Once the patient has described the problem (such as procrastination, feelings of inadequacy, or a troubled relationship), you can ask what a “miracle cure” might look like. You might say something like this: “Suppose today was the most amazing session, and you walked out of the session thinking that our work together had changed your life in some fantastic, wonderful way. What would that change look like? What would be different? What would the solution to this problem look like?”
42
What are the basic PAS Techniques?
1) Empathy; 2) The Invitation; 3) Sitting with Open Hands; 4) Fallback Position; 5) Changing the Focus; 6) the Decision-Making Form
43
When does the TEAM Therapist issue the invitation, and what does he say at that time?
After a period of empathy and listening, one might say: "I would like to offer you something more than just support and listening, although that's obviously of great importance. I'm wonder if there's something you want help with in today's session? You've mentioned a lot of heartbreaking issues today, such as . . I have many powerful tools to help you deal with these problems, and I'm wondering if this would be a good time for us to roll up our sleeves and get to work. Or, if you need more time to talk and vent, that's okay too. I don't want to jump in prematurely, before you're ready."
44
What are the typical sources of Outcome Resistance (Clinging to the Status Quo) with Anxiety?
a) Magical Thinking (My fears protect me or my loved ones. If I stop worrying, something terrible may happen); b) No Pain, No Gain (My constant worrying is the price I have to pay to do superb work. If I stop worrying, I'll get complacent and fail; c) Conflict / Anger Phobia (I don't want to face the problem that's triggering my anxiety in the first place)
45
What are the Truth-Based Techniques?
They are: a) Examine the Evidence; b) Experimental Technique; c) Survey Method; and d) Reattribution
46
What are the Logic-Based Techniques?
They are: a) Socratic Method; b) Thinking in Shades of Gray; and c) Process vs. Outcome
47
What are the Semantic Techniques?
These are; 1) Semantic Method; 2) Let's Define Terms; and 3) Be Specific
48
What is Paradoxical Inquiry?
Paradoxical inquiry can be helpful for Outcome and Process Resistance. When the patient resists, youcan ask a paradoxical question that may lead the patient to the irrationality of the resistance, rather than using persuasion in an attempt to change the patient's mind. For example, the patient who’s describing a conflict with his brother may say, “Why should I have to change? He’s the one who’s screwed up.” Using PI you might say, “Certainly, you shouldn’t have to change and you don’t have to change. Are you saying that you don’t want to?” You can also point out that he may be saying that he doesn’t really want to work on the relationship, and perhaps just wanted you to know how difficult and irritating his brother is. If so, you can then ask if there’s something else he’d prefer to work on. PI must be delivered with warmth, respect, and authenticity.
49
How might a Gentle Ultimatum be presented with a depressed patient?
“Pedro, I’m looking forward to working with you to overcome the feelings of depression and worthlessness that have been plaguing you for so many years. However, if you want me to help you, you’re going have to do daily psychotherapy homework for 15 to 30 minutes, even when you’re not in the mood or feel convinced that it couldn’t possibly help. It’s a little like going to a tenniscoach to improve your tennis game. You’d have to practice between sessions to get the real benefit. And if you’re willing to do the homework, I believe I can show you how to change your life. That would be exciting to me.
50
What is a Brief Example of a Paradoxical Invitation?
“Are you asking for help with the problem with your husband, or did you simply want me to know about how lonely and frustrated you’ve been feeling?”
51
How might a Gentle Ultimatum be presented with a depressed patient?
Or, let’s say the patient is anxious, but doesn’t want to have to use exposure. You could point out that most therapists in the community offer long-term talk therapy without exposure for patients struggling with anxiety. You could also say, “If you feel strongly that you’re looking for that approach, I feel that you have every right to pursue it—but I don’t have those kinds of skills.” You can emphasize that you have great respect for the patient and hope she or he will decide to work with you. You can also let the patient know that you feel convinced that you can do some tremendous work together (Dangling the Carrot again.) However, they should know that the exposure requirement would not be negotiable.
52
What is a brief example of Sitting with Open Hands?
“It sounds like you don’t want any help with problems X. Y, and Z, and I’m fine with that. I’mwondering if there’s anything else that you do want help with that we could work on together?”
53
What messages is the Straightforward Invitation meant to convey?
The Straightforward Invitation gives the patient three messages: 1. I'm here to support you, although that's obviously of great importance; 2. I have much more to offer you than just listening, and more will be necessary if you really want to change your life; 3. Change is possible if we work together as a team.
54
What are the basic methods for addressing depression and anxiety?
a) Daily Mood Log; b) Recovery Circle; and c) 50 Ways to Untwist Your Thinking
55
What is a brief example of Sitting with Open Hands?
“It sounds like you don’t want any help with problems X. Y, and Z, and I’m fine with that. I’m wondering if there’s anything else that you do want help with that we could work on together?”
56
What are the basic methods for Relationship Problems?
a) Interpersonal Decision-Making; b) Relationship Cost-Benefit Analysis; c) Relationship Journal; and d) Five Secrets of Effective Communication
57
What are the basic methods for Habits and Addictions?
a) Decision-Making Form; b) Habit/Addiction Log; and c) Devil's Advocate Technique
58
What are the most common sources of Outcome Resistance in Depression?
a) Hopelessness; b) Motivational Paralysis; c) Overwhelmed; d) Entitlement; e) Medical Model; and f) Traditional Counseling Model.
59
What are the most common sources of Process Resistance with Anxiety?
a) Avoidance; and b) Medical Model.
60
What are the most common sources of Outcome Resistance with Anger/Relationship Problems?
a) Low Desire; b) Martyrdom / Heroism. I like the role of victim; c) Moral Superiority; d) Gossip / Scapegoating; e) Power; f) Revenge; g) Anger addiction; g) Violence. Aggression is exciting. I enjoy hurting you; and f) Self-Righteousness
61
What are the most common sources of Process Resistance with Relationship Issues?
a) Truth; b) Blame; c) Pride; d) Entitlement; e) Fear; f) Hopelessness.
62
What are the most common sources of Outcome Resistance with Habits and Addictions?
a) Instant Rewards; b) Entitlement; c) Narcissism.; d) Denial; e) Conflict Phobia
63
What's an example of what to say in the Specificity aspect of Agenda setting?
“Can you describe one specific interaction with your husband that was upsetting to you that you want some help with? Let’s write down exactly one thing that he said to you and exactly what you said next.”
64
What is an example of what to say in doing Process Resistance negotiation?
“What would it be worth to you, if I agreed to help you; a) Overcome your depression and feelings of inferiority?; b) Overcome your shyness in social situations?; c) Develop a more loving and satisfying relationship with X?; d) Overcome your overeating (or drinking or procrastinating, etc) What would you bring to the table?
65
What are the Quantitative Techniques?
a) Self-monitoring; and b) Negative Practice/Worry breaks
66
What are the Humor-Based Techniques?
a) Paradoxical Magnification; and b) Shame-Attacking exercises
67
What are the Role-Playing Techniques?
a) Externalization of Voices: and b) Feared Fantasy TechniqueOther techniques that can be converted into role play techniques include: a) Double Standard Technique; b) Acceptance Paradox; c) The Devil's Advocate Technique; d) the David Letterman technique; e) Flirting training; f) Five Secrets of Effective Communiaction; and g) One-Minute Drill
68
What are the Philosophical/Spiritual Techniques?
There is only one: the Acceptance Paradox
69
What are the Visual Imaging Techniques?
a) Time Projection; b) Humorous Imaging; and c) Cognitive Hypnosis
70
What is Externalization of Voices?
This technique transforms intellectual understanding into emotional change at the gutlevel. It's the most powerful of all the CBT techniques, but it can be quite challenging andeven a bit upsetting at first.You and another person will take turns playing the role of your negative thoughts and therole of your positive thoughts. The person playing the negative thoughts attacks, and theperson playing the positive thoughts defends. Use role-reversals when you get stuck.In the "I-I" version of the Externalization of Voices, both of you will speak in the firstperson, "I." In the "You-I" version, the person playing the negative thoughts will speak inthe second-person, "You," and the person playing the positive thoughts will speak in thefirst person, "I." The "I-I" method is gentle and safe, but less effective. The "You-I" methodis more intimidating and challenging, but has far greater healing power.
71
What are the Instructions for Externalization of Voices?
a) Explain that I'm going to play the negative voices in the client's mind, and the client will play the positive voice and try to defeat me; b) Ask the client what his or her name is. Now ask your client what you're name is; c) Attack your client with one NT, but speak in the second person ("You), then ask the client to defeat me using the second person ("I"); d) Now ask the client won the exchange - if the client says he or she one, ask them if they won small, big, or huge; e) If the client does not hit the ball out of the park, or was unconvincing, do a role reversal so that I can try to model a more powerful and effective response.Tips - use the Self-Defense paradigm, and Acceptance Paradox, or a combination of the two.
72
What is paradoxical magnification?
Instead of trying to refute your negative thoughts, you can buy into them and exaggerate them. Try to make them as extreme as possible. For example, if you feel inferior, you could tell yourself, "Yes, it's true. In fact, I'm probably the most inferior person in California at this time." Paradoxically, this can sometimes provide objectivity and relief. Of course, if you're really upset, this technique mayhave the unintended effect of making you feel even worse. If so, try another method.
73
What are shame-attacking exercises?
If you suffer from shyness, you probably have intense fears of looking foolish in front of other people. Shame-Attacking Exercises are a specific and potent antidote to these kinds of fears. You intentionally do something foolish in public so you can get over this fear. For example, you could stand up and announce each stop on a bus or shout out the time in a crowded department store. When you make a fool of yourself on purpose, you discover that the world doesn't come to an end after all, and that people don't really look down on you. This discovery can be liberating.
74
What are the Humor-based techniques?
a) Shame-Attacking exercises; and b) Paradoxical Magnification
75
What are the Role-Playing Techniques?
a) Externalization of Voices; and b) Feared Fantasy Technique
76
What is Externalization of Voices?
This technique transforms intellectual understanding into emotional change at the gut level. It's the most powerful of all the CBT techniques, but it can be quite challenging and even a bit upsetting at first. You and another person will take turns playing the role of your negative thoughts and the role of your positive thoughts. The person playing the negative thoughtsattacks, and the person playing the positive thoughts defends. Use role-reversals when you get stuck. In the "I-I" version of the Externalization of Voices, both of you will speak in the first person, "I." In the "You-I" version, the person playing the negative thoughts will speak in the second-person, "You," and the person playing the positive thoughts will speak in the first person, "I." The "I-I" method is gentle and safe, but less effective. The "You-I" method is more intimidating and challenging, but has far greater healing power.
77
What is the Feared Fantasy technique?
Like the Externalization of Voices, this is a two-person technique. You and the other person act out your worst fears, such as being rejected by an exceptionally hostile critic because you aren't smart enough or good enough. When you faceyour worst fear, you often gain liberation from it. Your worst fears don't usually turn out to be real monsters, but figments of your imagination that you can defeat with a little logic, compassion, and common sense.
78
Other than Externalization of Voices and the Feared Fantasy Technique, what are some other role-playing techniques?
Many techniques are much more effective in a role-playing format. They include Cognitive Techniques like the Double Standard Technique and Acceptance Paradox, Motivational Techniques like the Devil's Advocate, and Exposure Techniques like the David Letterman Technique and Flirting Training. The Interpersonal Techniques, such as the Five Secrets of Effective Communication (#49) and One-Minute Drill (#50) also work extremely well in a role-playing format.
79
What is the Acceptance Paradox?
Instead of defending against your own self-criticisms, you can find truth in them and accept your shortcomings with tranquility. Tell yourself, "It's true that I have many inadequacies. In fact, there is very little, if anything, about me that couldn't be improved considerably."
80
What are the three main Advanced Empathy Techniques?
a) Changing the Focus; b) Multiple Choice Empathy; and c) Positive Reframing
81
What is Changing the Focus?
In this Advance Empathy Technique, you focus on the process rather than the content of the argument. In other words, you mightgently point out that the two of you are arguing and not working together as a team. You bringthe conflict to conscious awareness in a kindly way, so you can both talk about your feelings,rather than trying to figure out who's right and who's wrong.In a sense, there's an elephant in the room, but everyone's ignoring the tension pretending itisn't there. When you change the focus, you point to the elephant and say, "Do you see what Isee?"
82
What is Multiple Choice Empathy?
When you have no idea where someone is coming from, and they're reluctant to tell you, youcan suggest several possibilities and ask if any of them ring a bell. It's like priming the pump.You might say, “I can imagine you might be feeling X, Y, or Z. Do any of those words ring abell?” X, Y and Z could be words from the Feeling Words chart.Multiple-Choice Empathy can be especially helpful when the other person refuses to open upand tell you how they're feeling. You'll have to be disarming rather than blaming when you listthe possible reasons why the other person doesn’t want to talk to you. You'll also have to dothis in a way that sounds caring, respectful, and concerned, and not demanding orcondescending.
83
What are the steps of Paradoxical Agenda Setting?
a) The Invitation (straightforward or paradoxical)
b) Specificity (the client selects the problem and describes one moment when the problem was upsetting him or her
c) Conceptualization (Individual Mood problem? Relationship Problem? Habit/Addiction? Non-problem?)
d) Motivation Step (the therapist melts away Outcome and Process Resistance)
84
What is Positive Reframing?
You put a positive spin on the situation. For example, you can reframe an angry conflict as a golden opportunity to develop a better relationship with the person you’re at odds with, ratherthan viewing the problem as a prelude to Armageddon.You can also reframe the other person's motives or behavior in a positive way.
For example, if someone seems stubborn, dogmatic, and argumentative, you could think of them as havingintense conviction and desperately wanting you to understand them. You can also consider thealmost possibility that you haven’t been disarming them in a genuine way, and that’s theprecise reason they keep arguing. Or, if a loved one is acting nasty, you could reframe theirbehavior as an expression of the hurt, loneliness, or frustration she or he is feeling.
85
How did David Burns use Paradoxical Agenda setting with Ramesh?
“Rameesh, I have some powerful tools to help you with your low self-esteem and the problems you’re encountering at work, and I’d love to work with you. I believe you’re very smart, and I like you, and it would be a joy for me to show you how to turn your life around. I have no doubt that we could do exactly that. But I’m not sure it would be the right thing to do, and I’m really reluctant to share these tools with you.”
86
What is an example of what the therapist might say if he gets a less than perfect rating on the Empathy Scale?
“Ralph, on the empathy scale you indicated that I didn’t always convey as much warmth and support as you might have wanted. You also indicated that I didn’t always understand how you were feeling inside. I greatly appreciated that feedback, and want you to know that we’re on the same page. Last session I also felt that I wasn’t as warm as I wanted to be, and it seemed like I didn’t always understand how you were really feeling. This is incredibly important. Tell me a bit more about where I’ve been missing the boat.”
87
What is Sitting with Open Hands?
* This is a basic PAS Technique
* Sitting with Open Hands means that although you’re eager to help your patient, if she or he wants to change, you don’t have a need to help him or her. It means that you are truly willing to have your patients remain symptomatic. Your job is to find out if there is something he does want help with, and not to impose treatments on him based on his diagnosis or some problem he might have.
* Sitting with Open Hands is important for one reason: If you try to help patients who have not asked for help, you will usually run into a wall of resistance and the therapy will be unsuccessful.
* Many therapists struggle with the idea of Sitting with Open Hands. They feel the need to jump in, trying some technique they think might help, without taking the time to find out what, if anything, the patient wants help with, and without resolving the patient’s Outcome and Process Resistance.
88
What are the basic PAS Techniques?
1. Empathy
2. The Invitation
3. Sitting with Open Hands
4. Fallback position
89
What are the Techniques that Target Outcome Resistance?
1. Dangling the Carrot
2. The Miracle Cure
3. Magic Button
4. Acid Test
5. Magic Dial
6. Straightforward/Paradoxical CBA
7. Externalization of Resistance
90
What are the techniques that target Process Resistance?
1. Gentle Ultimatum
2. Paradoxical Inquiry
3. Devil's Advocate Technique
4. Decision-Making Form
91
What are some examples of Outcome Resistance?
1. A depressed man may think that he deserves to suffer because he did something morally bad or failed in some way.
2. An intensely anxious woman may feel that her anxiety serves a protective function, and may think that something terrible will happen if she gives up the compulsive worrying.
3. A woman with a troubled relationship may not want to get close to the person that she's complaining about and may not be asking for help.
4. A man with a habit or addiction, like alcoholism, binge eating, or an internet porn addiction may not want to give up his greatest, and perhaps only, source of pleasure and reward in a life that feels stressful and unrewarding.
92
What are examples of
Process Resistance?
1. A depressed patient may not want to do psychotherapy homework between sessions because he feels so hopeless, unmotivated, and overwhelmed.
2. An anxious patient probably won¡¦t want to confront her fears using exposure techniques because the exposure seems so dangerous and terrifying.
3. A patient with a troubled marriage probably won¡¦t want to examine his own role in the problem because he¡¦s totally convinced their relationship problems are all his wife¡¦s fault.
4. A patient with an addiction may not want to have to go through withdrawal. A patient with a habit, like procrastination, may not want to face the anxiety of doing a task he¡¦s been putting off.
93
What are common therapist errors when
working with Habits and Addictions?
1. We encourage our patients to change
2. We think our patients want to change
3. We cheerlead
4. We side with the healthy part of our patients.
This natural - and well-intentioned - errors cause our patients to resist. They will tend to tell us all the reasons they might not want to change, and all the reasons why it is just too hard to change.
94
What is Paradoxical Agenda Settting with Habitsa and Addiction?
Instead of chasing our patients - or cheerleading on their behalf - we can learn to:
1. Align with our patient's resistance to change - what are some good reasons *not* to change?
2. Switch roles with our patients - and get *them* to argue for change
3. Learn to hold our patients accountable for change and doing the hard work needed for change.
This is the antidote to chasing after patients, encouraging them to change, and then pushing them to change while they dig in their heels.
95
What is the purpose - and set-up - of the Decision-Making Form?
1. If you're having trouble making up your mind about something, you can use the Decision-Making Form. This form will show why you're getting hung up and will help you finalize your decision.
2. The purpose of the Decision-Making Form is not to tell you what to do, but to show you what the real issues are and how you feel about them.
3. Make a list of all your options and choose the best two. Call them Option A and Option B, and write them at the top of the Decision-Making Form.
4. Then list all the advantages and disadvantages for both options in the appropriate columns.
96
What are three myths about treating patients with Trauma?
1. Clients can be treated effectively with treatment packages, methods, or manuals based on a diagnosis such as PTSD
2. Empathy is the necessary and sufficient condition for healing
3. Effective treatment must be slow
97
What are the ways in which Trauma can impact a person?
Trauma can lead to the following problems - either individually or in combination:
1. Anxiety
2. Depression/Anhedonia
3. Interpersonal Problems
* Anger/Conflict/Aggression/Mistrust/Isolation
4. Addictions
5. Normal grief in some cases.
As such, we don't treat Trauma, we only treat the impacts of trauma based on what the client's agenda is, and how hard they are willing to work at it.
98
What is the Cognitive Model of Trauma?
Your thoughts and beliefs - rather than the trauma per se - trigger your emotional reactions.
* Is this true?
* Is this liberating - or politically incorrect?
* 9/11
* ISIS
99
What are the goals of the Recovery Circle,
and the philosophy behind it?
1. Select at least 15 techniques for challenging
* A Negative thought
* A Self-defeating belief
2. Fail as fast as you can through the different techniques
* Help the patient develop effective PTs from the techniques on the Recovery Circle
3. This can be done alone or with a patient.
4. It is the "engine" of the DML
5. l
100
What aspects of TEAM Therapy do I currently need to work on to improve my skillset?
1. Dangling the Carrot
2. Hold clients accountable
3. Paradoxical Agenda-Setting
4. Gentle Ultimatum
5. The Five Secrets of Effective Communication
* Disarming
* Feeling Empathy
* I Feel Statements
* Stroking
101
What is the rationale for using the paradox with patients contending with Habits and Addictions?
(or any other problem, for that matter)
1. You bring voice to the client's resistance, and the patient voices the change agenda
* Or not - in which case of the client agrees with us then that tells us that the client doesn't really want to work on this problem
2. Out patients want to be understood and they want to be right! PAS allows us to wholeheartedly agree with our patients
3. Most people think about the costs of using and the benefits of changing, and they make it look easy! It isn't easy - and we need to consider the benefits of continuing the habit or addiction.
102
What are some examples of PAS Outcome Resistance statements?
1. "Given all of the good things your drinking does for you - why would you want to give it up?"
2. "Given all of these powerful reasons to keep procrastinating or to keeping having fun - why would you want to work with me on this?"
103
What are the basic PAS Outcome Resistance Tools?
1. Dangling the Carrot
2. Voice the patient's resistance (highlight the good reasons to keep doing X)
3. "Given all of these good reasons to keep doing X, why would you want to give it up?"
4. Paradoxical CBA
5. Patient argues for change and lists the reasons to change
104
What are some of the basic questions to consider
when doing PAS with a client?
1. What are some good reasons why this client will *not* want to change?
2. What are some ways in which this habit or addiction works for the client?
3. What are some awesome and positive qualities that the client posseses that are reflected in his symptoms.
105
What's an example of Dangling the Carrot
+ Voicing the Patient's Resistance?
* "Julia, you've said that you really want my help giving up your drinking. I can see how much trouble it is causing you in your relationship with your husband and how crappy you feel each morning."
* "I would love to help you to stop this cycle, and to have you feeling happier and healthier again, and I think we can work together really productively on this."
* "But at the same time, I can see how much pleasure you take from drinking, how good it feels and howyou love how it takes the dge off after a long day of work."
* "I can see a lot of ways in which your drinking is working for you. Can you think of some advantages to your drinking?"
106
What is something we can say to disarm someone who has angry fantansies and who likes to act out aggressively towards others?
"I myself get so angry with someone that I just want to yell at them, even fantasize beating someone up. I’ve just never had the courage to act on this."
107
What are 7 reasons - among others - why it can be dangerous to base our self-esteem on achievements or love?
1. Your self-esteem will depend on your achievements, so it is always contingent and going up and down, like a roller coaster ride--because sometimes we tend to fail, and sometimes we are more successful.
2. Is it true that people who achieve more are more worthwhile than people who achieve less? Some highly successful individuals have done lots of horrible things to people.
3. You have to be successful to be lovable. In fact, if someone loves you and is attracted to you because of your success, money, power, or status, you may be in for some trouble!
4. What happens when you fail, or hit a bad patch, and don't feel particularly successful? Does this mean you are suddenly less worthwhile, and less lovable?
5. And if you achieve a great deal, does it mean you are "more worthwhile" or "more lovable"? More worthwhile and lovable than who?
6. How much "success" does one need, on a scale from 0 to 100, to be "worthwhile" or "lovable"? Is there some magical cut-off point, such as 65, or 85, on the scale? If so, it means that billions of human are "worthless" and "unlovable."
7. Self-esteem becomes something you have to constantly earn, so you are never truly secure. We can never guarantee endless successes.
108
What do we say to a client after they say they were crush the magic button in the service of reframing?
1. What do your symptoms and negative thoughts show about you that's really awesome and positive?
2. What do these negative thoughts and feelings show about you that’s awesome and positive?
3. (We list with those qualities are) "Maybe we don't want to make that - or these symptoms - go away"
4. The patient's symptoms for a reflection of what's beautiful about them know what's awesome about them – not an indicator of pathology per se
109
What are two things we must get from our client in order to do paradoxical agenda setting?
1. We need to know what they want to work on, if anything.
2. We need to know how hard they are willing to work; what they're willing to bring to the table in order to get better
110
What are four options we have
for dealing with negative thoughts?
1. Crush
2. Destroy
3. Talk back to
4. Befriend
111
What are some of the things that we don't do during Empathy phase of team therapy?
1. Don't encourage
2. Don't cheerlead
3. Don't try to cheer someone up
4. Don't try to help
5. Don't normalize their feelings
112
What are two of the most common self-defeating beliefs with social anxiety?
1. The spotlight Fallacy
2. The Brushfire Fallacy
113
What are the five types of methods
in the Recovery Circle?
1. Motivational Techniques: These melt away resistance.
2. Cognitive Techniques: For modifying distorted thoughts.
3. Behavioral / Exposure Techniques: Confront the monster that we fear.
4. Hidden Emotion Technique: Bring hidden conflicts and feelings to conscious awareness.
5. Uncovering Techniques: Identify Self-Defeating Individual and Interpersonal Beliefs
114
What are common sources of
outcome resistance with depression?
1. **Worthlessness.** I don't deserve to feel good because I really am inferior or defective.
2. **Guilt.** I don't deserve any happiness or self-esteem because I'm bad and I deserve to suffer.
3. **Realism of Depression.** Life really is awful. People who feel happy are stupid and naïve.
4. **Perfectionism.** If I beat up on myself relentlessly whenever I fall short, it will motivate me to achieve great things.
5. **Achievement Addiction.** I couldn't possibly feel happy or fulfilled until I've accomplished something outstanding. But I've never done anything special, so I could never feel any real joy or self-esteem.
6. **Love Addiction.** I couldn't possibly feel happy or fulfilled without a loving relationship.
7. **Self-Pity.** I like being a victim and feeling sorry for myself.
115
What are the basic tools and methods
for dealing with habits and addictions?
1. Decision-Making Form
2. Habit and Addiction Log
3. Devil’s Advocate Technique
116
What are the basic methods and tools
for dealing with relationship problems?
1. Interpersonal Decision-Making
2. Relationship Cost-Benefit Analysis
3. Relationship Journal
4. 5 Secrets of Effective Communication
117
What are the basic tools and methods
for dealing with depression and anxiety?
1. Daily Mood Log
2. Recovery Circle
3. 50 Ways to Untwist Your Thinking
118
What are the basic techniques that should be put on the Recovery Circle in working with Habits and Addictions?
1. Cognitive Techniques
2. Motivational Techniques
3. Uncovering Techniques
4. Anti-procrastination Techniques
5. Role-playing Techniques
119
In dealing with Depression, what five categories of problems should be represented in the Recovery Circle?
1. Cognitive Techniques
2. Behavioral Activation Techniques
3. Motivational Techniques
4. Interpersonal Techniques
5. Uncovering Techniques
120
In working on Anxiety Disorders, what are the three categories of techniques that should be represented on the Recovery Circle?
1. The Hidden Emotion Technique
2. Cognitive Techniques
3. Exposure Techniques (In-vivo and Cognitive)
121
What is the Devil's Advocate Technique?
1. This is a Role-Playing Technique; a role-playing version of the Paradoxical CBA. It's helpful for patients with Habits and Addictions, and should be used early in one's work with them.
2. Another person plays the role of the Devil who tempts you to drink, overeat, procrastinate, or date the wrong person. Your job is talk back to those thoughts in real time. Use role-reversals when you get stuck.
3. For example, if you're struggling to stick with your diet, imagine being in a mall where fast food is sold. The Devil might say, "Gee, why don't you go and get one of those hot, buttery cinnamon buns? They just came out of the oven. It would taste so good. You deserve it!"
4. You can fight back and say, "I don't need a cinnamon bun, and I'll feel terrible if I give in. I'm determined to stick with my diet, and I'm looking forward to fitting into more attractive clothes." The Devil will try to break you down again, and you can fight back.
5. This method can be surprisingly challenging, especially if the Devil is familiar with your own rationalizations and expresses them in a seductive and persuasive manner.
122
What are the three dimensions in grading TEAM Therapy homework - whether it is from a client, a group member, or a supervisee?
1. Letter grade
2. What you liked and didn’t like
3. Which tools were used effectively, and which tools were not used effectively
123
What are the Motivational Techniques?
1. Straightforward and Paradoxical CBA
2. Devil's Advocate Technique
3. Stimulus Control
4. Decision-Making Form
5. Daily Activity Schedule
6. Pleasure Predicting Sheet
7. Anti-procrastination Sheet
124
What are examples of Mind-Reading, Fortune Telling,
and Emotional Reasoning in the context
of Habits & Addictions?
## Footnote
**Mind Reading**
When your patient contemplates drinking he may may assume that other people don’t have to struggle with temptations, or that people who do abstain have drab, unfulfilling lives. These are cognitive distortions we call Jumping-to-Conclusions, and Mind-Reading.
**Fortune Telling**
When we tell ourselves “if I take that drink, I”ll feel great and my problems will disappear.” Or, “I’ll just have one drink” or “one bite,” even though we’ve never stopped at just one drink or bite in the past, a form of Fortune-Telling.
**Emotional Reasoning**
A common habits and addictions related cognitive distortion is Emotional-Reasoning. We tell ourselves, “I’ll clean my desk (or start my diet) when I’m more in the mood. I just don’t feel like it right now.”
125
What are some aspects of the Forced Empathy technique?
1. This person has drank vial of truth serum first.
126
What did David Burns say in response to my question about whether modifying SDBs could help with relapse prevention?
## Footnote
"I always teach that in workshops, but don't know if it is true in reality. It does sound good, but is based on the assumption of a causal role for SDBs. My own published research casts some doubt on that hypothesis. d"
127
According to the Beck Insitute, what are the three "C's" of Cognitive Therapy in socializing children and adolescents to this model?
To engage children in treatment, therapists often frame the therapy experience as "becoming a detective" to investigate their thinking. The first step involves teaching them to "Catch" the thoughts that are associated with a specific experience of negative emotion. By building on skills that have been taught in earlier sessions, children reflect on a previous situation in which they became upset. Once they identify their automatic thoughts, the therapist asks them to rate how strongly they believe the thoughts, implying that thoughts may be completely true or completely false or some place in between. They begin to see their experience in light of the cognitive model-that their negative emotions are associated with specific thoughts.
The next step in the detective work for children is "Checking" the thought. They learn to gather evidence for or against a thought and consider alternative explanations for the situation. They may be asked to consider the impact of their thought, the worst case scenario if the thought were true, and what they might say to a friend if something similar happened to him or her. If a thought is both accurate and distressing, the therapist helps guide the child to "Check" whether the thought is helpful.
Once children have mastered catching and checking, they learn how to "Change" their thoughts. Their therapist guides them to develop more accurate and helpful responses to distressing situations. These responses must be believable, in the children's own words, and short enough to be said quickly. Children then practice using these more helpful responses in session and then out of session. As they encounter similar situations that formerly led to distress, they begin to perceive these new experiences differently.
128
What are David Burns' thoughts about recording therapy sessions, and how it can be valuable?
Hi colleagues,
The idea of recording the Ext. of Voices during relapse prevention training is a good one that I have always used and promoted in workshops for decades. In fact, when in clinical practice, I required clients to record ALL of their sessions and listen to the recordings between sessions as part of their psychotherapy homework. This seems to be a logical thing to do, but almost no therapists do it.
From a practical perspective, if you have a good session, with lots of ext. of voices and breakthroughs during the session, you feel great, and so does the client at the end of the session. But if you ask clients one or two hours later what they learned and what was so helpful, most won't have a clue. So if you think your therapy sessions are worthwhile, it would seems logical to give the client the tools needed to incorporate what they learned at an intellectual and emotional level. The therapy happens too quickly--especially if it is active and fast-moving--for clients to be able to retain most of it.
On the other hand, if you think your therapy sessions are not helpful, but simply amount to schmoozing behind closed doors with the occasional piece of advice thrown in, then recording is not necessary.
In my clinical work, clients often reported that they listened to really helpful sessions on many occasions and finally "got it," so to speak. The Acceptance Paradox would be something needing to be heard many times, for example. But it is HUGE when clients finally "get it."
At the initial evaluation, some clients said they "couldn't" or wouldn't listen to themselves between sessions, for a wide variety of "excuses." They said that they couldn't stand hearing their own voices on recordings, or that it would disrupt the session, or that they don't have time, or that a family member will steal the recording and hear the private information, etc etc etc. By the way, at intake, they typically raised similar objections to written psychotherapy homework.
I simply told them that was sad, since I couldn't do therapy without this vitally important feature or recording the sessions. I emphasized that almost all the other therapists in the community would not require them to record therapy sessions, so they might decide I'm not the therapist they are looking for. In all cases, the patients decided to remain in therapy, and almost all found the recording feature surprisingly helpful. I can't actually remember a single patient I lost due to this feature.
You can use the recording technique in many ways, and I won't detail all the possibilities here except for six obvious applications:
1. Clients can review what they learned and pinpoint what helped the most. This is the obvious value of the recording.
2. They can listen for any errors that you, the therapist, made, or anything you did or said that upset them, so they can tell you at the next session.
3. They can hear their own style of interacting and responding to the therapist, including complaining, being oppositional, not listening, "yes-butting," etc. This insight can tie in with the Interpersonal Vertical Arrow Technique, where you identify the role clients play in their relationships and the roles they expect others to play. So it might highlight their role as the hopeless and resistant person and your role as the frustrated rescuer, but a wide variety of patterns can emerge.
4. It can be a reminder for them to do any psychotherapy homework that might have been assigned during the session.
5. It can help them correct misperceptions of things that happened. For example, I often had patients who said they hated me at the end of the session because of this or that thing I did or said that offended them or seemed uncaring. Then, when they listened to the recording, they said they discovered I had not said or behaved in the way they thought, and that I was actually very patient and kind. This surprising phenomenon was always striking and interesting, but without the recording, the client would have had a radically different memory of the session. This discovery was often stunning to the client, and always unexpected.
6. In interpersonal therapy (individual or couples), they can see their errors more clearly when trying to use the Five Secrets. Usually, we cannot "see" ourselves because we are always looking at the other person and seeing what they are doing wrong. The recording, audio or video, radically changes the visual perspective.
The applications and uses of recording can be expanded in a variety of ways. We don't have many costly, high-tech tools, like MRIs or EKGs and such, in our field, but we do have cell phones that record nicely.
If you like this posting, add your own thoughts and ideas about the uses or misuses of recording therapy sessions.
One last thought. Usually recording in training sessions is to be listened to by the therapist and supervisor to provide feedback about the therapist's errors. That can be very useful, or course. But what I am talking about in this email is radically different, since the patient listens to and owns the recordings.
david
129
130
According to Angela Krumm, what are the steps that are involved in Relapse Prevention?
When doing Relapse Prevention, you take out a Daily Mood Journal and have the client imagine a moment, in the future, when they return to feeling the symptoms. They imagine what they will tell themselves (e.g., "This is proof that the treatment did not work for me." "These tools are garbage." "I really am a hopeless case.") They then generate the rebuttals that will help lift them out of the relapse. Often the rebuttals will include reminders of the tools that you discovered worked for them.
Having this Daily Mood Journal available to them, for when they do experiencing suffering, can be quite empowering. If the client calls you for future treatment, you can also refer to the Daily Mood Journal to see if it can be used to quickly provide relief.
Some of us make the mistake of letting our clients leave treatment, after feeling better, without doing adequate Relapse Prevention. When we make this mistake, I fear we set them up for a major fall when things get difficult in the future.
Again, please consider reviewing chp 32 of the ebook to really grasp this tool!
131
According to Ofer Zur,
what are the 6 steps I Need to Take to Avoid Board Complaints, Protect My License, and Get a Worry-Free Night's Sleep?
1. Do not make custody recommendations or get involved with legal aspects of divorce and custody
2. Do NOT ever meet with a board investigator without legal representation
3. Be extra careful with boundaries with Borderline Personality disordered clients.
4. Pay attention to issues of privacy and confidentiality when it comes to online communications, including FaceBook, or responding to online negative reviews on Yelp.
5. Have in place the necessary clinical forms and treatment records
* Have clients read and sign, at the onset of treatment, the Informed Consent to Treatment form where basic confidentiality and limits to confidentiality, fees, termination, missed sessions, etc. are articulated.
* When it applies, have the HIPAA Notice of Privacy Practices, Authorization to Release Information and other relevant forms in the clients' files.
* Have a basic Treatment Plan outlining the presenting problem, goals of therapy, means/techniques/orientations, etc.
* In many situations, not having some of the above-mentioned forms in the clients' files constitutes substandard care.
6. Make sure that your malpractice insurance includes coverage for board investigations
7. Consulting with experts on difficult cases
8. The Obvious: Never have sex with your clients, and never drink and drive.
