3005PSY Module 5 - Setting Up Cognitive Therapy PDF

So in setting up cognitive therapy in the initial stage, we're trying to identify what the problem is and to establish rapport. So, like all therapies, rapport is really key. Identifying the problem leads to goal setting, and these goals need to be concrete, specific and measurable. So without a cle...

So in setting up cognitive therapy in the initial stage, we're trying to identify what the problem is and to establish rapport. So, like all therapies, rapport is really key. Identifying the problem leads to goal setting, and these goals need to be concrete, specific and measurable. So without a clear and collaborative understanding of what the problem is, we're not going to have agreement on the goals. There's also socialization to therapy and discussion to elicit expectations. So cognitive therapy is different to many other types of therapy. It does require a lot of active participation from the client, particularly with regards to in-session tasks and homework. Not all therapies are like this. They differ in terms of how much is expected of the client in and outside of sessions. So it's really important to discuss this with the client. So they've got a good, clear idea of what cognitive therapy involves and what their involvement in the process will be. We also do a psychometric assessments, a number of psychometric assessments, you might choose to use the Beck Depression Inventory if your client is reporting low mood. Or there's also the Beck Anxiety Inventory. But really, you can use whatever psychometric assessments you like as long as they're valid and reliable and have clear alignment with the problem and what you're trying to assess in therapy. We then give the client psycho education about the cognitive model, and this is what you learned about earlier in this this module, the idea that a situation leads to a thought, which leads then to the emotion and behavior, with the thought being really central in terms of how we interpret an otherwise neutral or ambiguous situation. And so we may do an ambiguous picture activity with a client- I often do this with clients or we may draw those circles and talk it through with the client. But the idea of being at the end of it, they should have an idea that within the style of therapy that we're doing, we're going to be focusing on thoughts and they should have an understanding as to why we're doing that, why the thoughts are so central. We also work with clients for them to be able to identify subsequent emotions and behavior. So firstly, learning to identify emotions, at the start of this module, you learned that emotions are considered to be the combination of thoughts, feelings and behavior. We would do the same thing with a client and we'd ask them to really practice explaining how did you feel at this point in time? And some clients are not very good at this. Some clients, they may report it was just really overwhelming or I'm not sure. I'm not sure what I was feeling. I just didn't like it. And so in some instances, we may need to do some work expanding their emotion vocabulary. We asked them to rate the intensity of the emotion on a zero to 100 scale, which is a visual analog scale, so how anxious were you? Zero to one hundred, zero is not at all, one hundred is that's the most anxious I've ever been. And you'll see with the treatment components that we keep coming back to these visual analogue scales in terms of intensity of emotions, but also belief in thoughts. So we then link the emotion to the automatic thought and specifically that the automatic thought was probably before the emotion, the automatic thought caused the emotion. So we use the Socratic questions, like when you had the thought- "She thinks I'm an idiot"- What were you feeling then? You might do it as a reflection. So when you had that thought, you then became anxious? So either way, we're trying to specifically link here that you had the thought and then you felt anxious or you had the thought, and then how did you feel after having that thought? And then linking it to behavior so that made you suppress your own ideas and just go with hers. So this is from the thought "she thinks I'm an idiot". So you- had the thought- you felt anxious and then- that made you suppress your own ideas and just go with her. So linking it then to the behavior. So this is the cognitive model then in action. So we're taking that broad notion of the cognitive model and now applying it to a specific situation for a client. So when you had the emotion, what did you do next? So trying to elicit the behavior that then followed that emotion. Early on in cognitive therapy, usually from the first or second session, we start getting clients to use what we call an ABC record, and this is when this is for them to record their thoughts. So at the start of the module, I ask you to think about a situation and to record your thoughts. This is very similar to that. So we give a big table to clients and we ask them to throughout the week, any time they're feeling a strong emotion, write it down and write it down as close to the event as possible so that those thoughts are really fresh and they don't have to sort of think back- what was I thinking then? So the ABC, the essence of antecedent, which is the situation or the critical incident as they write it down. So the situation might be- Went for a coffee with a friend. So, they've walked into the coffee place. Now, the belief, these are the thoughts, or the cognition. So what were they thinking? So the thought might be- she's getting really bored with me. She didn't want to be here, that's why she rescheduled so many times. I don't think she really likes me. And then the consequence of that, which are the emotions and the behavior, so the consequence, is that I felt anxious and I'd write that at about a 60 percent, a 60 on my visual analogue scale. And because I felt anxious, it meant that I started stuttering a bit more with my speech. I was wringing my hands. I know I was looking down a lot and I left my sunglasses on because that's a bit of a safety thing for me in terms of not having to make eye contact too much. So I write down all of those behaviors. Now, we're not doing anything with this yet. We start this early on in the treatment process and we collect a lot of data for this will probably end up with quite a few weeks worth of data before we actually go back and start examining these thoughts in more detail. But this is really the start of cognitive therapy before we get into the more active treatment components.