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Introducing CBT to Clients

The way in which the CBT model is presented to clients is integral to positive outcomes. Ahead of an intensive two-day Psychotherapy Excellence training in November, John Ludgate, Ph.D., Founding Fellow of the Academy of Cognitive Therapy, sets out the essentials for introducing your clients to CBT.

 

In practicing CBT for several decades and supervising CBT therapists for many years, I am repeatedly struck by how important the initial orientation of clients to the CBT model is in terms of positive outcomes. If this is presented well and the client ‘buys in’, then this investment leads to more engagement in sessions and more active participation in between-session homework assignments, which in turn facilitates more positive outcomes.

A few points worth keeping in mind:

  1. Talk through the model
    Handing a client a book or pamphlet to read about CBT is not an effective method by itself. It is advisable to go over the model with the client using simple examples, preferably ones from the client’s own life (anxiety about coming to therapy etc) to demonstrate how situations, thoughts, feelings and behaviors connect up. The reading assignment can then elaborate on this. In my experience, sections from David Burns’ book, Feeling Good and Greenberger and Padesky’s workbook, Mind over Mood are very useful supplements. 
  2. Get feedback
    Making sure to get feedback from the client on the brief presentation of this model is important. If clients have significant doubts or have different explanations of where their problems come from (“I have a chemical imbalance”, “I am this way because of my family”), these should be addressed as this will interfere with engagement and compliance.
  3. Keep it simple
    This introduction should not be overly lengthy or contain too much theory or research information. The ‘keep it simple rule’ applies here. CBT contains some simple, commonsense ideas that have face validity and should be presented as such with easy-to-understand examples to demonstrate the ideas.

 

What the client needs to know before embarking on CBT therapy

  • Cognitive Behavior Therapy (CBT) is a form of short-term, problem-focused therapy, which has been successfully used with a number of psychological and emotional problems, including depression, anxiety and addictive behaviors, over the last 20-30 years.
  • CBT aims to help clients identify and change thinking and behavior patterns that cause distress.
  • The CBT approach suggests that:

 

  • Thoughts play a major role in the emotional and behavioral problems experienced by individuals. While situations (a friend not returning a telephone call) can elicit some feelings (irritation or anxiety), the way we think about this situation (“Something is wrong” or “This person doesn’t care”) can make the emotional reaction more severe or intense.
  • Behaviors can also be part of the problem. For example, if the individual, who is feeling bad waiting for a return call from a friend, calls repeatedly leaving angry messages for the other person, it is likely the situation will be made worse.
  • Exploring the connection between situations, thoughts, feelings and behavior will be helpful in revealing maladaptive thinking or behavioral patterns, which can then be changed leading to less emotional distress.

 

  • CBT therapy sessions tend to be:
  • Structured (there is a clear plan for each session)
  • Focussed largely on present problems that are causing distress
  • Collaborative (client and therapist work together to find solutions)
  • Skill-building (clients learn skills that can help them to deal better with problem situations, and practice these both within and between sessions)
  • Emphasise thinking and behavior patterns that may be more effective than those in operation currently
  • Look at thinking which causes distress
  • Focus on practical ways to change all of the above

 

  • Techniques which may be used include:
  • Evidence Review (is there a good reason to believe what is assumed?)
  • Generating alternatives (is there another way one could look at this?)
  • Reviewing the usefulness of thoughts (does it help to think this way?)
  • De-catastrophising (how likely is it that something bad will happen and what could be done, if it did?)
  • Action plan (what can be done to check things out or to improve the situation?)
  • These strategies will be explained in greater detail and practiced during CBT sessions.

 

  • There will be a plan or agenda for each session when one or two problems will be focussed on; discussion and identification of the problem related to the day’s issues will proceed systematically; possible solutions will be considered and then selected; and the therapist, in collaboration with the client, may assign a ‘homework’ for them to work on in the intervening period until the next session.
  • Feedback regarding the session and the therapy in general will also be sought in a systematic way and any issues arising will be discussed.
  • The aim is for the client to ultimately become their own therapist, using the improved skills on their own between sessions and after CBT, which is usually short term, ends.

Cognitive Behavioural Therapy Certificate Workshop, a 2-Day Intensive Training with John Ludgate, is at the Hilton London Olympia, London W14, on 8 and 9 November 2019.

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John Ludgate

John W. Ludgate, Ph.D., is a licensed clinical psychologist who has worked as a psychotherapist for almost 30 years. He is a Founding Fellow of the Academy of Cognitive Therapy. His practice, which involves work in both a private practice and in an outpatient psychiatric center, consists largely of treating clients referred with mood problems and/or anxiety conditions. He is currently working at the Cognitive-Behavioral Therapy Center of Western North Carolina in Asheville, North Carolina.

In the early 1990s, Dr. Ludgate was a Research Clinical Psychologist at the University of Oxford in England and served as cognitive therapist in several outcome studies of panic disorder, agoraphobia, social phobia and hypochondriasis. He authored Cognitive Behavioral Therapy and Relapse Prevention for Depression and Anxiety (Professional Resources Press, 2009) and was co-editor with Wright, Thase and Beck of Cognitive Therapy with Inpatients: Developing a Cognitive Milieu (Guilford Press, 1993). His other books include Overcoming Compassion Fatigue (PESI, 2014) co-authored with Martha Teater and The CBT Couples Toolbox (PESI, 2018).

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