Cognitive Therapy In Practice

A typical cognitive therapy session involves checking how the client has been doing, reviewing the previous session, setting an agenda, working through the agenda items, setting homework, reviewing/summarising the session and eliciting feedback. It begins with the therapist and client negotiating an agenda or list of topics that they agree to work on in that session. This involves ensuring the agenda is manageable, prioritising the items and linking them to the therapy goals. The therapist will usually ask the client for a brief synopsis of the time since they last met and as far as possible will try to enable a linking of both positive and negative experiences to thoughts and behaviours. For example, a client who reports feeling less depressed may go on to link this to returning to work and having less time to ruminate. A session would then review the homework from the previous session, again seeking to link progress or lack of progress to the therapy goals. For example, an adolescent female client with borderline personality traits may have a goal of having more control over her rapid and distressing mood cycles. Her homework involved identifying the thoughts at the beginning of a mood cycle over the course of a week and labelling these as one of a range of cognitive distortions. In the review of the homework, it became clear that all-or-nothing thinking was a characteristic of almost all the rapid mood cycling.

The session then moves on to the further agenda items. As they work through the items, the therapist and client seek to examine how the issues can be understood in terms of the cognitive formulation and how the issues relate to the therapeutic goals. Once there is a hypothesis about how the issue can be meaningfully understood, an appropriate intervention can be suggested. This is done collaboratively, with the therapist setting out the rationale and proceeding where there is a clear basis for collaboration. With the example of the adolescent client with borderline traits, an agenda item might well be conflict with a friend. Through collaborative empiricism, it emerged that the client's behaviour was based on mind reading the motives for her friend's behaviour. This provides the basis for socialising to the cognitive model and the beginnings of thought challenging. As the therapist and client work through the agenda items, the therapist makes use of frequent capsule summaries. These serve to ensure therapist and client agree about what has been said, provide a chance to review the session as it proceeds and build a strong therapeutic relationship.

At the end of the session, the therapist asks the client for a summary of the session (for example, 'What do you think you can take away from today's session that might be useful to you?'). The therapist and client agree homework that will move the client on towards his or her goals and solve any anticipated difficulties with the homework. Finally, the therapist asks for any feedback, both positive and negative, on the session (for example, 'What did you like and not like about how today went so that we can ensure next time things are working well for you?').

A typical cognitive therapy might comprise three phases. The first involves ensuring a sound therapeutic relationship, socialising the client to cognitive therapy and establishing the problem/goal list. The therapist aims for some improvements very early (preferably in the first session), to build a sense of hope about the therapeutic process. The second phase involves identifying and evaluating the client's thoughts and behaviours that are involved in maintaining the presenting problems. As appropriate, client and therapist work together to challenge maladaptive thought patterns (for example, all-or-nothing thinking) and develop more adaptive ways of thinking. Similarly, maladaptive behaviours (such as avoidance) are identified, evaluated and alternative behaviours are tried out. The third and final phase of therapy focusses on relapse prevention. The goal of cognitive therapy is to enable clients to 'become their own cognitive therapists', anticipating problematic situations, challenging their maladaptive thinking in these situations and experimenting with new and more adaptive ways of thinking and behaving. The therapist increasingly assumes the role of consultant to the 'client cognitive therapist', reviewing what the client learned in therapy, reinforcing the client's effective problem solving, supporting the client in preparing for setbacks and supporting the client with learning effective problem-solving skills. Sessions tend to become less frequent and are discontinued as the client and therapist have confidence that the therapeutic goals have substantively been attained and the client has the cognitive and behavioural skills to manage both everyday and anticipated future problems. The cognitive formulation of the client's presenting problems should enable a good prediction of what future difficulties are most likely to prove problematic. This is used to rehearse how the client might manage these difficulties and thereby prevent future relapse if these difficulties occur.

Exploring EFT

Exploring EFT

EFT stands for Emotional Freedom Technique. It works to free the user of both physical and emotional pain and relieve chronic conditions by healing the physical responses our bodies make after we've been hurt or experienced pain. While some people do not carry the effects of these experiences, others have bodies that hold onto these memories, which affect the way the body works. Because it is a free and fast technique, even if you are not one hundred percent committed to whether it works or not, it is still worth giving it a shot and seeing if there is any improvement.

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