Please watch it and offer some of your reactions to her methods. It is only a snippet, so imagine how it might continue. What did you like about her interactions with the client? What didn't you like? What could you see yourself incorporating into your own work?
Sunday, November 1, 2015
Cognitive Behavioral Treatment
Please watch it and offer some of your reactions to her methods. It is only a snippet, so imagine how it might continue. What did you like about her interactions with the client? What didn't you like? What could you see yourself incorporating into your own work?
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In all honesty, CBT has been a difficult concept for me to grasp. I understand the techniques behind using this approach but also feel like I have worked diligently at not going into each session with an agenda and allowing the client to lead the flow of the session, which seems very contradictory to this approach. I’m sure there are pieces of CBT that I incorporate with my clients (providing education and occasionally assigning a homework in order to help them move forward in their recovery)but I’m not sure I like the entire “setup” per say. I did like that Beck provided the client with positive reinforcement for arriving to the session and seeking help for her anxiety. Sometimes I see so many clients throughout the day that I lose sight of what a major step this might be for a client who is seeking treatment for the first time. I think this is an important concept in validating the client’s arrival to the session and helps with building rapport. This is certainly something I would like to add to my own therapy concept and one major piece that I would take away from this clip. As previously mentioned, I didn’t like having an “agenda” and laying this out for the client. It felt too guided and appeared that the therapist was leading the conversation and engaging more than the client; she appeared very word and didn’t appear to give enough time for the client to feel validated. I also felt uncomfortable when she disclosed the location where she lives and that she has a cousin who works at a local school similar to the client. Not only does this perhaps affect her safety, but in a roundabout way may affect the confidentiality of her cousin. If I was in Beck’s place I might ask more questions about her anxiety and how she can verify that she is feeling anxiety (ie: how does anxiety feel in your body? How is this different from another feeling such as fear or anger?). I might also ask about coping techniques that have been successful in the past as well as perhaps educating her around new coping techniques that she might try as part of a homework assignment.
ReplyDeleteHi Rebecca,
DeleteThroughout my two internships I have struggled with my personal style of incorporating an agenda into sessions with individuals and in groups. I appreciate your comments about this style feeling too structured and like more input is coming from the therapist rather than the client. I think a lot of this comes down to the type of issues clients are facing. I think CBT is great for individuals dealing with the thought/emotion/behavior issuew, somehow the wires are crossed. I certainly do not think that CBT would be effective in grief therapy etc. I think this approach is completely based on what individuals are dealing with and it makes sense that not all social workers are going to utilize this technique.
I'm glad we are able to talk about both sides, the positive and negative aspects to these approaches. It is helpful in understanding the strengths and limitations.
Christine
Hi Rebecca,
DeleteI agree with the idea of leaving the agendas out of the therapy sessions. I feel they can sometimes interfere with the client's ability/willingness to open up...if they start feeling pressured. That said, if you're meeting with a client multiple times and you're noticing an unhealthy pattern of thought, then I think some of these CBT techniques are perfect for helping him/her work through them. So I guess where my comfort level is (presently) is to sort of apply these techniques on a case by case basis.
Rebecca,
DeleteI agree I have had some difficulty grasping CBT and I hope to continue reading more articles and doing more research until I get a firm grasp on it. I look forward to the presentations by classmates on CBT to expand my understanding. When your applying these techniques on a case by case basis are there certain things you are looking for to know it is appropriate to apply CBT to the intervention.
Christine Mc.
I think the setting of the agenda has a significant role to play in this intervention. My daughter was a victim of bullying at her college, though I was unaware of it for quite a while. What I saw was a confident, competent, brilliant girl go off to school and over period of a couple of years change into an insecure, frightened young woman. Anyway, she was determined to finish at this school, so our deal was she see a CBT trained therapist. I found one, and within a few a very short time- a few sessions, she was on the road to recovery. The agenda, the homework, the handouts-the calm and assuredness of the counselor, all contributes to her fill recovery.
DeleteRebeca you bring up two very interesting points- One being the challenge of going in with a clear agenda but also being about to be flexible and letting the client control the flow of the session. I am interested in CBT and imagine it works for some people, but personally if I were in therapy I would not want someone controlling the session so much and giving me "homework". I also think you bring up a good point in mentioning that Alice Beck showed her client positive reinforcement which is an interesting approach and I imagine it could work very well with clients. I think going to therapy is a difficult decision and I imagine by starting session with a praise, it could help empower the client and their choice to be in therapy.
DeleteRebecca,
DeleteI agree that I have had to work to not go into a session with an agenda, especially if it is a client that I have been working with and they seem to be struggling with the same problem over and over. However I have found that having a few CBT exercises kind of in mind, often I can use the concept of CBT and use the exercise to work with what ever they are bringing in to the session. So going in knowing that I am going to be challenging their beliefs, but being ready to roll with what ever belief they are bringing in that day keeps me form having an agenda but allows me to be able to know I am going to be working with their thinking patterns helps me to move the session forward. Also knowing if they are in crisis that I may have to throw my plans out the window and be ok with that helps too.
Amanda
I thought the video was a great example of a first meeting. Its a good example of how to set the agenda and bridging. Judith Beck did a great job in making the client feel comfortable with some "small talk" in the beginning. I could see how clients who may have been anxious about meeting with a therapist could feel less anxious after meeting her. Judith Beck also stayed focus on the thoughts of the client and how she and her therapist could continue to work on those thoughts in a way to address the concerns. There was no mention of the emotions. She set a clear agenda so the client would know what to expect out of the session and introduced the idea of "homework" in suggesting ways she and her therapist could work together moving forward. I also appreciated that she asked the clients permission/approval before beginning. I could see this as a way to empower a client.
ReplyDeleteThe question I have is the agency I work for have many strict policies about employees discussing personal information with clients. In the lectures and in this video there were varies levels of personal information provided to clients. How would one take the same approach to build a trusting therapeutic relationship with a client without disclosing personal information. We are not even allowed to discuss with clients where we live, or if we have children....
Also, in lecture 2 I found the statement "Change the thought to change the emotion," the perfect summary of what the goal of CBT is.
Hi Jennifer,
DeleteI think everyday things like the weather or possibly an upcoming weekend could be neutral topics that can be discussed to help clients to feel at ease. I agree that many agencies have policies and many of us have personal boundaries that we follow that would limit the amount of personal information we share. When I run groups, I ask general questions as an ice breaker, such as one fun fact, what did you have for breakfast, favorite food, or favorite holiday. These may be too juvenile or too awkward for an individual session, but I think there is a lot of statements that can be made by us or the client to "break the ice".
Christine
Hi Jennifer -
DeleteI worry about self disclosing as well, especially regarding the location at which she lived. While the client didn't seem over threatening, I'm still not sure I would feel comfortable disclosing where I live or that I had family working at the same school as the client did. This can be especially worrisome in locations that I have worked in the past (ie: correctional settings), where the rules are extremely strict and even vanity license plates are frowned upon. I personally think you can never be too safe. Good insight.
Rebecca
I too think Judith did a great job putting the client at ease with the "small talk" at the outset of the session. I think you really help yourself as a therapist when you can begin as she has ---guard down, disarm, etc.
DeleteI liked how she welcomed the client to her table by making an immediate connection and even offering to perhaps talk of it later after the session. She took charge in a way that was confident and friendly, not controlling. Her setting of the agenda was informative, not unlike nurse who alerts you to the fact that in a moment "you will be getting a shot, but don't worry it will feel like a prick and she will let you know exactly when it is going to happen." By setting the stage, the agenda, she has given the client a moment to start thinking, and thinking specifically about her anxiety. She may even begin to feel anxious...which would be a good time to uncover her common beliefs, distortions, automatic thoughts, feelings and behaviors. There wasn't anything I didn't like, but I felt caught off guard by the knife like precision and getting "things rolling."
ReplyDeleteI like CBT and would want to someday have the confidence of an experienced person like Judith Beck.
Gail,
DeleteI like how you analyzed the interaction between Judith and the client, I had the same opinions. I hope to buy some books on CBT and research more articles to strengthen my skills with CBT. Do you have any plans to sharpen your techniques in the mean time?
Christine McGovern
I am still deciding what I think of CBT and after reading your post I think you being up some very valid points in how it can be a positive form of therapeutic intervention. I can imagine for some people "setting the stage" could be a relief because they then know what to except and are able to freely reflect and share -- or it could immediately make them feed anxious therefor pushing them to open up about that... its interesting to think about. Wish we could of seen more of the clip!
DeleteHi Gail,
DeleteI agree that there is a certain amount of confidence and precision when using CBT, especially during the first session. Throughout this module I have thought about situations and clients where CBT would be appropriate. I think this takes a lot of skill as a clinician to be able to identify the need for different approaches and be willing to step back and try things from a different angle. Thank you for bringing up these points.
Christine
I liked how Judith came in and she discussed with the client how they had something in to get the conversation going and then she said we will get back to that later, then proceeded to move on to setting the agenda. This allowed the client to open up and then knew what to expect next, as did the therapist. It was helpful having Judith ask the client to talk about the panic attacks, by describing the symptoms and the worse feared catastrophe. Everybody experiences symptoms differently, so to hear in her own words is extremely important for her treatment. That will be beneficial for her in coping techniques and to the therapist in their future work together. The therapist can use Cognitive-restructuring interventions, which are designed to assist patients with recognizing dysfunctional and inaccurate thinking patterns and to cultivate more adaptive and precise ways to understand panic symptoms. Common thinking traps that individuals with panic disorder have are over-estimating the likelihood of a negative outcome and catastrophizing or assuming the consequence will be unmanageable (Otto, Michael & Murray, Heather). This is one I would chose for a technique, once I am more comfortable with CBT techniques.
ReplyDelete“Anxiety sensitivity is believed to contribute to the maintenance of panic disorder. Anxiety sensitivity is the fear of anxiety-like physiological sensations which results from catastrophic misinterpretations of these sensations” (McNally, 2002). Though stress predicts the manifestation of panic attacks, people with greater levels of anxiety sensitivity may be at larger risk for having panic attacks in response to stress (McNally, 2002).
Reference
McNally RJ. Anxiety sensitivity and panic disorder. Biol Psychiatry 2002; 52(10):938-46.
The original version of these slides was provided by Michael W. Otto, Ph.D. & Heather W. Murray, Ph.D., with support from NIMH Excellence in Training Award at the Center for Anxiety and Related Disorders at Boston University (R25 MH08478)
Hi Christine,
DeleteI think you raised a good point about how important it is to describe her symptoms in her own words. Not only is it true that each person may experience their symptoms differently, I also feel like by allowing them free rein to talk about it, you're opening up an opportunity for the client to talk about satellite issues...such as the life events surrounding the onset of symptoms, which can help you tune in to what might be going through their heads cognitively.
Whoops. Sorry about the run-on sentence there.
DeleteAlice,
DeleteIt is so important to give clients/patients that opportunity to freely open up about things that have been bottled up, causing anxiety or irritability which is interfering with their daily functioning.
Christine Mc.
Hi Christine -
DeleteI agree that it was important to Judith to ask about the symptoms of anxiety as often times anxiety plays out differently in the body for everyone. I also liked how she asked about the worst possible outcome. Sometimes (even personally) when I get anxiety I imagine the worst possible outcome and completely catastrophize the situation. I think it's important that Judith is able to normalize these feelings for the client later in the session and help her to develop a plan for when she is feeling anxious and how to appropriately manage these uncomfortable feelings.
Rebecca
Hi Christine,
DeleteLike others mentioned, I agree with your observation in regards to allowing the patient to describe their symptoms in their own words. I agree that this is extremely important in helping the person understand and acknowledge what they are going through. It can also be empowering and can help to minimize the assumptions that clinicians make in regards to how symptoms material internally and externally.
Christine George
Okay. For some reason I can't get this video to load for me. I've tried three different computers, plus my tablet. I've tried different Wi-Fi areas, and waited till different days; none of it is fixing the problem. So I apologize, but I can't give my reaction to the video, because I can't see it. I hate to admit defeat, though. But it's already Friday so I think it's too late now. (Maybe could you include a hyperlink too next time? Just in case of technical difficulties?)
ReplyDeleteOne of the first things I noticed when hearing Beck speak was her calm and nurturing tone. After viewing this clip I was also interested in exploring the amount of relationship building that went on. I understand that this was a clip which clearly being filmed and Judith Beck was acting as a consultant of CBT for both the patient and clinician. With that being said, I was uncomfortable with how much sharing went on about their family members and where they were studying. I think regardless of the situation, it is important to help clients feel at ease without relating to them regarding where they live, or where family members are attending school. I would be interested to talk more about relationship building with everyone and what techniques work and don't work. In terms of CBT I think Beck is clearly a professional and expert in the way she walked the client through what her treatment process is and will be after identifying the problem. I think CBT is great technique to use especially if someone is suffering from one specific problem like panic attacks and has clear fears which this client presented as her main problem. I would have been curious to hear more than two minutes of this case- did my computer not load the whole thing? Was it meant to be longer? When it comes to CBT I am most interested in the core problem. I think its interesting to thing about thoughts/actions and emotions and again I think when there is a specific problem CBT is great. I would imagine myself being interested in using this at some point, but I would be more interested in working with someone trying to understand more the core beliefs about themselves- not necessarily how these beliefs are effecting their actions on a daily basis.
ReplyDeleteHi Annie,
DeleteThank you for bringing up the point about Judith's calming tone of voice. I also think the speed at which she speaks is important to consider. I often find that when I have an agenda for an individual session, group or family meeting I talk faster in an attempt to "get things moving". I found that Judith had a calming tone and pace that helped the client to feel safe and at ease.
Christine George
Well, Judith is offering feedback to both a client and her therapist. My guess is that once she gets the "history" she'll validate the work that been done, but then fill-in procedural gaps should they present themselves, all the while modeling appropriate therapist behavior, in the interest of opportunistically advancing the therapy. She'll proceed very efficiently in other words, which I like. I really didn't see anything I didn't like.
ReplyDeleteI feel that the video does a great job of showing how to bring CBT into the session. She was able to bring in some casual conversation to set the client at ease and then move forward. I was slightly uncomfortable with the personal information being shared, but that is because I have been taught to avoid using my personal information to as s short cut to building rapport with a client; and that was what it felt like she was doing.
ReplyDelete