4) Psychoeducation and Preparing Clients for CBT Flashcards

1
Q

Is T-C relationship important, essential, and/or sufficient to affect change?

A
  • T-C relationship is important for change
  • T-C relationship is essential for change
  • BUT T-C relationship alone is not sufficient to affect change
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2
Q

What role should the clinician take in the T-C relationship in terms of…
* classical psychoanalysis
* Counselling
* CT
* BT

A
  • Classical psychoanalysis: Objective and neutral; “distant”
  • Some counselling approaches: supportive, non-directive, reflective
  • CT:
    o Beckian: Collaborative empiricism, guided discovery, Socratic dialogue
    o Ellis: didactic, argued with client
  • BT: Expert and coach
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3
Q

Identify and describe considerations of the T-C relationship in CBT. (5)

A
  • Establish a good relationship early in therapy
  • Maintain relationship throughout therapy
  • Attend to any problems (distrust, ruptures)
  • Key features of CBT (collaboration, active participation, guided discovery) contribute to good alliance
  • Here-and-now first (without inferring this is based on transference)
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4
Q

How should resistance be analysed? (2)

A
  • Analysed as a consequence of client beliefs about therapist or therapist’s actions
  • If persistent/pattern of resistance, examine schemas
     Look for what their beliefs are
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5
Q

Identify and describe relationship competencies required for the Beckian therapist. (3; 1; 3)

A

Collaborative empiricism
* Mutual agreement and discussion with regard to:
 Goals, how to achieve them, time frame and monitoring outcomes
 Formulation and ongoing changes to formulation
* Active involvement of client in therapy
* Guided discovery:
 Use of Socratic dialogue
 Learning experiments/experiences (Behavioural experiments, “homework”)

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6
Q

What enhances the T-C alliance? (4)

A
  • Collaborative empiricism
  • Mutual agreement and discussion with regard to:
     Goals, how to achieve them, time frame and monitoring outcomes
     Formulation and ongoing changes to formulation
  • Active involvement of client in therapy
  • use of Guided discovery through socratic dialogue/learning experiments
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7
Q

Outline the process of Socratic dialogue (4)

A
  • 1) Asking informational questions
     Not just asking random questions, but questions that guide and direct
  • 2) Empathic listening
  • 3) Frequent summaries
     Helps client remember what they discussed
     Helps organise information
  • 4) Asking synthesising questions
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8
Q

What roles/duties does the therapist have in the T-C relationship? (7)

A
  • o Shift roles based on needs of situation
  • o Therapist roles
  • o Shifts the lens/focus to particular areas of their life and get client to reflect that particular period of their life.
  • o Reflective and insight-orientation to change beliefs and schemas
  • o Skills training (coach) when required
  • o Teach (expert) – data, research and facts
  • o Supportive and validating of client’s emotions and experience
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9
Q

Are there differences in T-C relationships across therapist orientations? (2)

A

o More pronounced in past; greater overlap now
o Greater in theory than practice (e.g., counselling uses exposure therapy, ALL use homework exercises)

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10
Q

Are there differences in T-C relationships within CBT? (3)

A

o Most therapists are not purists
o Individual differences within CBT
o Beckian: greater emphasis on relationships than classical BT/RET

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11
Q

What are some cultural considerations that need to be taken into account in the T-C relationship? (6)

A
  • Awareness that own beliefs and perceptions are grounded in “dominant” or “own” culture
    o Diagnoses
    o Cause of illness
    o What is required to facilitate change
  • Aware of blind spots
  • Greater effort/time in engagement if different cultures
    o Show respect
    o Acknowledge difficulties
    o Be sensitive to race/minority status impacts
  • CBT translates well to different belief systems
  • Aware of different perceptions of pathology/helping/therapist
  • Aware of language/translation difficulties
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12
Q

What are some ethical considerations for T-C relationship in CBT? (1;4; 2; 1)

A
  • Similar issues in CBT than other therapies
  • Sexual relationships
    o Statistics (1% to 12%)
    o Power/consent – major issues
    o Extremely damaging to client
    o Severe penalties including loss of registration
  • Other boundary violations
    o Dual relationships to be avoided as much as possible
    o Seek supervision if in doubt
  • Extra care required during out-of-clinic outings for interventions (e.g., exposure therapy)
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13
Q

Does psychoeducation differ from education? If so, in what ways?

A
  • Psychoeducation is not just education
  • Education
    o This component is a minor and relatively easy component of the psychoeducation intervention
    o Can be achieved by videotapes, handouts, internet, computer
    o Does not require a therapist
    o Focus is on **communication of accurate information **
  • Psychoeducation is NOT education about psychological matters.
  • Mental health professionals require education about psychoeducation!
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14
Q

What is the CT perspective on psychoeducation? What is their perspective on receivers (i.e., the client)? (6)

A
  • All receivers are biased processors – everyone, including therapists, are biased processors
  • Information flow is dynamic - receivers actively shape the flow of information
    o They are not passive recipients (e.g., processing biases, “cognitive distortion” “thinking errors”
  • Information may not be received in exactly the same way, even if the information is delivered in the same way to multiple individuals
    o Because individuals have different beliefs/processing biases
  • Psychoeducation makes sure that clients receive information accurately, not really a focus on whether info is delivered by clinicians accurately
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15
Q

What does psychoeducation focus on (1;2)? Why?

A

Focus is on
* Identification of barriers and resistance (beliefs and assumptions)
* Getting past barriers so information is received accurately
 Cognitive barriers
 Emotional barriers (I know it in my mind; but don’t know it in my heart/gut)

Why?
There are major barriers in receiving and interpreting information accurately

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16
Q

What are the principles of psychoeducation? (11)

A
  • Proceed from known to unknown
    o Use existing knowledge to integrate new information
  • Deliver information in bite-sized chunks, not as in lectures
  • Use verbal and visual information, adapt information to style of receiver
  • If you sound like a tutor or lecturer, you’re doing it the wrong way
  • Check out whether the client has understood the information
  • Identify and work through barriers
  • Check whether client finds the information credible now and when distressed
  • Be aware of the “yes” response bias (attend to nonverbal content)
  • Encourage discussion of misgivings, doubts, clarifications
  • Pay attention to nonverbal cues
  • Examine what the client believed about the problem, why the client held such assumptions and how this position has changed after the new information has been obtained
17
Q

What are some ways to overcome emotional barriers during psychoeducation? (10)

A
  • Knowledge through experience is often more powerful, as it is mostly experiental
  • Identify beliefs and assumptions that are cause of misappraisal or failure to grasp issues
  • Use therapeutic interventions (not educational methods) to overcome maladaptive beliefs and assumptions
  • Pace and absorption of information are slower.
  • Repetition, consolidation and corroboration may be necessary
  • Use analogies from disorders other than client’s to illustrate points
    o E.g., can use medical or eating disorder analogies – use whatever is more credible to client to help them relate and understand more
  • Use behavioural experiments to test out aspects of the model if necessary
  • Use homework tasks to corroborate, confirm, or consolidate message
  • Get them to do ratings of beliefs – can compare from last week to this week
  • The best psychoeducation is delivered in a two-way dialogue
18
Q

When considering a client’s beliefs about diagnosis, what should we examine? (4)

A
  • What the diagnosis means to the client
  • Has the client encountered someone else with a similar diagnosis?
    o Best case vs. worst case
  • Does label have prognostic implications for client?
  • Attitudes, assumptions and attributions
    o Ability to cope E.g., I just can’t cope with this now. This is the last straw
    o Beliefs about dangerousness E.g., Persons who are relieved/distressed they have panic attacks (vs. heart attacks) differ because they have differential beliefs regarding what is more/less dangerous
    o Dad/mum/god told me I would get this illness; they was right!
19
Q

When considering a client’s beliefs about psychopathology, what should we examine? (2)

A
  • Clarify client’s pre-diagnostic conceptualisation - aetiology (cause) and maintenance
  • E.g., I have a biochemical imbalance
  • E.g., I am a professional/professor; it makes me angry when you say my thinking is distorted and dysfunctional
  • E.g., I deserve this. I’ve done this to myself.
  • E.g., I don’t deserve this. Why do bad things always happen to me?
20
Q

When considering a client’s beliefs about therapy, what are some common blocks? (7)

A
  • Your solution does not fit my problem
  • Size mismatch: “I’m not going to feel better by these simple strategies! “It’s too big to be fixed, period. I’m here just to hear you confirm that.”
  • Causal mismatch: I don’t think psychotherapy, I have a biochemical problem
    o Linear vs. Circular causality
  • Solution is too hard for me: “I don’t think I’ll be able to do this. I’m not that strong or motivated enough or capable enough for this solution.”
  • Sequence mismatched: Cart before the horse: “Reduce my anxiety first, then I’ll do exposure therapy,” or “Get rid of my depression first, then I’ll do all of these activities you want me to do.”
  • Solution is unfair:
    o Work/wicked witch put me in this hole! Why should I work so hard to become better
  • I thought therapy was about someone else fixing my problems, but you seem to be saying that I’ve got to do all the hard work
21
Q

What are some other aspects (apart from psychoeducation) that we should prepare our clients for in CBT? (4)

A
  • Active engagement in therapy - Unlike what client may expect
  • Monitoring and evaluation
  • Learning and discovery tasks (homework exercises)
  • “Therapy” happens between sessions
22
Q

What is the CBT’s therapist approach? (4)

A

empathic, collaborative, flexible, patient

23
Q

Summarise:
CBT (3)
Psychoeducation (4)

A

CBT
* Relationship competencies are important but not sufficient to effect change
* Need scientific and skilled application of cognitive and behavioural principles
* Prepare clients before you deliver therapy

Psychoeducation
* Use best practice principles including but restricted to
* Clear dissemination of information
* Identification of barriers
* Ensure accurate reception/acceptance of information