4) Psychoeducation and Preparing Clients for CBT Flashcards
Is T-C relationship important, essential, and/or sufficient to affect change?
- 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
What role should the clinician take in the T-C relationship in terms of…
* classical psychoanalysis
* Counselling
* CT
* BT
- 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
Identify and describe considerations of the T-C relationship in CBT. (5)
- 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)
How should resistance be analysed? (2)
- 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
Identify and describe relationship competencies required for the Beckian therapist. (3; 1; 3)
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”)
What enhances the T-C alliance? (4)
- 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
Outline the process of Socratic dialogue (4)
- 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
What roles/duties does the therapist have in the T-C relationship? (7)
- 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
Are there differences in T-C relationships across therapist orientations? (2)
o More pronounced in past; greater overlap now
o Greater in theory than practice (e.g., counselling uses exposure therapy, ALL use homework exercises)
Are there differences in T-C relationships within CBT? (3)
o Most therapists are not purists
o Individual differences within CBT
o Beckian: greater emphasis on relationships than classical BT/RET
What are some cultural considerations that need to be taken into account in the T-C relationship? (6)
- 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
What are some ethical considerations for T-C relationship in CBT? (1;4; 2; 1)
- 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)
Does psychoeducation differ from education? If so, in what ways?
- 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!
What is the CT perspective on psychoeducation? What is their perspective on receivers (i.e., the client)? (6)
- 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
What does psychoeducation focus on (1;2)? Why?
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