Chapter 4: setting the stage for CBT through building alliance and planning ahead

Question 1

What does the development of a strong alliance require?

Answer 1

warmth, empathy, respect…

Question 2

definition of therapeutic alliance

Answer 2

• therapist-client agreement on therapeutic goals and tasks through which the goals will be achieved
• formation of bond between therapist and client

Question 3

therapeutic alliance: expertise vs. equality

Answer 3

• having expertise does not mean therapist is an expert about the client
• client may also have areas of expertise unrelated to treatment which can lead to a relationship of two experts with different skill sets working to solve a set of problems
• -> collaboration: clients active engagement in the shared work of therapy
• relationship will never be completely equal, bc client is consulting therapist as expert

Question 4

therapeutic alliance: role of the therapist: strategies (6)

Answer 4

1. expertise vs. equality
2. coping vs. mastery
3. use of self-disclosure
4. use of metacognition
5. use of affect
6. encouraging courage

Question 5

therapeutic alliance: coping vs. mastery

Answer 5

• as therapist, you are often model for clients (implicitly or explicitly)
• it can be unhelpful to appear perfect, can intimidate clients from their own attempts at change in the presence of what they experience as highly skilled and knowledgable person
• -> clients learn more from coping than mastery model

Question 6

therapeutic alliance: use of self-disclosure

Answer 6

• clearly answer questions about your training, background and expertise
• occasionally: disclosure of problems you have encountered in your life and how you have dealt with them –> if it helps to normalise the clients concerns, if it helps to see you as a person, if the strategies you used are similar to the ones you are proposing in treatment

Question 7

therapeutic alliance: content disclosure

Answer 7

• content disclosure: questions by the client such as how old are you –> answer what you feel comfortable with

Question 8

therapeutic alliance: process-oriented self- disclosure

Answer 8

• sharing your automatic thoughts or emotional responses, particularly with clients who have interpersonal problems –> valuable to clients bc they may seldom receive honest feedback –> can lead to increased interpersonal understanding

Question 9

Therapeutic alliance: use of affect

Answer 9

• affect is triggered by many interventions (e.g., exposure) and is required for them to work
• therapists may also express their emotions, e.g. enthusiasm about clients effort, frustration at lack of effort etc.

Question 10

therapeutic alliance: encouraging courage

Answer 10

• crucial to encourage clients to be courageous in quest for change; without these efforts, change will not occur (natural to avoid, procrastinate etc.)

Question 11

therapeutic alliance: therapeutic contract

Answer 11

• development of a treatment contract is an intervention in and of itself
• improves adherence and motivation
• clear statement on clients intentions and goals for change

Question 12

Therapeutic alliance: goal setting

Answer 12

• set early goal that is likely to quick success or reduction in distress
• establish ways to access outcome
• SMART goals: specific, measurable, achievable, realistic and relevant and time limited