cognitive behavioral therapy

cognitive behavioral therapy Order Description Assignment supporting details This are the list of topic cover during the module Preparing you to apply CBT skills in your practice. Making sense of CBT informed skills and knowledge. CBT and therapeutic relationships. Therapeutic relationships - practitioner variables. Therapeutic relationships - client variables. Therapeutic relationships - context variables. Establishing the relationship. Developing the relationship. Maintaining the relationship. Repairing ruptures. These assignment is a separate assignment i.e assignment one is different from assignment 2 and must be done separately to include the following on each separate assignment . The confidentiality and Turnitin statement must be written in such a way that is different but still saying the same thing In both assignment.The role overview in assignment one is a role of a registered mental health and registered nurse carrying out CBT on a patient that came to see her after referral by the GENERAL PRACTITIONER due to presenting with depressive symptoms.The therapist is not a CBT Specialist but a nurse, but using a relational and interview skill to carry out CBT and she is going to critique the skills that she has use effectively and the one she need to develop on. -firstly confidentiality statement -secondly, Turnitin statement -Thirdly , introduction , brief patient reason for coming for cbt. In the introduction part you need to state that the assignment will highlight the differences between CBT and other therapies namely psychodynamic and client centred practice using available relevant literature.This must reflect in the assignment. Please you have to note in the assignment those terminology that will be used interchangeably, eg CT i.e cognitive therapy, CBT ,Cognitive behavioural therapist, CB therapist, service user can be use for the patient with depressive symptoms. Assignment 0ne- 2000 words. The critique part should not be less than 1000words. You will critically evaluate your own current practice and identify how you plan to integrate the relational and interviewing skills, and insights from CBT approaches within your practice in order to improve therapeutic relationships with your clients. Critically analyse the use of relational and interviewing skills by you during a session with a patient that has depressive symptoms. It is an hypothetic case. No video was given. The assignment is for you to watch yourself doing as a CBT therapy session with a patient with depressive symptoms .And write down what you did well and what you did not do well and need to improve on in your practice. Every statement must be supported by literature. The use of therapeutic relationships and interview skills must be demonstrated during the session. Then you will then critique the relational, interviewing and assessment skills used and not used.You will now create another subheading on how you may integrate this knowledge and skills from CBT may be integrate safely into your current professional practice to improve therapeutic relationship with patient. Fourtly-the critique of the cbt session detailing the skills that was use effectively and not use. For example therapeutic relationship skill was use because the therapist provides a warm welcome , respect the patient by asking how she need to be address , Collaborative Empiricism is an equal adult partnership, using an open, honest, enquiring and respectful dialogue to examine the client's view of their world by saying this or that.This statement is an example of what you can pull out in your critique if it was used effectively or not.”According to Hardy et al. 2007, there are 3 components that contributes to a well- developed alliance, which are the bond, the goals and the tasks as well as the relationship history of the participants, and Tone (2012) furthers the statement by adding that the qualities of the client and therapist and interaction between them is what the therapeutic relationship is comprised of. The bond is how the therapist is liked, trusted and by the client and how well the client is understood by the therapist(Horvah & Greenberg , 1989). The therapist and the client sets a goal for the treatment and a plan for how the goal should be achieved would be the tasks (Bordin, 1979). If the client and the therapist are not in agreement about what the goals of treatment should be, this could cause a rupture in the relationship (Cully & Teten 2008). Newman (1998) confirms that the goals and treatment plan should be 'taylor fit' for the client.”This was done by the therapist doing this and that. I want the essay to states that I have learned about the important therapeutic relationship in other to carry out successful CBT and discuss how I am going to implement it into my nursing practice to build therapeutic relationship with my patient. References in Harvard style with page number if require. Please note that assignment one did not have video to watch it is an hypothetical case. That is the reason while I have said to make it look like you are the therapist doing a cbt session with a patient that has depressive symptoms. Now you what to critique yourself what you have done well and did not do well. Assignment two . 2000 words.The critique must be about 1000words. You will critically analyse the relational and interviewing skills of a suggested CB therapist recommended by a module tutor. You will use the literature to argue the strengths and limitations of the Assignment supporting details These assignment is a separate assignment from assignment one and must be done separately to include the following . The confidentiality and Turnitin statement must be written in such a way that is different but still saying the same thing In both assignment.The role overview in assignment two is a role of a registered mental health and registered nurse watching a CBT session of a patient that has performance anxiety .The nurse watching the video is not a CBT Specialist but a nurse, but using a relational and interview skill to critique the skills that was demonstrated by the therapist, commenting on the strength and weakness and what can be improve on. Clear, legible presentation. This should include at least 1.5 line spacing and a font size of 12. -firstly confidentiality statement -secondly, Turnitin statement -Thirdly , introduction , brief patient reason for coming for cbt. In the introduction part you need to state that the assignment will highlight the differences between CBT and other therapies namely psychodynamic and client centred practice using available relevant literature.This must reflect in the assignment.Please you have to note in the assignment those terminology that will be used interchangeably, eg CT i.e cognitive therapy, CBT ,Cognitive behavioural therapist, CB therapist, service user can be use for the patient with depressive symptoms. Below I have attach the link to the video you need to watch for assignment 2 https://www.youtube.com/watch?v=8qWBvWaMBdY&feature=youtu.be sample assignment for course work two is attached below Focus of both assignment are the following. Key concepts and skills used or not used Relevant observations I have made Assess the skills used using the literature Use of the literature to suggest change is an example of essay for assignment 2 Remember you can use subheading for both assignment for example empathetic listening skills was demonstrated and used the literature to back it. Collaborative empiricism was demonstrated used literature to back it. The therapist was not judgemental by doing so, so and so, use literature to back it. Client-centred therapy operates according to three basic principles that reflect the attitude of the therapist to the client: -The therapist is congruent with the client by asking or do so so and so -The therapist provides the client with unconditional positive regard by doing so so and so -The therapist shows empathetic understanding to the client. Back everything with literature . Do not put state of assumption that you can not back up with literature Sample for assignment 2 is attached below.Assignment one is different in a way because iwith the fact that there is no video to watch. You need to discuss how you are going to implement what you learn about the important of therapeutic relationship in cbt in you practice in addition to that. Confidentiality-Throughout this assignment all material has been written in such a way as to ensure the anonymity of any client material and that clients’ identities have been protected, this also extends to any organisational reference and or material used. Turnitin I confirm that I have checked the originality of this report through Turnitin confirming that I am the author and that it has not been submitted for marking by myself or anyone else at any other educational institution. Introduction This is a critique of an interview between a cognitive behavioural therapist and a client who experiences performance anxiety, the main focus of this critique will be the relational skills demonstrated and suggestions will be made as to how this may be improved. In addition, it will highlight the differences between CBT and other therapies namely psychodynamic and client centred practice using available relevant literature. The author of this critique is an integrative counsellor with a psychodynamic core therefore doesn’t have an in-depth understanding of CBT and inevitably will be commenting on the material from this perspective. Please note that CT, CBT and CB therapist are interchangeable terms that are used in this document. Critique of relational and interviewing skills demonstrated This was the initial meeting and assessment for a client who presented with anxiety, it must be noted however that the therapist didn’t ask the client what the presenting issue was until over six minutes into the meeting and during that time the client spoke very little. An important part of the assessment process from a CT perspective is the beginning of learning for the client through the therapists’ teaching. Neenan and Dryden explain “During the first session, the therapist introduces the cognitive model so clients can make an early start in detecting their negative thoughts and how these thoughts influence their feelings” (2011, p. 23). The therapist in this instance certainly demonstrated this process well, clearly explaining the connection between thought and feelings and how understanding the thought process may help manage the feelings activated by those thoughts. The therapist also ‘set the scene’ and checked with the client that they had received information on what the service offered, discussed confidentiality and its limits and then clarifying the exceptions which might cause him to break confidentiality such as situations where an individual may be at risk to themselves or others and in particular children. All the information was delivered with clarity and in line with BACP’s new ethical framework, the therapist was clear about the limitations of confidentiality (2016, p. 12). Alongside this process the therapist also mentioned his responsibility to act in the event of suspected terrorist activity; working in line with the prevention of terrorism act and its impact on confidentiality (Reform 2005, p. 108). This is an important new development within the counselling field, and has an impact on how we as therapists build the contract with our clients and the need for being open with them regarding disclosure however; he did not mention the possibility of having to disclose any information regarding radicalisation another issue that has been discussed within the counselling field and the need to clarify this with clients. He also reminded the client that filming was taking place and confirmed that the client consented to this. However; he could have clarified for the client what would happen to the recording once it had been used, Dale stipulates “If you take notes or record sessions, it is important to tell clients what you intend doing with those notes (e.g. use as a tool for supervision) and how long you will keep them for.” (2010, p. 02) The therapist appeared not to place enough emphasis on developing a connection with the client; although he covered the necessary information well he seemed to speak quite fast and didn’t allow any room for responses or interjections by the client. He didn’t appear to ‘establish a rapport’ with the client, building a rapport with the client is one of the essential skills of a CB therapist according to Newman (2013). Another factor that influences the potential therapeutic alliance is body language, the therapist in this instance had his foot on the knee of his other leg, in - other words he was sitting in a crossed leg manner; non-verbal communication including body language can have an important impact on the therapeutic alliance, it was Stickley that coined the acronym SURETY (2011) which stands for: • Sit at an angle to the client, sitting squarely may be seen as confrontational • Uncross arms and legs, crossed arms and legs can be interpreted as defensiveness, superiority or lack of interest • Relax, a relaxed posture can help the therapist and the client feel comfortable • Eye contact, retaining eye contact is an important part of relating to the other, however it’s very different to staring which can be intimidating • Touch, the appropriate use of touch, being mindful of cultural norms and the adult safe zones for touch such as the lower arm or shoulder • Your intuition, use your sensitivity and intuition Apart from the issues mentioned the therapist did maintain good eye contact and overall a relaxed style. What was immediately noticeable and something that could have an impact on the meeting was the setting, it appeared to be a medical office offering very little comfort and seemed quite cramped, under these conditions could the client feel a little intimidated? the therapist being male and the client female – might this have an impact on their interactions? Another observation was the therapists use of pen and paper, although this is a matter of preference it’s worthy to note that there can be a danger of this interrupting the flow of the discussion, it was observed that at crucial moments when the client was sharing something important - her experience of the choir, he darted back and forth between client and writing. The whole emphasis in the beginning section of the interview seemed to be about information giving and teaching with very little regard for the client’s world, a very different approach to that of a psychodynamic or person centred practitioner where the therapist is mainly led by the client, as suggested in a section of Rogers’ talk on empathy where he states “It means checking with him as to the accuracy of your sensings and being guided by his responses…” (2012). What this interview highlighted was the difference between CT and psychodynamic/person centred therapy and the different emphasis placed on the importance and role of the therapeutic relationship by the two schools of thought. One of the main criticisms of CT has been the perception of it being very formulaic, robotic and lacking a human face. Beck responds by stating that “We start with the head and we try to get to the heart through the head, because the heart is blocked up and so we try to get it unblocked.” (2013). The video of this interview certainly displayed the human element of the therapist however the role of the relationship between the client and therapist is prioritised differently, Beck argues that “One of the fundamental principles of the CBT model, namely that the mechanism of change lies in the CBT interventions themselves and the therapeutic relationship, while important, is considered secondary to the interventions themselves as a mechanism for change.” (cited in Kinsella and Garland 2008, p. 53). In contrast Jacobs states “The relationship between counsellor and the client is indeed reckoned to be a crucial aspect in nearly every school of counselling and psycho-dynamic counselling is no exception”. (2010, p. 17). Towards the latter part of the interview the therapist began exploring with the client the issue that had brought her to therapy, namely her performance anxiety. One of the techniques he used to explore her situation further was the use of guided discovery through Socratic questioning, (the Socratic method of questioning is named after the Greek philosopher Socrates) “Guided discovery is a process whereby the therapist acts as a guide to help clients uncover, examine and reality-test their maladaptive thoughts and belief;” (Neenan and Dryden, 2011, p. 16) this was demonstrated when the therapist asked “How does that feel for you today, being here, meeting me for the first time and having to speak out?”. And she responded by saying “Well I suppose there’s elements of that now really. I worry about people thinking I’m stupid, because I sometimes get so strung out I can’t get my words out.” Her response indicated that she realised that what she was feeling and experiencing in this moment was similar to the feelings she experiences in the other situations that she finds difficult. There was also evidence of the clients’ negative automatic thoughts (NAT’s) “These are thoughts that come rapidly, automatically and involuntarily to mind when a person is stressed or upset” (Neenan and Dryden, 2011, p. 6) her comment of “I worry about people thinking I’m stupid” could be classed as one of these. This video was very brief however, one can surmise that if it had continued more guided discovery and Socratic questioning would have taken place. The aim of this process would be to begin the formulation or case conceptualisation “This refers to making sense of a client’s problem within the cognitive model.” (Neenan and Dryden, 2011, p. 18) and also to begin the process of ‘collaborative empiricism’ with the client “In the process, both the therapist and the patient will collect data and information pertaining to the way they construe and conceptualize the problems. This can only be done by examining the information experientially, objectively and empirically.” (Wing Wong, 2013, p. 390) and Beck adds “Thus, collaborative empiricism involves treating patients as informed consumers and providing them with information about their illness.” (cited by Wing Wong, 2013, p. 390) Conclusion It’s recognised that this was a very short video with limited time to demonstrate important elements of CBT in artificial circumstances this may have added to the impression that the therapist was speaking fast and speaking much more so than the client. However, this video demonstrated that CBT places a different emphasis on the role of the therapeutic relationship to that of psychodynamic or client centred therapies. The CB therapist is far more verbal and active in the relationship, appearing to take on a teaching role within the relationship, with the client being the authority on their experience and life and the therapist as the guide (Beck, 2014). The video also demonstrated the very useful ways in which a client can be empowered by the collaborative nature of CBT. However, there are potential dangers in this approach to the therapeutic alliance, a lack of rapport and the possibility of clients not feeling listened to, this was demonstrated at the beginning of the video where there seemed to be very little room for the client to engage or steer the conversation. There was also the potential for information overload this could have been balanced with the therapist speaking more slowly, pacing the meeting more appropriately and checking with the client that they had really understood what was being said. Upon observation of this video it becomes obvious that there is a real need for the therapist to be well trained and highly skilled and have an ability to tune in to the emotional status of the client; to be able to recognise the clients’ needs and respond accordingly. References BACP. (2016) Ethical Framework for Counselling and Psychotherapy. Lutterworth: British Association of Counselling and Psychotherapy Dale, H. (2010) P11 Information Sheet: Making the Contract for Counselling and Psychotherapy. Lutterworth: British Association for Counselling and Psychotherapy Beck Institute for Cognitive Behaviour Therapy (2014) Comparison of the Therapeutic Relationship in Psychoanalytic and Cognitive Therapy [Online]. Available at: https://www.youtube.com/watch? v=GuxeTnmUi00 [Accessed: 6 Aug. 2016] Beck Institute for Cognitive Behaviour Therapy (2013). The Human Element in CBT. [online] Available at: https://www.youtube.com/watch?v=KqJSEfOnfyA [Accessed 4 Aug. 2016]. Kinsella, P. and Garland, A. (2008). Cognitive behavioural therapy for mental health workers. London: Routledge. Jacobs, M. (2010). Psychodynamic Counselling in Action. 4th edn. London: Sage Publishing Ltd.. Neenan, M., and Dryden, W. (2011) Cognitive Therapy in a Nutshell. 2nd edn. London: Sage Publication Ltd.. Newman, C. (2013) Core Competencies in Cognitive-Behavioural Therapy: Becoming a Highly Effective and Competent Cognitive-Behavioural Therapist. Routledge: London. Reform, I., 2005. Terrorism Prevention Act of 2004. Public Law, 458, p.108. Stickley, T. (2011) From SOLER to SURETY for effective non-verbal communication, Nurse Education in Practice, 11(6), pp.395-398. Wing Wong, C. (2013) Collaborative Empiricism in Culturally Sensitive Cognitive Behavior Therapy, Cognitive Behavioral Practice 20 p. 390-398. YouTube. (2012). Part - 1 Carl Rogers's 1974 lecture on empathy. [online] Available at: https://www.youtube.com/watch?v=iMi7uY83z-U [Accessed 31 Jul. 2016]. I have suggested references that can be use this is attached below 1. • Experiencing CBT from the inside out: a self-practice/self-reflection workbook for therapists - James Bennett-Levy, Richard Thwaites, Beverly Haarhoff, Helen Perry 2015 2. Formulation in psychology and psychotherapy: making sense of people's problems 2014 3. Cognitive-behavioural counselling in action - Peter Trower, Andrew Casey, Windy Dryden 1988 4. Formulation in psychology and psychotherapy: making sense of people's problems 2014 5. Assessment and case formulation in cognitive behavioural therapy 2015 Chapter 1 The Therapeutic Alliance Reconsidered -in- Negotiating the therapeutic alliance: a relational treatment guide Chapter For Copyright Cleared Content click the Online Resource button Cognitive behavioural counselling in action - Jason Jones 2010 Chapter 3 - The Therapeutic Relationship -in- An introduction to cognitive behaviour therapy: skills and applications Cognitive behavioural therapy explained - Graeme Whitfield, Alan Davidson c2007 An introduction to cognitive behaviour therapy: skills and applications - David Westbrook, Helen Kennerley, Joan Kirk 2011 Cognitive behavioural therapy explained - Graeme Whitfield, Alan Davidson c2007 1. Overcoming obstacles in CBT - Craig Chigwedere 2012 (electronic resource) 2. Cognitive behavioural therapy in mental health care - Alec Grant 2010 (electronic resource) Book Please read the Chapter - Grant, A., and Townend, M. (2010) ‘The Therapeutic Relationship’ An introduction to modern CBT: psychological solutions to mental health problems - Stefan G. Hofmann 2012 (electronic resource) 3. Core competencies in cognitive-behavioral therapy: becoming a highly effective and competent cognitive-behavioral therapist - Cory Frank Newman 2012 (electronic resource) Communication skills for mental health nurses: an introduction - Jean Morrissey, Patrick Callaghan 2011 (electronic resource) The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies - Paul Gilbert, Robert L. Leahy 2007 (electronic resource) 4. Cognitive behavioural therapy in mental health care - Alec Grant 2010 (electronic resource) Book Read the Chapter titled The Therapeutic Relationship 5. An introduction to modern CBT: psychological solutions to mental health problems - Stefan G. Hofmann 2012 (electronic resource) Communication skills for mental health nurses: an introduction - Jean Morrissey, Patrick Callaghan 2011 (electronic resource) 6. Core competencies in cognitive-behavioral therapy: becoming a highly effective and competent cognitive-behavioral therapist - Cory Frank Newman 2012 (electronic resource) Psychotherapy relationships that work: therapist contributions and responsiveness to patients - John C. Norcross 2002 (electronic resource) 7. Compassion: conceptualisations, research and use in psychotherapy - Paul Gilbert 2005 (electronic resource) Book Please read the Chapter: Lee, D.A. (2005). The perfect nurturer: A model to develop a compassionate mind within the context of cognitive therapy. • Concept Mapping the Client's Perspective on Counseling Alliance Formation. - Robinder P. Bedi 2006 A review and critical appraisal of measures of therapist-patient interactions in mental health settings - J Cahill, M Barkham, G Hardy, S Gilbody 06/2008 Social representation of therapeutic relationship among cognitive-behavioral psychotherapists. - Omar Carlo Gioacchino Gelo, Roberto Ziglio, Stefania Armenio, Francesco Fattori 2016 1. The importance of identifying and understanding therapist schema in cognitive therapy training and supervision - Beverly A. Haarhoff 2. How a return to theory could help alliance research. - Robert L. Hatcher, Alex W. Barends 2006 3. Alliance in action: A new measure of clients' perceptions of therapists' alliance activity - Jesse Owen, Robert J Reese, Kelley Quirk, Emil Rodolfa 01/2013 4. Repairing alliance ruptures. - Jeremy D. Safran, J. Christopher Muran, Catherine Eubanks-Carter 2011 5. Therapist alliance activity, therapist comfort, and systemic alliance on individual psychotherapy outcome. - Norah C. 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