KHA714 Lecture Notes - Lecture 3: Reinforcement, Mylo, Risk Assessment
24 Jun 2018
School
Department
Course
Professor
Behaviour Change
Week3
Setting the Foundations for CBT
- THERAPEUTIC ALLIANCE IS KEY
oWe don’t necessarily need to establish trust per say
oOther factors at play
When the relationship isn’t working
- Therapeutic collaboration
oLarge emphasis in psycho-education
Don’t let this take away from collaboration
oInterpersonal dynamic within CBT that consists of an active
partnership
And discovery
oTrial and error
Work out what works
oSuccessful alliance
Agenda setting: not your agenda
Client
What they want to cover in the session
Help guide what they want to discuss
Bring your skill to guide it and keep it on track
Based on client goals
Often you may not agree with their goals
Go around it- ‘at the moment its clear you don’t want to
work on this, so perhaps we focus on something first
and then perhaps we might want to re-addresss
this/evaluate this down the track’
Often they wkll see the importance down the track
Respectful way of challenging clients
Goals
When do I challenge or confront? Or name something
up
When you can see that it is a clear road block:
oBetween your therapeutic relationship
oOr progressing in therapy in terms of their goals
- The role of a therapist
oWhat the client says they want:
Physically safe and private space
Free of distraction
Respectful
Treat concerns seriously
“Just working with the worried world” – never say this
This is irrelevant what you think is a challenge or
something that isn’t
It is what they perceive is as a problem
Don’t ever refer to clients as their diagnostic label
If supervisor uses that language
find more resources at oneclass.com
find more resources at oneclass.com
“My Borderline”
1. They aren’t yours
2. They are more than their label
Competence
PD
Social media
Share practical information about hot to make life
improvements
Not theoretical
Permit personal choice in therapy
Pace themselves
Book ahead
When you thought about coming along to see me, how
often were you thinking you would be coming along to
see me?
Review how the client gets on if therapeutic recommendations
- Ways of building a positive and collaborative relationship
oUse general CBT principles
oMicro- skills
oFirst sessions- client will do most of the talking
Even down the track, let them do most of the talking
Step in, and out
Continual swapping in dialogue
oDon’t rush agenda
Shared time setting
Teaching them how to set an agenda
Say this up front
What we will do at the start of each session, is you will
begin by sharing things you want to discuss in detail in
our session. Just provide a small bit of info about it first
oMaking it clear that feedback is welcome
Not just at the end of the session
The can always say so
oCarefully establishing the client’s goals for treatment
- Video on engaging the client:
oI strongly believe that CBT will be helpful for you
oI think a good start would be to map out some of the things that we
discussed..
CBT model
Small bit of psycho-education
Orienting client to the model
Mapping in his examples
Lots of feedback and summaring
oSocialize client to the fact that we will often ‘make notes’ of what they
mention
If they aren’t things you as a therapist think are important
oHit the pause button on explanation
find more resources at oneclass.com
find more resources at oneclass.com
Reflection in practice
Realise when client isn’t sold on/following what you are saying
- Guiding principles:
oEstablish a good relationship early in therapy
Aware of quality of the relationship
Attend to any problems that may arise in the relationship
oRating scales
To open up dialogue around client concerns
oGuided discovery
Don’t tell the client what is happening to them
Questioning and observing
Step in and out
oTherapy can be seen as a laboratory where problems can be worked on
oCardinal features
Collaboration
Active participation
oGuiding
Client may talk at the surface level
Who is genuinely curious and respectful of the client’s
perspectives, aiming to broaden the range of possibilities open
to the client
- The Therapeutic Relationship in CBT
oRogerian counseling skills
Empathetic
Positive regard
Basic counseling skills
Showing interest via body language
Authentic
Value what they are saying
oClient talking at the surface level:
Not problem focused
Look into what you know about the client, and sharing a deeper
understanding of the issue they describe
“I’m upset because I got a B..”
Reframe that into “I can see that you are exhausted from your
high standards, and this is getting you down”
oPositive reinforcement
Look for opportunities to do this
Positively reinforcing:
Improves relationship
Modeling what is helpful behaviour
Teaching client to give credit to themselves
oAsk for feedback
Is there anything you didn’t like or that I could do better? Is
there something I could have understood better?
Negative reinforcement
I really appreciate you telling me that
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Therapeutic alliance is key: we don"t necessarily need to establish trust per say, other factors at play. Therapeutic collaboration: large emphasis in psycho-education. Don"t let this take away from collaboration: interpersonal dynamic within cbt that consists of an active partnership. Work out what works: successful alliance. What they want to cover in the session. Help guide what they want to discuss. Bring your skill to guide it and keep it on track. Often you may not agree with their goals. Go around it- at the moment its clear you don"t want to work on this, so perhaps we focus on something first and then perhaps we might want to re-addresss this/evaluate this down the track". Often they wkll see the importance down the track. When you can see that it is a clear road block: between your therapeutic relationship, or progressing in therapy in terms of their goals. The role of a therapist: what the client says they want:
