______________________ Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition
therapy and collaboratively develop therapeutic goals. This approach necessitates emphasizing the present time; cognitive therapy focuses on current issues to facilitate change. Such problems are considered salient, real, here-and-now opportu- nities for the team to effect change and address maladaptive cognitions. Attention may be shifted to the client’s past in certain circumstances (such as in addressing personality dis- orders). Still, generally, cognitive therapy does not require a significant investment of resources in determining the origin of maladaptive cognitions in order to make lasting changes in the present and future. In keeping with the collaborative nature of cognitive therapy, psychoeducation is a necessary and integral component. The therapist educates the client regarding the cognitive model, guides the process of cognitive therapy, and helps the client to understand and conceptualize their experiences. Psycho- education may also include information about when and why particular techniques can be helpful. The therapist may teach the client specific skills in order to alleviate specific problems. For example, the therapist will provide the client with psychoeducation regarding automatic thoughts, interme- diate beliefs, and core beliefs to help the client identify and modify maladaptive thought processes, ideally leading to more adaptive functioning. The therapist may assign homework so the client can practice between sessions to reinforce learning and support the development of healthy coping through its application. Education facilitates the goal of helping the client to become their own therapist over time. Doing so allows the client to succeed over the long term and ideally assists relapse prevention. In this way, many of the benefits of therapy are experienced not only during the course of treatment but will ideally persist even after therapy is terminated. Cognitive therapy is time-limited in many regards. This is true in relation to the session’s format and the length of the overall course of treatment. Sessions often range in duration from 30 to 90 minutes. Depending on the condition, treatment may consist of a few sessions for relatively straightforward presenta- tions to a year or more for those suffering from highly rigid dysfunctional beliefs, thought patterns, and behaviors (J. S. Beck, 2020). Ultimately, however, cognitive therapy aims to have an “end” and support the client in owning responsibil- ity for their recovery and progress. The team contracts for a certain length and number of sessions, which can be revisited as therapy progresses. Additionally, session frequency can be reduced as therapy draws to a close. “Booster” or “refresher” sessions can also be scheduled a month or more following the agreed-upon termination date. Benefits of this practice include but are not limited to providing the client a scheduled and thus anticipated opportunity to discuss any challenges they have had in maintaining change, addressing any questions that have arisen in the interim, supporting the client in learning to be their own therapist, reviewing therapy content, and evaluating if additional intervention may be required.
To facilitate the time-limited nature of cognitive therapy, ses- sions are structured. Agenda setting is a key component of each session. Initially, the therapist may take the lead in set- ting an agenda for each session. As the client becomes more accustomed to the nature of cognitive therapy and experiences improvement in mood and functioning, they take an increas- ingly active role in agenda setting, eventually taking most of the responsibility. Session agendas generally include a review of the previous week’s session and events since the last ses- sion (i.e., brief check-in regarding mood and functioning), collaborative agenda setting, homework review, discussion of key treatment topic(s), assignment of new homework, and the eliciting/providing of feedback (J. S. Beck, 2020). The therapist encourages the client to summarize the information presented and discussed during the session, ask questions, and express concerns throughout the session. The therapist may also reserve time at the end of the session for further discus- sion of questions and concerns that have arisen. Assessment In cognitive therapy, assessment consists of a clinical interview and may often include formal assessment measures. As thor- ough a history as possible is collected within the time allotted. Many clinics differ about the time devoted to an initial intake assessment. Such interviews can range from 30 minutes (e.g., in a primary care setting) to an hour or more (e.g., in research projects or private practice). The therapist will collect informa- tion about the client’s presenting problem/chief complaint, demographics, and treatment history (psychosocial, cultural, medical, occupational, and developmental). It is recommended that a mental status exam (MSE) be conducted as well. Also, clients are encouraged to receive a physical check-up, as many medical conditions can produce psychiatric symptoms. Depending on the circumstances, presenting problem, setting, and logistics of permission, collecting information from indi- viduals who know the client well, such as spouses, partners, parents, friends, and caregivers, can be helpful. During the assessment period, the therapist is not only noting information presented verbally by the client but is also attend- ing to nonverbal information. For example, the therapist may observe a client’s discomfort in speaking about a particular topic and other nonverbal cues present when discussing the client’s situation. Additionally, during the assessment process, the therapist attends to emerging patterns exhibited by the client that may indicate the client’s particular belief structure. Questionnaires and formal assessment measures are also avail- able to the clinician. These may be useful not only in the initial phase of therapy but also as ongoing measures of symptom changes as therapy progresses. There are many instruments available, including the Beck Scales for adult and children, available for purchase from Pearson Assessments (PearsonAs- sessments.com): Beck Depression Inventory-II, Beck Anxiety Inventory (BAI), Beck Scale for Suicide Ideation (BSS), Beck
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