______________________ Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition
Self-Assessment Question 2. Marguerite is a 62-year-old married Latina woman who has a history of agoraphobia with panic attacks. Her symptoms are interfering with her relationships with her adult children and grandchildren and her ability to maintain employment outside of the house. To fully develop the individualized case formulation for Marguerite, the therapist may want to: A) Conduct an assessment and clinical interview and look at all domains of health, including such things as physical well-being, medical health, mood, achievement, and interpersonal relationships. B) Discuss Marguerite’s day-to-day challenges with her family, their response, and the impact of her family’s response on her. C) Ask Marguerite her beliefs about the development of her symptoms, as well as her well-being and recovery. D) Identify the central, dysfunctional beliefs underlying her symptoms. E) All of the above. Treatment Plan Based on the case formulation, the next step is developing a treatment plan to guide therapy. The therapist must determine the appropriate course of therapy considering the diagnosis, case formulation, strength of the therapeutic alliance, degree to which the client subscribes to the cognitive model, level of active core beliefs during the session, amount of insight the client exhibits, and how rigid or concrete the client’s thinking patterns are (J. S. Beck, 2020). Treatment plans are tailored to the individual. For example, for a client who lacks confidence or is new to therapy, the therapist may determine it best to focus on the most straightforward problem first to enhance the client’s confidence in therapy and skill in particular coping techniques (Messer & Kaslow, 2019). Generally, cognitive therapy includes interventions related to automatic thoughts, intermediate beliefs, core beliefs, behaviors, and/or emotions. A competent cognitive therapist attends to each of the aspects presented in the schematic in Figure 1 (p. 6), including medical, cultural, developmental, biological, and environmental factors. COGNITIVE THERAPY TECHNIQUES As previously emphasized, the selection of therapeutic inter- ventions is driven by the case formulation or conceptualiza- tion. Techniques are chosen based on the conceptualization and goals for treatment; there is not necessarily a standard prescription of methods that are applied. Generally, a cognitive therapist may begin by addressing a client’s automatic thoughts, typically the most accessible and malleable. The therapist and client may eventually transition to working with intermediate or core beliefs. The descriptions of core practices and tech- niques presented below are derived from seminal sources for information regarding the practice and application of cognitive
therapy: Beck (2020) and Leahy (2017). Beck (2020) provides a thorough and detailed description of cognitive therapy, its model, and its practice. Leahy (2017) presents a compendium of cognitive therapy techniques and applications. The reader is also referred to Freeman and colleagues (2004), as this resource shares a comprehensive compendium of information for apply- ing cognitive therapy in the real world. It is important to note that the concepts and techniques presented by such sources draw heavily on the work of Aaron Beck. Aspiring cognitive therapists would be well served to review Beck’s original works. (See the Reference section.) Fundamental Practices Strategies such as collaborative empiricism, Socratic question- ing, and guided discovery are central to cognitive therapy. Still, other strategies can be applied, including techniques from different orientations and behavioral and problem-solving techniques (J. S. Beck, 2020). This course reviews these three core practices; however, clinicians should remember that vari- ous techniques apply to cognitive therapy. Collaborative empiricism is a phrase often heard about cognitive therapy and refers to the process in which a therapist and cli- ent work together to test cognitions using empirical evidence. The therapist educates the client about the cognitive model and acclimates to the notion of working together with the therapist as “scientists” to test hypotheses regarding cogni- tions. In this process, clients are supported as they evaluate their cognitions scientifically and objectively. Logical analysis and experimentation are used to assess the utility and valid- ity of a thought or belief. Many techniques described in this course are tools the therapist and client can use to practice collaborative empiricism. Socratic dialogue denotes a particular style of interaction or inquiry. While questioning is a primary therapeutic device in many forms of therapy, the Socratic style of questioning is the central tenet in cognitive therapy. Essentially, Socratic dialogu- ing helps the client arrive at logical conclusions independently, without being led. Examples of Socratic questioning include: • What do you mean when you say that? • What assumptions is that conclusion based on? • What evidence is there to support that statement or view? • What alternatives are there to how you are viewing this situation? • What might the consequences of that assumption/ behavior be? • What would happen if you gave up that attitude? • What are the costs of maintaining that thought/ belief? • What might you tell a friend in a similar situation? • What is the worst that could happen?
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