Week 2 PDF

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Summer 2020 Course...

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Week 2: Cognitive Behavioural Therapy -

Not all therapies require delving into childhood… i.e., brief therapies (solution-focused)

RECAP FROM LAST WEEK Therapy as Art vs Therapy as Science ● People that say it is an art re people who use integration of different methods ○ Trained in a certain method and use parts of it in their practice but also parts from other methods ○ They tailor their approach to every client ● Theory is cut and dry and practice is not ○ It is an art because therapists use themselves in therapy (have to be genuine) ■ Use your kindness, not judgmental, can’t assume you know what the client is experiencing, stay curious, always ask questions - investigate their view of the world ■ Share parts of yourself to make yourself more relatable but not too much because it is not about you, but is about the client ○ Research therapy ■ Have to prove it is effective so it needs to be standardized - for research to be valid everything has to be conducted similarly ■ CBT - it is structured (worksheets, manuals), can be researched easily and is the most common method of therapy used - lots of evidence based research one on this method (is a science because of the research) ● Need to focus on the client ○ This is where science and art become intertwined because if it was just a science then anyone could conduct the therapy session but it is an art because things don't always go as planned ○ If you are following a manual (manualized therapy) and the client asks a question or derails, it is the therapist's job to restructure how the session will continue. The manual won't account for those off topic stages of the session ● Some therapists use their one main method of therapy ○ Most people will use different aspects of each method and integrate it into their practice ○ Each client is different so things need to have approached based on each individual ● The importance of therapeutic alliance ○ You have to have a relationship between the therapist and client - really matters ○ Some people say it could be more about the relationship as opposed to the method used ● Actual practice does not go by a script, you could use it as a framework Initial Session ● Therapist discusses confidentiality, limits of confidentiality, goals and process ● With individuals, couples, or families, therapists ask why they came in, when did the problem start, how long has it been going on ● Active listening paraphrasing validating, reframing challenging ● Focus on strengths, coping skills already present ● With couples/families, therapist does not take sides ● Works to improve attachment relationships, interactions, and communication ● Therapy offers a safe, empathetic space to work through issues CBT BEGINS Cognitive Behavioural Therapy ● Cbt is an evolution

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Behaviourism and the psychoanalysis came first but there were limitations of them which is what CBT emerged from ○ Behaviourism was about changing behaviour but didn't stick because if you change behaviour without changing underlying thoughts it won't last ○ Psychoanalysis focussed to heavily on the childhood and early experiences and involved long term therapy - some people can't afford that Aaron Beck was the founder of CBT ○ It is a short term therapy focussed on changing underlying thoughts so you can change your behaviours and it be lasting ○ Most common therapy and most research conducted

Origins And Basis of CBT ● Founder Aaron Beck wanted to investigate Freud’s hypothesis that depression resulted from repressed anger ○ Instead Beck discovered his patients’ underlying feelings were more about “defeat, failure, and loss” and that they subsequently tended to have negative thought biases (Jones-Smith, 2014, p. 175) ● Negative schemas developed in childhood: “Early childhood experiences become the foundation for basic beliefs about ourselves and our world” (back to childhood templates) ○ Schemas are cognitive templates or shortcuts ■ We learn about relationships based on how parents and caregivers treated us as kids ● Our thoughts influence perception of events, not the actual events Key Concepts of CBT ● Cognitive Schemas (Cognitive frameworks/shortcuts) - leads to ○ Automatic negative thoughts (ANT’s) (reactive/reflexive) - leads to ■ Cognitive Distortions - leads to ● CBT therapists look for ANT’s, negative or maladaptive schemas/distortions and help clients become aware of them so they can be changed ○ When you mess up and call yourself an idiot, you become aware of how you self talk and how harsh it is How Change Occurs in CBT ● Therapeutic relationship is key - client trusts the therapist to uncover the schemas ● Positive regard and empathy ● Collaborative empiricism, Socratic dialogue and guided discovery (Jones-Smith, 2021) ○ What is the evidence for this belief? ■ “I'm disorganized” and the therapist asks how often? Every situation? ○ How else might you interpret the situation? ■ Help people realize there are different interpretations and the one they have may not be true and is holding them back ○ If it is true what are the implications? ■ ○ Collaborative empiricism - collaboration between therapist and client ■ Client will try to figure out what their self talk is and therapist will help eliminate it ■ Once they are aware of it they can observe it and change it and therapist guides you through this

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Socratic dialogue ■ Questions the therapists asks to uncover these schemas ○ Guided discovery ■ Is how you are going to change them Relationship between thoughts, feelings and behaviour ○ Change underlying thoughts can change feelings and long lasting behaviours Gradual awareness of cognitive schemas and updating them to be more realistic and positive

Guided Discovery ● Clients are not aware of their self talk so you can put the client back to that time ○ Panic attacks → go back and see what they were thinking before it (unpack it) to figure out what is going on ● Questions ○ “What do you say to yourself when..?” ○ Put yourself back in that moment, what were you thinking?” ○ Journaling ■ Accesses a different part of your brain that you don’t get when talking ○ Self statement inventory ■ Jot things down in the moment ○ “Next time you are feeling blank write down what your thoughts are?” ○ Perception gives meaning Cognitive Distortions - we all have them because of the half second delay ● All or nothing thinking ○ This always or this never or everyone - way of thinking and therapist questions if it really is always ● Selective abstraction - picking a smalls spect of a topic and focussing on that as opposed to the whole picture ● Overgeneralization ● Mind reading - assume they know what someone is thinking and it is usually not the case (jumping to conclusions) ● Magnification and Minimization - magnify the negative and minimize the positive ● Personalization - take things personally ● Negative prediction ● Labeling and mislabeling ● Catastrophizing - always assume the worst possible outcome Cognitive Triad - Beck ● Negative view of themselves, the world and the future ● Negative bias - people depressed look at the world from a negative lens Phases of Therapy ● Initial: Therapeutic alliance, education client re: CBT, goals, homework ● Middle and later: Guided discovery ○ Guide client through negative thoughts and beliefs and make them positive ones ○ Just because you can imagine the worst outcome doesn’t mean you should ○ Don’t do your pain in advance ● Termination: When clients have built new cognitive pathways then you can end therapy because they have learned to do that on their own

Aaron Beck ● What is CBT → it is an architecture ○ To understand CBT yu have to understand the blueprint, and once you know the blueprint you can use the tools to built the therapy based on it ○ CBT - individuals experience vulnerabilities that can be symbolized by maladaptive attitudes ■ Ex. if I talk in public people will ridicule me ● Overtime these attitudes become fortified and permeate the person's personality which result sin a personality disorder (beliefs are deeply encrusted and influence people's interactions) ● Biased attitudes (I'm no good) to biased perception (people don't listen to me which means i am no good) ○ Perception is twisted and not based on evidence just on internal factors ○ CBT changes certain key elements in this issue. It changes the negative perceptions so the person doesn't see things as balck and white ■ Changes bias beliefs ● Efficacy of CBT - change in basic attitudes and perceptions...