Full transcript of “Lecture#2 CBT: Principles of Treatment (CBT: Basics and Beyond Judith S. Beck)”. Click a timestamp to open the video at that moment. Need another video? Use the YouTube transcript generator.
0:00 Salam alaikum everyone. Cheers to my channel. My name is Kainat Ali and I have a Masters Degree in Clinical Psychology. So this is my series in which I will teach you Cognitive Behavior Therapy in the format of a slide presentation through Judeth Asbeck's highly recommended book CBT Basics and Beyond in the Curriculum. Let's move on. A Today we are studying chapter two which is an overview of treatment. Right? Which contains principles of treatment. In the original second edition, we had 10 principles of treatment. But in the third edition, now we have like 14 principles of treatment.
0:45 So basically what is this? So, I'll read a little bit. The basic principles described in this chapter apply to most clients guided by your cognitive conceptualization of each client. You will very carefully select the techniques you use to tailor them to the individual. Correct? So basically the principles that you have are a format. This is a design on the basis of which the therapy sessions will be conducted. Correct? And that means, these principles of CBT apply to most of the clients on whom you do therapy. If it comes to making some changes , it comes to the preferences of some principles that some can be used here, some cannot. You can tailor that thing very carefully.
1:32 But on the whole, these are the basic principles of CBT which are applicable to every client. So CBT treatment takes into account individuals' cultures, family history and important characteristics, the nature of their difficulties, their goals and aspirations, their ability to form a strong therapeutic bond, their motivation to change, their previous experiences with therapy and their preferences. The foundation and treatment is always a solid therapeutic relationship. So basically this is a small summary of these principles. Right? That we have culture coming to us, history coming to us, therapeutic alliance coming to us, goals of the client and past experiences of therapy etc. Correct. So let's start with our first
2:18 principle. Ok. CBT treatment plans are based on ever evolving cognitive conceptualization. So basically what cognitive conceptualization is is that your client's specific thinking patterns, his schemas, his behavioral strategies i.e. what specific behaviors he uses which are functional or dysfunctional. Ok? And that is the case with every disorder, because the possibility is that if your client has a clinical disorder, then it has some signature thinking processes. Cognitive
3:03 distortions occur. His ways of thinking are correct and there are specific behavior strategies through which you can identify that disorder. So when you observe the patterns of your client and make cognitive conceptualizations, you will also get hints from there as to what possible disorder may arise from this. For example, if we take the example of borderline disorder. Ok? So the hinting patterns in it are very black and white. The way we assess and perceive the world is very black and white. Either this or either that. True all or nothing is black and white type of thinking. And his behavior strategies are
3:48 mostly in line with those thinking patterns. Correct. There are extreme types of behaviors. Self harm also comes under behavior. Drug use also comes under behavior. Because their thinking patterns are like this. Negative emotionality is generated. And then from that emotionality, parallel behaviors, dysfunctional behaviors, are generated. Right? So initially no from the beginning I incorporate their strengths, positive qualities and resources into my conceptualization too. So basically, Judeth is telling you that I mean the first day of the session, when you are taking the intake and history of your client, she also looks at
4:35 what are the strengths, positive qualities and resources of the client because basically those are his own resources, we will utilize those things when we are teaching these skills within the therapy, right, then further I continue to define this conceptualization through out therapy as I collect additional data and I use the conceptualization to plan the treatment. Well, your initial conceptualization about your client, you took two sessions, three sessions, you gathered a lot of his data and induction. Right? But that conceptualization keeps getting updated. You will find revolutions in upcoming sessions that you may not have found in your initial sessions. So because of that,
5:20 you update the previous conceptualization that you have made and on that basis you make a treatment plan. What disorders are included in the treatment plan, which therapy is being used, which symptoms are being targeted, which techniques are being used etc. Unless you have the conceptualization down of your client, you won't know how to exactly apply your therapy to him or her. So this is variant in CBT. So, we have given an example of a client who has a depressive disorder. So in this, I have conceptualized as her difficulties in three time frames from the beginning I identify current cognitions that are obstacles to her aspirations, I am a failure, I can't do anything, right, that means her current thinking pattern is negative thoughts
6:07 and her beliefs which are bothering her the most, right, so she is starting conceptualization from there, from there her thinking pattern, that means her negative thoughts which are the most common and are troubling her right now. It conceptualizes him. I also identify behavioral obstacles that serve to maintain his depression, isolating himself and inactivity. Look at the right behavioral obstacles, we are talking about CBT. Both cognition and behavior like them are a huge part of this therapy. If you have dysfunctional negative cognitive patterns. There are beliefs and thoughts. Right? If they are maintaining your depressive disorder or any other disorder, then your dysfunctional beliefs are also
6:55 maintaining whatever dysfunctional cognitions you have. Ok? So, that means you are first identifying the thought patterns. Then you are identifying his behavioral strategies where he isolates himself or he becomes completely passive. Due to which his depression is actually getting fertilized. It is getting stronger. Ok? So you identified these two things. Correct. Second I identify precipitating factors that influence abuse perception at the onset of depression. That is, those factors are precipitating factors, that is, triggering factors. Ok? Those factors which have caused this depression or this mental state or emotional state. So, it identified that he struggled at work and then lost his job.
7:41 His wife became increasingly critical and divorced him. These events led to the belief that he was incompetent. So the event that triggered his depression was basically the loss of his job. The wife divorced him. Because of that, he had a belief about himself of incompetence. Either it was already created and became active or it got created now given the circumstances that it perceived it like this. I mean of course it is a very tragic circumstance. And off course is a negative life event. Now he saw this thing , perceived negative assessments about the world, about others and about himself. So, the belief was formed that he is a competent individual who further meant that by continuing doing it, he got depressed.
8:29 Correct. Meaning, these entire patterns are going on - of belief, negative thinking, and then negative emotions. These are again dysfunctional behaviors that are maintaining each other. Ok? Negative cognitions than negative emotions, if you remember in my last video I told you about chains and then you have your behaviors. This is negative so this is negative so this is negative. Right? So this means that your thoughts are going on unconsciously, it means you are not conscious. You don't know about them. So they have a lot of power to dictate your emotions and behaviors. And then these returns your behavior also reinforces your thought patterns. Because you are proving yourself. Really I am not capable. I am a useless person
9:15 because I do not know how to do any work properly. Right? So it means that overtime you will get depressed. Correct. So the Third Eye hypothesises about the key developmental events and the enduring patterns of interpreting the kinds of events that may have predisposed him to depression. The right predisposition to something could be genetic or it could be your thinking patterns. Basically predisposition means that there is already a tendency inside you that that thing can happen to you. Right so that means you will watch developmental events. Past developmental events include what past events happened in your life, it could be in your childhood
10:01 or it could be in your recent history too due to which you are thinking in a certain way or you have formed a belief about yourself. I have formed a negative belief. So here we have talked about enduring patterns. Every person has some unique way of thinking. Correct? So what are its enduring patterns that remain similar through out time as it perceives the world. Ok? So, it means that she is checking the factors whether she is matching with those people who mostly suffer from depression. Meaning, by collecting all the data, you are making a proper case. You are making a proper cognitive conceptualization. First of all, is this person suffering from depression and what are the unique factors of this individual
10:47 due to which his depression is being maintained. Right and of course along with that you are also looking at the maintaining factors of depression and its associated cognitions. You are simultaneously studying and then you are also collecting the history and information of your client. Ok? Principle Number Two CBT Requires a Sound Therapeutic Relationship. Well, you have to always remember this thing that when we talk about therapy, it is not important that you are the most skilled therapist in the world. You have read 20 books in CBT. You have four degrees. I mean, you have taken workshops in different schools of thought. That means you are very skilled.
11:32 You know all the techniques and you are following every structure from A to G. True, that in itself is not enough to instigate healing or change within your client. The force of healing that occurs in true therapy comes from the quality of your relationships. Your therapeutic alliance is how connected you are with your client. Correct. Relationship is the main point. If that thing is not established then you both are not connected. You guys are not on the same page. Right with each other on a human level, then no matter how sophisticated techniques you apply, they will not work. And on the other hand, your therapeutic relationship with your client is so strong in the beginning, so first of all, you had
12:19 built the report. Your strong alliance has been formed. You are not using that many techniques. Too technical, you are not using therapy on that. But just sing down in that relationship and having conversations. That guy got inspired automatically and started changing. Healing has begun. It also goes this way. So this is the most important thing, your therapeutic alliance or relationship. So here I will briefly tell you about using good raw genetic counselling skills i.e. empathy, unconditional positive regard, genuineness within which you will build your report. Ok? Asking him for his reaction to the treatment plan, making collaborative decisions about treatment, providing rationale for interventions, using self-disclosure, listening feedback during and at the end of the sessions, and
13:04 working hard to achieve and have him recognize progress contributed to our alliance. So, this is basically telling us which things strengthened our relationship, alliance and therapy. Right? And that means in this relationship, you have built the strength of the relationship, so you use the relationship to provide evidence that the client's negative beliefs, particularly beliefs about the self, are in accurate and that more positive beliefs are valid. Basically, now that your alliance has been formed, if you tell him anything, he will not be receptive. He will not only listen to what you say on a deep level but will also agree with it and implement it. So now this is the time when he is in receptive mode and if you educate him, okay? So
13:49 he will receive that education properly and then will also implement it. Correct ? So you can maximize the time you spend helping clients resolve obstacles they will face in the coming week. The more sound the alliance, the better you can prepare him for how to deal with his difficulties outside the therapy room. Now the next third principle is that CBT continuously monitors client progress, that is, session by session, whenever a client comes to you, you check his mood. You ask him about last week. You ask about his homework assignments. You inquire from him about the things that we discussed in the previous session, the techniques that we applied in the session, whether they were useful in your real life or not.
14:35 Ok? Meaning that this is something which helps a lot in the treatment of the client. Because usefully if you tell him something during the session, he forgets it. Ok? And like that thing does not continue. If there was some problem or he did not understand something, then it means you address these things session by session. You check everything including the mood. You inquire into the thought patterns, the do's, everything. Right? The Fourth Principle is CBT is culturally adapted and tailors treatment to the individual. Well remember now Cognitive Behavior Therapy is a Western therapy. There is a western medicine that was made for some specific people. Ok? It was developed in the US, so
15:22 it was targeting that audience only. So CBT tends to emphasize rationality, the scientific method and individualism. So its main meaning, the principal basis is coming from scientific method, individualism, rationality and those things. But now I also tell you that different clients come to you from different cultures. It is different in Pakistan. It is different in Germany. It is different in Bangladesh. Even in Pakistan, people in KPK have a different culture. It is a different language. Sindhi people are different. Punjabi people are different. Balochi people are different. Different languages, different foods, different patterns of thinking, right? So, you have to consider this thing. And it also means that clients from other cultures hold different
16:08 values and preferences. For example emotional reasoning, varying, degrees of emotional expression and collectivism and interdependence. Our culture is a classic example of this. Emotional Reasoning and Degrees of Emotional Expression. That means our emotional coping is quite high. We cope with things in groups. We share our thoughts. We vent things out. And then we are very emotional. We take decisions emotionally. Many things are common in Pakistan. And emotional reasoning is also a cognitive distortion. That's right, rather you should assess things logically. On the basis of your emotions, you are distinguishing between a truth or a lie or the truth by using your emotions. So this happens in our culture because yes we are a
16:53 collectivistic culture, we are an emotional culture right and we are interdependent, though we are more dependent, but interdependent is more of a positive thing, okay, we are not individualistic, basically our approach will also be different in CBT, right, when the clients' cultures are different from your own, you may need to improve your cultural competency, that is, friend, look, now you have to educate yourself, look, if I am based in Pakistan, then I know about my people. This is our inside language. We have our own patterns. We have to get up and sit down. Correct, these are our terminologies in our language. I understand that naturally. But if I go somewhere else then I have to educate myself. Because it can happen. You may in fact be largely unaware of your own cultural biases. Ok
17:40 ? What is normal in Pakistan may not be normal in the UK or Germany. And I am sitting here worried, friend. There, whenever I used to have therapy with my clients, they would shake hands with me. He used to be more friendly with me. He is not talking to me here and he feels uncomfortable. Ok? If I was a little more friendly or open. Right? Because that is an individualistic culture and ours is collectivistic. So you have to understand these things and also study them. Right and moving on or meaning that clients yes your clients may differ from you in many ways and add to culture. This includes age, religious and spiritual orientation, ethnicity, socioeconomic status,
18:26 disability, gender, sexual identity and sexual orientation. Ok? Make sure to educate yourself about your client's characteristics and anticipate how these differences might be relevant to treatment. Now friend, whatever I have said here, it also falls within your demographics. In the beginning, when you do history taking, you will find out about the client 's age, gender, religious orientation, whether he studies in school, has a job, is he married, is he single, or any disability, etc. These are very important markers because through these you will get very specific information about what kind of a person your client is, and you should know about these things because you will use these factors to
19:12 determine what kind of treatment will be beneficial for my client. Because we have to tailor it. We should know the treatment. Just like a tailor stitches your clothes, he decides which clothes will fit your specific body type. Ok? So we also have to do the same. Know which therapy will fit a specific type of person. Right? So let's move on. Okay one last thing, okay. Ah hey Haz means he did some research. Describe strategies to make CBT culturally responsive including assessing the clients' and families' needs, emphasizing culturally respectful behavior, identifying culturally related strengths and supports, and validating the clients'
19:57 experiences of operation. Correct. Meaning, have these things been defined as to what are the family needs ? And what do nos and yeses mean within the culture ? Eye contact, physical contact. Again our culture is more on the more touchy side. Different cultures do not prefer that you be more friendly with them, make more eye contact, or talk more freely. Ok? Monotones are more preferred in some cultures. Meaning there are a lot of differences. So you have said no to these things and every culture has its own strengths and weaknesses. You have a lot of emotional support in a collectivistic culture. Ok? The thing about an individualistic culture is that when you go on a journey of self-improvement and healing, you don't have a lot of interfering forces.
20:44 Because in collectivistic culture then it becomes a different issue. Correct. So you have to find the strengths, find the weaknesses and that means you have to validate the culture within which the client 's experience is. For that you will have to study everything. And it's best that you help people of your own culture because you are more equipped for them. Moving on to principle number five. CBT emphasises the positive. Correct. So in this you help clients actively work toward cultivating positive moods and thinking. It is also very important to inspire hope. Correct. So here's an example of Payet again, a client suffering from a preoccupied disorder. Like most depressed clients, they tend to focus on the negative. When he was in the depressive mode he
21:31 automatically without conscious awareness and selectively attended to negative experiences. He also misread neutral experiences as negative at times. So look, in the CBT module, problems are arising in your mental, emotional state and behavioral state because the main hypothesis, not your way of perceiving the world, your way of perceiving events, is dysfunctional, is negative. So here fsize positivity is done. Ok? Here you are using a cognitive bias. Especially in the case of depressed clients, you will fully focus on any bad or negative thing and will completely reject any positive thing. You will not have this capability and such a
22:18 mental filter will come into your system which is cognitive distortion. Right? That every bad thing you do, you will believe it like a religion and you will focus on it and in the same day if you do something good and if something good happens, you will not even consider it as if it does not exist. So you have to reframe this thinking and bring it towards positivity, remove this mental filter and look at things realistically. Positive: Right now we are doing specific positive things, look at the good things that have happened this day and whatever you have done, acknowledge them and praise yourself that you have done a good job. Right, you have to restructure their thinking towards the positive. Right? Because in depression it happens very much that the person
23:03 sees everything negatively and his self-related beliefs are very negative. So to counter this feature of depression you continuously help clients to attend to the positive. I want to start engaging in experiences in which he concludes he is a resourceful person who can solve problems, overcome obstacles and need a satisfying life. So here, to combat that type of thinking, she used to engage her clients in such activities. Assign homework or engage him in therapy sessions so that he can have positive experiences and get proof that he is a resourceful and good person. When he wants to do good work he can do it. He has the capability. The real meaning is that now she is making him believe in that thing by making him do the work and by making him acknowledge that thing.
23:51 Number Six CBT Stresses Collaboration and Active Participation. Well remember the CBT module is 50-50. It is collaborative. I will also work as a therapist and a teacher and my client will also actively participate. It is right to decide goals within a session, decide homework within a session, discuss things, take feedback. From my side, I will use my skill set and expertise. From the other side, going into real life, my client will apply the things he has learnt in the therapy session in his real life, which is his homework. And session by session we will discuss that homework also. I will also take feedback from him regarding his progress. Does this thing work for you? Do you think we should do something different
24:36 ? Or if I am making him do something and he is displeasing me. He is saying no we can do something better. That means, whatever resources it has , its own intelligence, its own skill set, we will give preference to that too. When he tries to press that button, we will give him space because this is a 50-50 collaboration. Ok? So that means both therapist and clients are active basically. Meaning I encourage you to view therapy as we work together and we decide what to work on in each session. How of course we should meet and what we can do between sessions. Correct. Within a session, deciding the steps to take towards our goals, problem solving, potential obstacles, evaluating our dysfunctional cognitions, summarizing points
25:23 in divining action, plus within this, both of us will work together on all these things. Now, Principle Seven of CBT is aspirational, values based and goal oriented, right session by session, your goal is to target the symptoms, which means you definitely have to target the symptoms, but at the same time, in your session, in the first session, you have to ask yourself what do you want to do in your life? The thing you want to do, the kind of person you want to be, because every person has some dream or the other. He has some vision that he wants to do this or he wants to become like this. You discern this thing. Then you set goals by targeting his symptoms as well, that we have to challenge this symptom or this negative thought and use these techniques and then we have to decide
26:09 that how to make our goals on the basis of his values and aspirations, what he wants to do and what he wants to become. Right? So I mean VC, what are those thoughts like I am really a failure. I Never Get a Job That's Obstacles. Ok? Obstacles are coming in the way of achieving those goals and aspirations. He has specific goals such as being a better father and grandfather and getting a good job. That's right, these are his goals and aspirations. Right? Those are his values. Has good family values and wants to be good at those things. Now we will identify which are those negative cognitions that are stopping him. Ok? And then we will work on them so that they
26:56 can achieve their goals. The number at CBT initially emphasizes the present. Look, our main focus in cognitive behavior therapy is on your current thinking patterns, current emotional state, and what dysfunctional behaviors are causing problems for you. We focus more on your beliefs and negative thoughts at this moment. Right? The treatment of most clients involves a strong focus on the skills they need to improve their mood and their lives. Teaching the right skills is a huge plus. You need to know how to deal with your negative cognitions. When it comes to how to deal , how to respond, how to respond to your emotions, how to replace your dysfunctional behaviors with better behaviors. This is your
27:42 entire coping skill which is taught to you , so we focus on that brother, what is the skill set of dealing with himself. Right? And what else is making it worse at this time? Correct. When a distressing situation is viewed more realistically, problems are solved and he moves towards goals, he becomes less depressed, which means that he was a client of depression and when he was taught, that is, his cognitive restructuring was done to him, to look at things realistically, he was taught the skill to solve the problem and that means his goal setting was done, now he was given a vision, a structure that you have to work on this, then slowly his symptoms of depression started reducing. Ok? My mood also got better. Ok? The focus
28:29 also became better and it meant he focused his attention on what was going well in his life and what admirable qualities those experiences indicated about him as a person. Now his thinking became more realistic. Now he is not thinking about himself on a pessimistic level. He is not saying anything bad about himself. Rather, now he does whatever is good. He is acknowledging them and using them as data that really or I am a resourceful and useful person. Due to which his emotional behavior and his depression has started improving. Look at the principles and treatments, we are focusing on the present. But there are some circumstances on which we will focus on the past. There are three circumstances. Otherwise present focus is the more important thing. Right? One when the client
29:15 expresses a strong desire to do it. So if the client is saying this again and again then it is okay, you should explore his past issues. To When Work Directed Toward Current Problems and Future Aspirations Produces Insufficient Change. That means no result is coming. We challenged the cognitions. We did homework, we did skills teaching. It doesn't make any difference. So that means there is some problem in the cognitive conceptualization right now currently. So, let's explore its past, what is the issue? To its childhood or its recent past. Number three, when you judge that it's important for you and clients to understand how and when their dysfunctional thoughts and behavioral coping strategies originated and became maintained. When you notice that this is a very important thing for the client, the negative beliefs he has
30:01 about himself and his negative dysfunctional behaviors, why is he so avoidant? Why is he procrastinating so much ? Why does he consider himself so worthless and stupid? Ok? Where did all these things come into him from? We then explore his developmental times and his childhood. Maybe his parents were strict with him or treated him very badly. He was critical due to which he carried negative beliefs about himself from there till today. Ok ? When the thing is important and we need to educate the client about where the thing is coming from, you can also explore his/her past. So you can also give reference from there. Correct. If an important thing is written here. If he had a personality disorder. I may have spent proportionately more time discussing the developmental history and childhood origins
30:48 of beliefs and coping behaviors. You have a slightly different standard for personality disorders. There you will explore the past. Because we are talking about personality development, we are talking about relationships. Ok? With your parental figures and others. So it is essential to explore these things here. Okay moving on to principle number nine CBT is educative a major goal of treatment is to make the process of therapy understandable there is a lot of psycho education in it process of therapy from a to g what is CBT what is the cognitive triad okay what is the chain of CBT like like cognitions lead to emotions negative thoughts lead to negative emotions which leads to negative behaviors right what is the cognitive triad views about self views views about
31:35 others views about the world how these things are things are interconnected right levels of beliefs come to you. Like you have your negative thoughts then you have your intermediate beliefs. Then you have your core beliefs. We have to educate ourselves about all these things. How to identify the thoughts , evaluate them, how to respond, mechanism of therapy. You will teach him everything from A to Z because you have to make him his own therapist. Correct? Here, as a therapist, you will be in therapist mode as well as teacher mode, and you are importing that skill set in him, which he will use after the therapy is over. He will use it during the therapy as well, he will train with you, he will learn, and then after that, when the sessions are over, he will use the
32:20 skill set that he has developed, so in our first session, I educate you about the nature and course of that disorder, the process of CBT, the structure of the sessions, and the cognitive process, right. This is something we have discussed, I provide him with additional psycho education in future sessions presenting my on-going and refined conceptualization and asking him for feedback. I use diagrams through treatment to help me understand why he sometimes has distorted thoughts and maladaptive reactions. Correctly going through the treatment after using various techniques I taught myself how to use the techniques. So he could learn to be his own therapist. Right through out the sessions, his education will continue about CBT, which
33:05 means educating the psyche about the disorder, what is its nature, what is its course, what are the symptoms of the disorder, educating him about the therapy, about the modules of CBT and importing the skill set, teaching him what are the reasons for the distorted thoughts and misadaptive reactions and now how do you have to respond to it. Right? So that he becomes his own therapist. 10. CBT is time sensitive. Look, this is time bound. It's not like your sessions will keep running randomly. There will be goal setting. You will have a complete structure from initial made till termination and you will have to finish it within a given time. Ideally, the treatment for depression and anxiety disorders typically involves six to 16 sessions, with the treatment completed within a week. But if your client is suicidal
33:51 or needs more sessions then you can take more sessions in his week. Which means that a lot of critical clients come to you, you can take you, you are supposed to be taking more of their sessions, risk assessment, there is a chance of suicide, and the like, then gradually you can give gaps, that is, when he keeps getting better, and that means if you have clients of kidsophrenia, substance personality disorder, substance use disorder, bipolar disorder, eating disorder, okay, then a year or even two of therapy may become insufficient, that means even after termination they may need periodic sessions and additionally usefully short courses of treatment. This means that it is also possible that the sessions continue for years. You gave the main treatment for two-three months. Now
34:37 he will not keep coming in the gaps either for booster sessions or for follow up sessions. This means that his treatment will continue. So it very much goes from disorder to disorder. But your timeline is set as to whether the treatment is to be continued from the start of a particular month to the end of a particular month. Ok? It is time sensitive, things are not happening randomly, sessions are structured within it, again initial fuzz, mid fuzz, termination fuzz, session by session, there are goals, we don't randomly come inside our room and pick up our pen and keep deciding, friend, what do we have to do now, tell me the problem, you have forgotten what we discussed last week, now you are coming with an angry face and asking in the session, ok tell me what is the problem, what did we have to do, what were the goals, friend, I don't even remember, don't do this scene,
35:23 you have to decide the goals. In the first session, you have to extract the main issues, that is, the first history sessions. On that basis you have to make goals session by session. You have to keep your notes ready. Before starting the session you have to study your notes as to what we discussed in the previous session. Right? And that means you have to follow a complete structure. Correct? CBT therapy means conducting therapy as efficiently as possible to help clients feel better as quickly as possible at hearing in a standard format as well as teaching the therapeutic techniques to clients to facilitate these objectives. You will tend to use this format in every session without losing your client objects in which case you may need to negotiate the structure initially. Ok? This is an important point that your
36:10 client should be strict about your instructions because he will not agree in every session that he will not follow the structure given by you. We are always following the routine. If I am bored or I am not seeing any progress then in the beginning you will have to balance the volume a little by increasing or decreasing it so that it gets adjusted with your client. Correct? Even if the structure needs to be loosened up a little in a session or two, there is no issue in it. But of course this varies from client to client. You have to see it. But there is a standard format that you have to follow. Correct. What I do in any given session is influenced by the abuser's goals and issues, my conceptualization, the strength of our therapeutic relationship, the abuser's preferences, and the stage of treatment. So, the goals and issues of the client and the
36:56 conceptualization that the therapist has made and how strong the therapeutic alliance is, is the most important thing as to how compliant your client will be with you. Ok? And what stage of treatment you are in and what your client's preferences are also matters when you're structuring things session by session. Correcting Your Goal in the First Part of the Therapy Session Is to Re-establish the Therapeutic Alliance Review the Action Plan and Collect Data So that You and the Client Can Collaboratively Set and Prioritize the Agenda. In the second part of the session, you and the client discuss the issues and goals on the agenda. The kinds of discussions and interventions naturally lead to action plans in the final part of the session You and the client summarize the session You make sure the action plan is reasonable and then elicit the response Elicit and respond
37:43 to the client's feedback Right, as I said earlier, you will come to the session, you will ask about the last session, you will check your mood, you will reestablish the therapeutic alliance, both of you are on the same page, you will collaboratively set your goals, you will prioritize, that means, from the last session, the things that we have initiated in the just now session, you will discuss it a little bit in the beginning and then you will start your agenda for the session. Right, and another important thing to remember is that at the end of the session, when the CBT session is about to end, you have to summarize all the things and tell the client that whatever things we have just discussed in the session, please summarize and tell me. This is a very important thing. Right? So that your client also knows. You can correct him
38:29 if he is wrong about something. True Well CBT uses guided discovery and teaches clients to respond to their dysfunctional cognitions. So guided discovery basically means that you do gentle Socratic questioning. Meaning, what happens in guided discovery is that his own cognitions issues and problems, the cognitive pattern with which he is perceiving the world, which is dysfunctional, you slowly, gently question and take him to his conclusions through a therapeutic conversation, you do not challenge him, you do not give him rebuttal, okay, refrain from challenging cognitions, but you do his cognitive restructuring and slowly you make him identify his bad adaptive thinking,
39:14 this is called guided discovery. Ok? So that means, like with a by using gentle Socratic questioning which helps him further sense that I'm truly interested in collaboratively in persuasiveness that is helping him determine the accuracy and usefulness of his ideas through a careful review of the evidence. Collaborative Empiricism means that both of us are doing work together in which we are trying to discover the truth. At hand, what evidence do we have regarding your thought, how true it is, how false it is, how dysfunctional it is. You are not making your client feel like he is stupid, crazy and that you are intellectually dominant. By challenging him you are telling him that you are wrong. Everything you do is wrong. This is not what we do. That's called debating. That's not called therapy. Ok
40:00 ? There is collaborative empiricism here. Either through questioning I also guide him evaluating the validity and functionality of his beliefs we just talked about. And from the beginning of the treatment I help him strengthen positive beliefs about himself by teaching him to give himself credit and guiding him to draw positive conclusions about the steps he has taken toward his goals. That means, from the beginning, there is a process through which she makes her client realise. He should realize and acknowledge his positive thoughts and his achievements. Ok? And that means giving yourself credit when you do a good job. She is teaching this thing. It is strengthening right inside him. And she guides him to automatically
40:51 reach such conclusions through his thoughts, his conversations and his rationality which are positive and through which he can reach his goals. Ok? Ok. We are guiding, leading and pushing. But we are not telling him everything directly. This guided discovery has resources within it itself. He will reach that conclusion. You have to help him. When automatic thoughts are part of a dysfunctional thought process such as rumination during sessions and continued self-criticism, you might help clients accept their thoughts non-judgmentally and allow them to come and go on their own. Every thought cannot be correct or you cannot generate its alternative yourself. Some thoughts are such that they just come and go. Ok? Like you detach yourself. Let them come and let them go. Correct. And to change cognitions at the emotional and gut level you might also use
41:39 imagery, tell stories, offer analogies and metaphors, which is a very important part of therapy. Employ experiential techniques such as role playing and suggest behavioral experiments. Challenging the right emotional level means when your negative cognitions affect you emotionally. If you are more emotionally dominant and do more emotional reasoning, then there are ways as well to help your client navigate through their negative thoughts and emotions. Correct? It includes techniques like metaphors, imagery, story formats, role playing, and other behavioral experiments. Now CBT Includes Action Plan Number 13 which is Therapy Homework. See,
42:25 all this talk and work is not happening in the air. Here you also take notes during your therapy. Your client is also taking down notes. You yourself are also taking down notes. Ok? This means that whatever you do in the previous session, you do not forget it in the next session. You have different worksheets, different homework that you have to go out and do in the session. And action pluses usefully consist of identifying and evaluating automatic thoughts that are obstacles to the client's goals. Implementing solutions to problems and obstacles that could arise in the coming week and or practicing behavioral skills learned in the session. Correct. So the aim of treatment is to help clients feel better by the end of the session and to set them up to have a better week. So you are making an action plan for the obstacles that are going to come his way, his own thought
43:12 patterns, which will cause trouble for him, his own dysfunctional beliefs, which will become obstacles that will ruin his day and week ahead. So these are the three things, identify which negative thoughts are troubling you. Evaluate them. Ok? You implement the steps which we decided in the sessions. We will sit in that session and decide how to cope with the challenges of the next week. Practicing behavioral skills learned in session. You will also practice the skills while sitting during the session. Then you will do it outside also. Then you will come and report in the next session. Correct. Principles of Treatment. Like it is mentioned here that an action here is an example of a therapy note that and I collaboratively
43:58 composed it means whatever action plus you will create, you have to note them down. Either you can do it manually in a diary or the client can do it, or both of you can do it together on one phone. Ok? If I start to think that I can't sit down and pay bills. Remind myself I'm going to do this for 10 minutes. It may be difficult but it may be difficult but probably won't be impossible. The first minute and two will probably be the hardest and then it likely to get easier. I should focus on the positive feeling. I will get by with completing something I haven't been able to do. Correct? So, here it is identified when I start to think that I can't go down and pay bills. So now it will give itself positive coping thoughts through which it will remind itself how I will deal with my negative thoughts. Because
44:44 she is becoming an obstacle due to which he is not able to work during his week. Right? Ok. Action plans flow naturally from the discussion of each goal and issue on the agenda. You will need to craft them carefully with clients based on the nature of the issue. Your conceptualization of what will help you most based on practical considerations such as time, energy and opportunity and client variables, level of motivation and concentration and preferences. A frequent mistake of a rapist is suggesting action places that are much too difficult. You don't overwhelm your clients. Simple action plans have to be given. We have to target one problem. You cannot solve all his problems. But you will solve the main issues. And it's best to start with the simplest problems by developing a simple action plan. And keeping in mind your
45:30 clients' needs, his level of motivation, his own variables like motivation, concentration preferences, time and energy, and practical considerations, you have to create an action plan. Ok? Lastly 14 Principles CBT uses a variety of techniques to change thinking, mood and behaviour. Correct. So, you don't necessarily have to go crazy and only use the techniques from the CBT module. Sorry my might got cut off. Well, in CBT it is not necessary that you only use the techniques from within the CBT module. But depending on the conceptualization of your client. You
46:19 can also use techniques from Acceptance and Commitment Therapy. Behaviour Therapy, Compassion Focused Psychotherapy, Dialectical Behaviour Therapy, DBT which is another favourite one of mind. Gist therapy, interpersonal psychotherapy etc. means that you can incorporate techniques from different therapy modules within CBT. Depending on whether your client will benefit from it or not. Right? For example, you can take any technique from the emotional regulation module of DBT. If your client is more emotionally dominant. There is more negative emotionality than that. So how do they regulate themselves? Right? Now when you are still learning CBT this is a very important point right when you are
47:04 still learning CBT it will be difficult for you to incorporate a wider variety of interventions than those that you will need to once you read about in this book I would encourage you to master the basics of CBT first and then learn additional techniques to implement within the framework of a cognitive conceptualization. As you progress as a CBT clinician it will be worthwhile to study this and other evidence-based treatments. You are a beginner, just learn Cognitive Behavior Therapy. Learn its basics. As you move forward, you will get more experience. You will be more well seasoned. You can then incorporate other therapies into your learning and study them. Correct? So just focus on the basics now and
47:50 look at the rest of the learning later. Ok? Ok? So take it easy on yourself. Anyway this was it for today's lecture and I really really hope you learn something. Inshallah I will upload next lecture soon about the third chapter in this book. And if you have any questions or want to give any feedback the comment section is open. I would really appreciate it. Thank you for watching. Greetings.
