Action Stage: Translating Insight to Change.

Goals of Stage IV Changes in one’s thoughts, feelings, or behaviors. Changes in one’s thoughts, feelings, or behaviors. 1. Creation of Action Plans. 2. Skill Development. 3. Enhanced Problem Solving. 4. Practicing New Behaviors. 5. Development & Implementation of new Decisions. 6. Feedback & Evaluation.

Cognitive-Behavior Therapy

Major Ideas/Assumptions Scientific view of behavior and therapy. Strong advocates of research and the importance of evaluating the outcome of helping. Scientific view of behavior and therapy. Strong advocates of research and the importance of evaluating the outcome of helping. Based on learning theory (classical conditioning, operant conditioning, social learning). Based on learning theory (classical conditioning, operant conditioning, social learning). All behavior, whether positive or negative, is learned. Cognition (thoughts, beliefs, attitudes, etc.) are also learned behaviors. All behavior, whether positive or negative, is learned. Cognition (thoughts, beliefs, attitudes, etc.) are also learned behaviors. Behavior is maintained by current antecedents and consequences, not historical events. Behavior is maintained by current antecedents and consequences, not historical events. Helper operates as a consultant or teacher. Helper operates as a consultant or teacher.

A-B-C Model of Behavior Change AntecedentsBehaviorsConsequences

Assumptions of Cognitive Therapy Our thoughts or self-statements about our experiences (not external events themselves) are responsible for emotional & behavioral reactions (problems). Consequently, changes in our thoughts will lead to changes in our emotions & behaviors. Our thoughts or self-statements about our experiences (not external events themselves) are responsible for emotional & behavioral reactions (problems). Consequently, changes in our thoughts will lead to changes in our emotions & behaviors. Although cognitions (self-statements) may have resulted from historical events, people re- indoctrinate themselves with these beliefs in the here-and-now. Although cognitions (self-statements) may have resulted from historical events, people re- indoctrinate themselves with these beliefs in the here-and-now.

Behavioral Techniques Stimulus Control: changing the environment or the antecedents of a behavior. Stimulus Control: changing the environment or the antecedents of a behavior. Self-Reinforcement: changing the consequences of behavior. Premack Principle: reinforcing an undesirable behavior with a highly desirable behavior. Self-Reinforcement: changing the consequences of behavior. Premack Principle: reinforcing an undesirable behavior with a highly desirable behavior. Skills Training: teaching clients new skills and how to control their own behavior (e.g., social skills, assertiveness, relaxation training). Skills Training: teaching clients new skills and how to control their own behavior (e.g., social skills, assertiveness, relaxation training). Role-Plays/Behavioral Rehearsal. Role-Plays/Behavioral Rehearsal. Exposure to Feared Stimuli. Exposure to Feared Stimuli. Self-Monitoring/Reactivity. Self-Monitoring/Reactivity.

CBT Techniques Education about CBT. Education about CBT. Countering or Cognitive Restructuring: replacing negative self-statements with more positive ones. Countering or Cognitive Restructuring: replacing negative self-statements with more positive ones. Where’s the evidence? Where’s the evidence? Best Friend Technique. Best Friend Technique. Alternative Explanations. Alternative Explanations. Behavioral Disputation: engaging in a feared or avoided behavior. Behavioral Disputation: engaging in a feared or avoided behavior. Coping Thoughts. Coping Thoughts. Thought Stopping: interrupting negative thoughts through use of a powerful distracter, followed by a positive counter-thought. Thought Stopping: interrupting negative thoughts through use of a powerful distracter, followed by a positive counter-thought.

Limitations of CBT A number of clients are simply looking for catharsis and support during tough times, not specific behavioral changes. A number of clients are simply looking for catharsis and support during tough times, not specific behavioral changes. Most clients do not arrive at counseling ready or willing to make specific behavioral changes. Clients need to be ready to change before these directive techniques will be helpful. Most clients do not arrive at counseling ready or willing to make specific behavioral changes. Clients need to be ready to change before these directive techniques will be helpful. Most appropriate for very specific behavior disorders (e.g., phobias, sexual disorders). Most appropriate for very specific behavior disorders (e.g., phobias, sexual disorders).

Other Action Techniques Paradoxical Injunctions. Paradoxical Injunctions. Bibliotherapy. Bibliotherapy. Psychoeducation. Psychoeducation. Problem-Solving Training. Problem-Solving Training.

Basic Problem-Solving Model 1. Define the problem. 2. Brainstorm potential solutions. 3. Evaluate potential solutions. 4. Select solution(s) that has the best probability of producing a favorable outcome. 5. Implement and evaluate the solution(s). 6. Repeat, if necessary.

Solution-Focused Therapy

Assumptions: Excessive exploration or insight about the problem is not necessary before change can occur. There is not necessarily a direct connection between a problem and its solution. Excessive exploration or insight about the problem is not necessary before change can occur. There is not necessarily a direct connection between a problem and its solution. Clients are resilient and possess the resources for solving their own problems; they are just not using these resources effectively. Clients are resilient and possess the resources for solving their own problems; they are just not using these resources effectively. Clients, not helpers, are responsible for bringing about change. Clients, not helpers, are responsible for bringing about change. Life is full of problems, and clients cannot solve all their problems through a helping relationship. Life is full of problems, and clients cannot solve all their problems through a helping relationship.

Philosophy of Intervention: Shift from a focus on “problem talk” to a focus on “solution talk” and clients’ strengths and resources. Shift from a focus on “problem talk” to a focus on “solution talk” and clients’ strengths and resources. Assume every session might be the last. Sessions should be scheduled intermittently on a PRN basis. Assume every session might be the last. Sessions should be scheduled intermittently on a PRN basis.

Techniques Exceptions Suggest Solutions. Identify exceptions to the problem, for therein lies the solution. (“What are you already doing that is helpful in reducing the severity of the problem?”or “Tell me about the times when the problem does not occur.”) Exceptions Suggest Solutions. Identify exceptions to the problem, for therein lies the solution. (“What are you already doing that is helpful in reducing the severity of the problem?”or “Tell me about the times when the problem does not occur.”) Compliments: affirm clients’ successes, strengths, or exception times. Compliments: affirm clients’ successes, strengths, or exception times.

Questioning Techniques Previous Solution Attempts: “What have you already tried to resolve this problem?” Previous Solution Attempts: “What have you already tried to resolve this problem?” Relationship Questions: “Once the problem is solved, what will be different between you and ___(significant other)?” Relationship Questions: “Once the problem is solved, what will be different between you and ___(significant other)?” Coping Questions: “How are you able to cope to as well as you are with such a difficult situation or prevent it from getting worse?” Coping Questions: “How are you able to cope to as well as you are with such a difficult situation or prevent it from getting worse?”

Past Successes: “Tell me about a time when you successfully dealt with a similar situation.” Past Successes: “Tell me about a time when you successfully dealt with a similar situation.” “What is better since the last time we met?” “What is better since the last time we met?”

Stage V: Termination/Evaluation

Goals of Stage V Review & Evaluate progress. Review & Evaluate progress. Discuss any termination issues (e.g., difficulty saying good-bye). Discuss any termination issues (e.g., difficulty saying good-bye). Develop plan for maintaining changes (e.g., relapse prevention). Develop plan for maintaining changes (e.g., relapse prevention). Plan for additional services, if needed. Plan for additional services, if needed. Develop external social support. Develop external social support.

When should counseling be terminated? Client reaches his or her goals. Client reaches his or her goals. Need to refer client to another professional because one cannot assist the client Need to refer client to another professional because one cannot assist the client Lack of progress. Lack of progress. Agency or insurance limits have been reached. Agency or insurance limits have been reached. Need to promote client independence. Need to promote client independence.

Guidelines Termination should be discussed throughout the relationship; assume every session could be the last. Termination should be discussed throughout the relationship; assume every session could be the last. Consider use of fade-out final sessions. Consider use of fade-out final sessions. Clients involved in long-term helping relationships should be prepared for termination. Clients involved in long-term helping relationships should be prepared for termination. Plan a follow-up phone call or session after termination. Plan a follow-up phone call or session after termination.