Assessment and information gathering in CBT

Bordin (1979) - therapeutic relationship components

Agreement on the task
Agreement on therapy goals
A positive therapist-client bond

Carl Rogers (1957) core conditions

Empathy
Unconditional positive regard
Congruence/genuineness

What are Rogers (1957) core conditions?

Conditions that are necessary and sufficient for psychological change

Frame of reference

A clients issues, concerns and values that are relevant to them in that moment

Aims of therapeutic listening

Understand the person’s experience as fully as possible
Avoid associative listening (introduces own experience)
Use encouragers and restatement

Techniques to be empathic

Active listening
Paraphrasing
SSummarising

Silence in therapy

Can be used as a defence when someone does not want to be scrutinised so they withdraw
Can be used to convey great emotion or respect for what is being said

Reasons to validate

Shows we are listening and understand
Shows acceptance, care and compassion
Removes pressure to be ‘right’
Decreases anger and defensiveness
Makes the client more likely to listen

Emotions and validation

If a client shows strong emotion, this can be reduced by reflecting and mirroring their emotions so they can calm down and self-regulate
But sometimes they may not be appropriate for therapy

Levels of validation

Pay attention
Reflect back
Read minds
Show understanding
Acknowledge the validity of their thoughts
Show equity

How to establish a collaborative relationship

Emphasise what the client can expect from therapy so they can anticipate what is likely to happen

Guided discovery/Socratic Questioning

Where the therapist asks open ended questions to encourage clients to think about their underlying assumptions and identify solutions for themselves

Padesky (1993) - what Socratic questioning does

Probe patients current assumptions
Question evidence for their beliefs
Highlight alternative perspectives
Probe implications

Roth and Pilling (2007) - 4 steps of guided discovery

Asking questions to uncover relevant information the client isn’t aware of
Accurate listening and reflection
Summarising information
Asking a questions that gets a client to apply new information to their original belief

Why questions in guided discovery

They can come across as challenging and cause patients to become defensive

Things to consider in assessments

Avoidance
Coping resources
Psychiatric and medical history
Previous treatment and response
Current medication
Beliefs on problem
Engagement
Employment context
General life context

Setting the scene for assessment

Address consent issues
Be transparent
Highlight that you have to report risk to self or others
Ask person to list and describe recent problems
Establish if either of you think the problems are connected

Forms of assessment

Clinical interview and observation
Written information
Diaries/records
Activity monitoring

Two categories of measurement

Standardised for specific problems and populations
Specific for individuals

Criteria for assessming impact

Frequency
Severity/intensity of the problem
Duraton
Onset
Time course

Questions to elicit moderating factors

Where does the problem occur?
What is happening around the client at the time?
When does it occur?
Is there a specific situation that makes it worse/better