How do you decide which techniques to use in a given therapy session? There are many factors to consider. It is helpful, before starting the session, to consider the following questions: What is the acute disorder(s) for which the client has sought treatment and what is the cognitive formulation for this disorder? What has research demonstrated to be effective in treating this disorder? What is your overall conceptualization of the patient? How strong is the therapeutic alliance? What are the client’s preferences and learning style? Which stage of treatment is the client in? How many sessions do you have left? How motivated is the client? What has worked well or not worked well with the client up to this point?
The next set of questions focuses on the here and now. What is a recent, specific example of the problem the patient wants to discuss? What is your conceptualization of this problem and has the patient confirmed it? Is it important to make an empathic statement and/or link the resolution of this problem to the clients’ values and goals? Will you work on one or several parts of the cognitive model: devising solutions for the problem? addressing the client’s automatic thoughts (and/or beliefs)? teaching emotional regulation skills? working on behavior change? decreasing the client’s physiological arousal? Making such decisions should be collaborative. If it’s not clear at which level(s) it would be most beneficial to work, ask the client. (“Do you think it would help more if we did _______ or ______?”)
When working at the automatic thought or belief level, you might draw from techniques from many psychotherapeutic modalities. To name a few, you might do Socratic questioning, propose an alternate viewpoint, do imaginal restructuring, devise a behavioral experiment, use self-disclosure, teach a distancing or mindfulness technique, help the client respond compassionately to his cognitions, and/or work toward acceptance (especially when the clients’ thoughts are accurate).
Throughout the session, you will likely create opportunities for both reflective and experiential learning. As noted in the video clip we’ve linked to below, it is also crucial, not only for symptomatic relief but also to prevent relapse, to modify clients’ basic beliefs.
Judith Beck, PhD
President, Beck Institute
Reference:
Beck, J.S. (2011). Cognitive Behavior Therapy: Basics and Beyond, 2nd edition, Guilford Press.
In this video clip from our 4th Annual Student Workshop, Dr. Aaron Beck discusses selecting techniques in CBT: