Patients sometimes express curiosity about their therapists by asking them personal questions. When treating patients who suffer from alcohol and other substance use disorders, it is not uncommon for therapists to be on the receiving end of questions such as, “Are you in recovery too?” or “Have you ever used [insert name of substance]?” or “Haven’t you ever binge-drank?”
When a client of mine, Adam, was 22, he received the following diagnosis during a routine physical: elevated liver enzymes. He thought, “Oh my God, I’m going to die.” It was later revealed that the lab results were in error, but as he reported to me ten years later: “This catapulted me into heath anxiety.”
Years ago I asked many of the individuals whom I treated. “What accounted for your improvement in treatment?” Not infrequently, instead of attributing their improvement to the therapeutic strategies, they would often reply “You believed in me.”
Susan reported being 60 pounds over her ideal body weight. She had tried many diets that resulted in weight loss but were followed by regain once she returned to her typical eating habits.
Once motivation is identified as a target mechanism of change, the big question is how to increase the individuals’ motivation and effort to engage in the activities that will restore them to mental health.
Not all clients benefit from behavioral activation.This was the case with one of my clients, Sam. When we were setting goals, I asked him, “How would your life look different if you were not depressed?” Sam told me that absolutely nothing would be different.
The following is a description of a consultation Dr. Beck had about an individual who has schizophrenia. Mary is a 47-year old woman who is upset about hearing voices (and hackers who will not leave her alone). She is divorced, unemployed, and somewhat hopeless. She has a good relationship with her 13-year old son.
My client Charlie had a stressful situation with the doorman at his friends’ apartment building. He was asked to sign in, which he did not want to do and hadn’t had to do in the past, and assumed the doorman was wielding his power.
CBT can help alleviate suffering for patients who have chronic pain and use opioids with the hope of getting relief. The CBT therapist uses many strategies.
The new emphasis is directed towards the discussion and visualization of the objectives themselves, thus the emphasis is away from removing the blocks to a positive motivation and to the increase of the motivation itself.
