Note taking in Session

judith-beck_1024w.jpgRecently, there’s been an interesting discussion on the Academy of Cognitive Therapy listserv about the therapy notes patients take home with them to review. Here’s how I make sure a patient is able to remember important ideas we discussed in treatment, specifically the changes a patient makes in his thinking:

Generally, when I ascertain that the patient has modified his thinking during a session (e.g., following Socratic questioning, behavioral experiments, roleplaying, etc.), I’ll ask the patient for a summary. I might say:

• Can you summarize what we just talked about?
• What do you think it would be important for you to remember this week?
• What do you think the main message is?

If the patient comes up with a good summary, I positively reinforce him and ask whether he wants to write it down or if he would like me to do so. If his summary is not quite on point, I usually offer a revised version and ask the patient whether he thinks it might be helpful to remember it this latter way. If he agrees, he or I will write the summary down. At that point or later on in the session, I will ask the patient how likely it is that he will read these important therapy notes every day at home. If he’s not highly likely, I’ll ask him about what might get in the way.

I’ve found that most patients just don’t learn the skill of writing cogent summaries. They rarely write down complete ideas and they usually add in extraneous or less important material which dilutes what is really important; that’s why I’m nicely directive about what is written down. I want to be certain the patient has good notes to read this week and ten years from now, if a similar problem arises.

Empirically Validated Treatments

There have been very interesting posts on the listserv this week, about the necessity (1) to validate the theory underpinning a particular treatment approach, (2) to insure that treatment is based on this validated formulation, and (3) to validate the efficacy of the treatment itself. A particular technique or strategy, devoid of a coherent and tested underlying theory, should not be labeled as an “empirically validated treatment,” much less a “system of psychotherapy,” as many are.

Here’s how Dr. Aaron Beck described cognitive therapy on the listserv:

There is no generic cognitive therapy that fits all cases. From the very beginning, we have focused on a specific conceptualization of each of the disorders. The treatment approach then is derived from the disorder-specific formulation. Thus, in obsessions and compulsions, the theoretical formulation followed by the British group and others centers on modifying the beliefs about the obsession and compulsions. These beliefs can then be modified through behavioral experiments (often referred to as “exposure therapy”) and explicit restructuring of the beliefs about the obsessions and compulsions. I’m afraid of using an artificial dichotomy in separating “cognitive” and “behavioral” techniques. Experience (facilitated by actual in vivo behavior) is one of the most powerful ways of achieving cognitive change. Behavior therapy does not have a monopoly on the behavioral techniques, but what does differentiate behavior therapy and cognitive therapy is the theoretical formulation.

—Posted by Dr. Judith Beck, Director, Beck Institute

Cognitive Behavior Therapist – How to Find One

Two days ago, we received a great comment that said, “This is *not* what I experienced when I saw a cognitive-behavioral therapist… I wish cognitive-behavioral therapy as described on this site was available. Too many CBT therapists are not well-trained and refuse to think!” (you can read Sam’s full comments about the kind of ‘CBT’ that he and his friend received on this post – his is the fourth comment down).

We thought it was important to highlight his experience because we think many consumers may not know about the vast differences in training and approach among people who call themselves Cognitive Therapists or Cognitive Behavior Therapists. Read more