YOUR TURN!
Exercise 2.1: Ruda Attends Playgroup
Practice seeing a client’s stressors and strengths.
Agenda Item #6: Understand Your Client’s Psychosocial History
Most therapists take a history of the presenting problem as well as a general psychosocial history.
Some therapists spend a whole session taking a detailed history; others ask for a quick thumbnail over- view. Even if you only take a brief history, it’s helpful to place your client’s current problems in the overall history of her life, being sure to also listen for her strengths and areas of resilience.
Generally, when taking a history you are trying to figure out how your clients’ past experiences relate to their current problems. As a CBT therapist, I take a psychosocial history in a similar manner as any other therapist; however, there are two main areas that I emphasize and that might be slightly different from non-CBT therapists. First, therapists usually ask clients how they felt about a given event in their past; I make sure that I also ask what it meant to them, or what their thoughts were at the time.
I am particularly interested in the messages my client learned about herself, others, and the future.
Some of the questions I ask are:
• How did you understand this event?
• How did you explain this event to yourself?
• What did this event mean about you?
• What did this event mean about other people?
• What did this event mean about your future?
For example, a client of mine, Lisa, failed grade six when her parents divorced, and she went to live with her grandparents. When I asked if she thought that failing grade six meant anything about her, she replied, “I am not very smart, and without my parents’ help I couldn’t manage.” This is important information. Another client of mine, Michael, was sexually abused by his uncle over a period of three years, starting when he was eight years old. When I asked him how he understood the sexual abuse, he explained that he thought it happened because something was wrong with him and that he can’t trust anyone; he then added that bad things are always going to happen to him in the future. Early messages such as these will influence how your client feels, thinks, and behaves in her current life.
The second area I emphasize is listening for strengths and evidence that my client is competent and lovable. I am starting to gather evidence that I can use later to counter any negative beliefs.
Although it is not a hard-and-fast rule, I usually don’t share my perception of my client’s strengths this early in therapy. I have found that if I share my perception of strengths too early, it is just rejected. For example, my client Lisa, who failed a grade the year her parents divorced, mentioned that she passed the next year and completed nursing training. She was also one of the few students in her class to be offered a job immediately upon graduating. I kept that information in my back pocket, so that down the
road when we start to explore her belief that she is not smart and can only manage with her parents’
help, I know that I have some evidence to counter that belief.
Agenda Item #7 : Explain CBT
After you have an understanding of your client’s problems and have taken a history, it is time to explain how CBT works. Here is an example of how I might explain CBT. (A copy of Explain CBT to Your Client is available at http://www.newharbinger.com/38501.)
I have heard a bit about your problems and how they are affecting your life. I want to tell you how I work. I use a CBT model. CBT is a goal-oriented form of therapy. I am going to ask you to set some goals for yourself in therapy and together we are going to focus on working toward them.
Therapy will involve us first understanding your problems by identifying your thoughts, feelings, physical reactions, and behavior and how they fit together. We will then start to help you make some changes by focusing on one of these factors at a time. Since they are all related, a change in one factor will influence all of the other factors.
At this point I often take a situation from my client’s life and together we explore her thoughts, feelings, physical reactions, and behavior. For example, in Raoul’s case we might pick his discomfort when he has to interact with his colleagues at work. You do not want to choose a situation in which your client has a very strong emotional reaction, as she will be too overwhelmed to listen to you and apply the four-factor model. After exploring a situation using the four-factor model, ask if this makes sense to your client.
If you are working with children or teens, there are many wonderful games you can use to explain how thoughts can influence feelings, physical reactions, and behavior (see, for example, Kendall, Choudhury, Hudson, & Webb, 2002; Stallard, 2005).
Video 2.2: Meet Charlotte and Explain CBT
Homework: Practice CBT
Before continuing with the next chapter, take some time to try the homework.
Apply What You Learned to Clinical Examples
Complete the following exercise.
Exercise 2.1: Ruda Attends Playgroup
Apply What You Learned to Your Own Life
Try looking at your life in terms of your own stressors and strengths.
Homework Assignment #1
Explore Your Own Stressors and Strengths
Use the table below to write down your stressors and strengths. Writing them down is important as it helps you step back and look at them. Did you learn anything about yourself?