Topic 4: Experiencing CBT: Self-Practice & Self-Reflection {by 6/21}

Based on the readings due this week consider the following two discussion points: (1) As a therapist in training, what are your general thoughts about practicing CBT skills/techniques on yourself?  (2) What technique/exercise provided you the most insight about yourself as a person or therapist (please only share information within your range of comfort; if it helps, focus on process rather than content)?  Explain.  Your original post should be posted by the beginning of class 6/21.  Post your two replies no later than 6/23.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

16 Comments (+add yours?)

  1. Allison Shea
    Jun 20, 2018 @ 18:39:10

    1.) I think that as future therapists practicing CBT skills on ourselves is a great idea. Because there is a gap of time between my internship and when I’ll have a job, using these skills on myself will be good practice until I’m seeing clients again. One reason why this practice is so important is because by doing the activities ourselves, we learn what the barriers are to getting them done. For example, finding time to do a Thought Record in a busy week might be a real concern a client has and now we have experienced this first hand. Another important aspect of practicing these skills is that it will make it easier to teach clients. I was thankful that we did some of these activities in 708, so when I used similar worksheets with clients it wasn’t the first time I was going through them! Likewise, I imagine that by using the techniques ourselves, we will constantly be reviewing which will help us better explain the skill and its rationale to clients. In addition, using these techniques will foster self-awareness which is an important trait of an effective therapist. Just doing a few of the activities in this book I realized there are some evident themes in the types of thoughts I have that might not be helpful to me. Hopefully by actively challenging some of these negative thoughts as I would with a client, I will develop some more helpful ways of thinking and decrease some anxiety.

    2.) One activity that provided the most insight about myself both as a therapist and a person was completing “My Cognitive Biases.” Before this activity, we were asked to complete a thought record. In each of my thought records it appeared as if similar themes ran through my negative thoughts. In the “My Cognitive Biases” section I was able to identify that a cognitive distortion I readily seem to commit is mind reading. I had imagined that all-or-nothing thinking or catastrophizing would have come up for me more. Now that I reflect on it, though, I realize I do have the tendency to assume what others are thinking. Not to go into too much detail about my actual thoughts, but I think I can quickly assume my client or client’s parent is thinking I’m too young and inexperienced to help when they haven’t actually indicated that. I now notice I commit this distortion in my personal life as well. Doing the activity where we consider the evidence for and against such negative thoughts was also helpful for me. I used this technique many times with the children I worked with as we put their “thoughts on trial” and weighed the evidence for a particular thought. However, I don’t tend to use this technique on myself. It would likely be helpful with the mind reading distortion because the majority of the time there isn’t much evidence to prove the negative thought.

    Reply

    • William Nall
      Jun 21, 2018 @ 10:41:57

      Allison

      I think you bring up a good point about realizing the obstacles that performing an automatic thought record present to our clients. They can take some time to fill out if you are not familiar with the material. I remember practicing on in 708 and thinking “this feels a lot more difficult than it should”. If I was struggling to fill it out, I can imagine how difficult it would be for a person experiencing depression. Odds are they may become overwhelmed with the task, fail, and possibly internalize that failure. That is one good reason why we should practice it on ourselves, to be able to communicate it more effectively to clients and understand the difficulties in completing it alone. I think in most cases, practicing with the client in session is a great way to acclimate them to the homework assignment and bolster their efficacy in its completion outside of therapy.

      Reply

    • Tinh Tran
      Jun 23, 2018 @ 21:31:27

      Allison,
      You reminded me about some clients that I worked with during my internship when I assigned them to do a thought record as homework. Indeed, it’s sometimes hard for some clients to find time to do a Thought Record in a busy week. I have also experienced this first hand when I have practiced a thought record on myself. Thus, I come to understand and have more sympathy toward clients when they did not do or forgot to do their homework. In addition, I also learn a lot when you mentioned “My Cognitive Biases” in your post. I tried to use this technique for some clients and received some benefits. This technique helped me to realize some cognitive distortions that they had in their mind and from there, I was able to help them to modify it.

      Reply

  2. William Nall
    Jun 21, 2018 @ 11:18:10

    1) I think it is important that as training therapist’s we are able to practice CBT skills/ techniques on ourselves. This can be most important when focusing on the cognitive aspect of CBT. The critical analysis of thought patterns and their modification can be a difficult and sometimes stubborn process. Without practice as therapist, we will not be as effective of implementing these strategies with our clients. One technique I use regularly is looking to identify my automatic thoughts towards events I may appraise as threatening. Typically when I appraise a situation as threatening I tend to focus on the emotional reaction towards the event, which can then dictate my behaviors. However, after practicing and learning about the identification of automatic thoughts, I have learned to “step back” and evaluate what I was thinking right before that emotional reaction. Just by learning to identify my maladaptive automatic thoughts towards an event has made it easier to analyze that thought process and therefore manipulate my behavioral and emotional reaction. From my, albeit limit, experience many folks who are experiencing a lot of distress have a difficult time identifying automatic thoughts and revert to expressing their emotional reaction. By teaching myself how to better identify these thoughts when they happen, I may be better at helping my clients identify thoughts when they happen in the moment. Being able to identify the salient and distressing thought patterns it will be easier to begin the evaluating them for validity. I believe this skill of identification of automatic thoughts is necessary to therapeutic change and has some relationship to Teasdale and Bernard’s Interacting Cognitive Subsystems. Without proper identification of automatic thoughts, one tends to only utilize the implication system which refers to “felt senses” that are derived from emotional input. By regularly identifying ATs, one may be able to work in the propositional system and be able to further evaluate thoughts through a more objective lens (without the influence of body, emotion, or sensory).

    2) The exercise I chose to do was “My Recurring Personal Themes”. This was the most insightful exercise because it forced me to become aware of repetitive triggers and cognitions that I experience in relation to common events. A reoccurring theme that occurs throughout my therapeutic experience is “am I doing this right?” I tend to have these thoughts when assigning homework assignments to clients, or providing them with psychoeducation about rationale or a mental illness. This is often triggered when clients seem “bored” or there is noncompliance towards homework. This exercise helped me identify what sort of thoughts accompany these situations, what emotions are derived from that, and some of my consequent behaviors. By being able to see these written down I am able to examine them more analytically for the usefulness of these thought patterns. This thought process is clearly unhelpful for me efficacy to perform effective therapy. These thoughts are therefore harmful for me and my client. As time has gone by, I have been better at disputing and disrupting these thoughts and have turned them into a more useful line of thinking, “how can I provide better service”. This style of thinking is more motivating and challenge appraised than the threatening thought of “am I doing this right”.

    Reply

    • Tinh Tran
      Jun 23, 2018 @ 21:55:25

      William,
      After reading your post, I feel that I should practice the techinque which is so-called “My Recurring Personal Themes” on myself as well. You have helped me to realize that it is a helpful technique for me as a therapist. Recalling what I have done in my internship, I realize that I often experienced and asked myself the question, “am I doing right?” when I did not see clients feel better or when I saw client did not feel interested in what I provided them, such as homework assigment. I hope that by practicing this technique more often in the future, I will be able to identify my unhelpful thought patterns and modify them so that I can become a more effective therapist.

      Reply

    • Kat Rondina
      Jun 23, 2018 @ 22:05:29

      Will,

      I identify with your examination of your own automatic thoughts. It’s definitely a useful skill to practice to better understand why you feel threatened in certain circumstances. It’s especially useful, as you mentioned, for slowing down the physical anxiety reactions to pause for a moment and consider the automatic thoughts in action.
      Also, I appreciate your reframe on your own cognitive distortions. Its definitely a great example of turning a negative appraisal into a more adaptive appraisal. Also, it shows your dedication to providing the best service you can.

      Reply

  3. Tinh Tran
    Jun 21, 2018 @ 11:25:01

    1. I feel that CBT skills help me in many ways. It is not only valuable to me at a professional level, but it brings benefits at personal level as well. First of all, it helps me to know the relationship between my thoughts, feelings, and behaviors and how one factor affects the others. When practicing CBT techniques, I feel that I have better understanding of underlying patterns of my behavior and unhelpful thinking styles in maintaining problems. I also feel that it is sometimes difficult to apply CBT skills/techniques on myself than guide/instruct others how to use these skills. This is because I have to stick to something when the only person I am accountable to is myself. CBT skills help me to adjust my thoughts, especially my unhealthy or negative ones. Moreover, I think that my personal experiences of using CBT techniques for myself also benefit for my clinical practice. When using CBT strategies to identify, formulate, and address my own problem, I am able to recognize what are helpful and what are unhelpful for me. Putting myself on others’ shoes, I think that personal experiences about CBT skills will help me to understand my clients better. As Bennett et al. (2015) pointed out in their book, I think that practicing CBT skills on myself affects my attitude toward clients, enhancing my interpersonal skills, and my therapeutic relationships. I have more empathy for clients, especially when they face difficulties of changes. Since I also experience some difficulties when practicing CBT techniques on myself, I come to realize the value of the therapeutic relationship in supporting the change process in clients.

    2. I feel that thought record is one of the exercise that can provide me insight about myself. This exercise helps me to slow down and identify what’s going on. In other words, it is a way to reflect on myself about things. This technique is helpful for me because it can modify thoughts, especially my negative automatic thoughts that I have about a person, or a situation/event. A thought record is a way that helps to put my thoughts to the test or to examine my thoughts in order to see whether or not it is reliable. By doing thought record, I come to realize that I sometimes don’t have to/should not believe every thought I have. In addition, reflecting on evidence that supports my thought and evidence that goes against my thoughts about a person or situation helps to change my unhelpful thinking/ beliefs that link to my negative feelings and behaviors. In other words, thought record helps to change my moods by finding a more balanced way of thinking about individuals, or things/situations. By practicing thought record, I am able to turn my attention to identify underlying patterns of styles of thought and behavior. It also makes me aware of which situations/events that most trigger my strong negative emotion/feelings so that I may be able to prepare to cope with it for the next time.

    Reply

    • William Nall
      Jun 21, 2018 @ 11:34:24

      Tihn

      I think you bring up a very important point about awareness to events that elicit particularly salient or influential thoughts and how that derives a strong emotional response. I agree with you when you say that awareness of these thought patterns or events allow us to better cope with them the next time they arrive. Having this knowledge of the events/ thoughts and having practiced them will increase a persons efficacy to address that issue. Also, knowing those situations allow us to prepare and practice coping methods to address distressing thoughts and situations. We would tailor these coping methods to produce the desired outcome. Therefore, awareness allows one to increase outcome expectancy and one’s efficacy expectation.

      Reply

  4. Taylor Schiff
    Jun 21, 2018 @ 11:29:18

    I am a huge advocate of practicing CBT skills and techniques on ourselves as there seems to be a great deal of benefits (and very little, if any, drawbacks) that arise as a result. Such a practice has the potential to yield a lot of useful insight, not only for practical purposes, but also to achieve a better understanding of our clients and their unique experience. Utilizing CBT techniques on ourselves can allow for a greater awareness of the therapeutic benefit and what we are truly trying to help the client gain. Further, we will be able to more accurately uncover some of the common pitfalls or challenges that clients may come to encounter while engaging in these exercises. Being aware of these difficulties beforehand can be extremely advantageous in that we can more effectively communicate them to our client and ideally avoid some possible setbacks. Individuals will undoubtedly encounter their own challenges and difficulties, but knowing common issues may help to ease any anxiety and increase the likelihood that exercise will be completed. By the same token, there is also the possibility that we discover different techniques or approaches that proved beneficial to us. Information in this sense could be of assistance when clients are feeling particularly ‘stuck’ or are having difficulty generating their own ideas. Having practiced on our own could also allow for an adjustment of the expectations or standards we might typically place on clients. Perhaps we expected too much of them or maybe we didn’t quite challenge them enough for it to prove valuable. Ultimately, utilizing these techniques within the context of our own lives gives us the opportunity to engage in the same experience we attempt to give our clients. Reflection of that experience can offer some great insight into how we can improve our own lives, but also those that we will come to treat.

    Interestingly enough, I found the activity and mood diary to be fairly revealing. I have had some recent changes in my schedule that have unfortunately left me feeling particularly unproductive. Because I am finished with internship, I decided to take on more days at work and have been putting in quite a bit of hours. Although as a result, I end up doing very little on my days off (mostly a whole lot of nothing). This arrangement was starting to induce some serious stress as my apartment was beginning to suffer and school work was being put off until the very last minute. The problem was once I started doing nothing, it was hard to pull myself out of that world only to do more work (i.e. house work and school work). But until my day was all written out and in front of me, I don’t think I truly realized just how much my behavior (or non-behavior in this case) affected my overall mood. Having this awareness and being able to recognize this link allowed me to make some necessary changes. Ironically, scheduling pleasurable and necessary activities turned out to be the best solution. I can’t tell you how many times I have covered this topic in group and even created individualized schedules with clients, and yet, I never once contemplated the idea of incorporating the technique into my own life. I guess my thought process for avoiding the exercise was, “I shouldn’t need a schedule to be written out just to able to get things done,” but having one really made the difference. Not only did it make things more organized, but it also made them more concrete rather than just fleeting thoughts throughout the day. (Funny enough, I made some of the same errors in thinking that many clients do.) It just goes to show you that are are much closer to our clients than we often recognize or acknowledge.

    Reply

    • Kat Rondina
      Jun 23, 2018 @ 22:12:37

      Taylor,

      I can definitely identify with your surprise at finding activity scheduling and a mood diary as an important skill. I too have found that the focus on getting so much work done, especially all at once, can really impact my mood and draw away a lot of the positive feelings of typically felt at the accomplishment of getting daily tasks done. The mixing in of pleasurable activities, even for small blocks of time, helps me feel better overall about my actions of the day. I also found it really interesting that you found that you make some of the same mistakes as your clients, it really shows the importance of practicing the skills we’re taught in classes. It also ties back to your comments on practicing CBT leading to insight about our own selves.

      Reply

  5. Kat Rondina
    Jun 21, 2018 @ 11:41:31

    1) I have often tried to incorporate the skills I’ve learned in this program to attempt to cope with situations that occur in my daily life. I’ve always found it to be useful, though I’ve noticed, at least for myself, I have to realize to pause strong emotional reactions before I can get at the thought that needs to be examined. Sometimes, especially if I can catch the content of a negative self schema that I’m aware I have, I can hit that pause button and break down why I’m feeling and reacting the way I am. Other times, when its something less clear to me, it can take me a little while to figure out that I should really look at what was going through my mind. I’ve found from these experiences of practicing CBT techniques on myself that it can actually be challenging in the moment to practice them. I’ve found it useful on many occasions, especially when I’m either mad at myself for something small or find I’m way more sad at something than makes sense to me, the downward arrow technique is useful for figuring out what’s going on.
    I have found that by practicing CBT techniques on myself that it can be more emotionally trying than it would seem. When you know the client well and have worked automatic thoughts and negativeschemas from the outside it may seem easy to piece together why they act or feel a certain way. Especially from the outside view of the therapist, the techniques sometimes seem “easy”. It’s important to practice these CBT techniques on yourself to realize sometimes it is not so easy, and that it can be really challenging. It also highlights the importance of appreciating the hard work that goes into these tasks when you ask clients to undertake them.

    2) While I’ve kept a daily activity schedule in the past to encourage myself to be more active and get things done in a more timely fashion, I think the method they use in the workbook that includes keeping a mood record would be even more useful. Especially on days when I don’t have work, I can get very caught up in being angry with myself for not getting tasks done. It would be useful to fiddle around with this technique and find a daily activity schedule that enables me to feel more positive about what I’m doing, which may be helped by alternating pleasurable and necessary activities.
    I also found the strength themed reframe of the five part formulation useful. I could find myself relating to the David examples, as I tend to struggle myself in unstructured large group environments where I don’t know many people. While I’ve used something similar before to better understand my own behavior, the strength themed reframe feels like it would be useful in building confidence and encouraging remembering of skills in difficult environments.

    Reply

    • Allison Shea
      Jun 21, 2018 @ 20:19:24

      Kat, I think it’s awesome that you’ve been able to incorporate the CBT skills we have learned into your own life. You bring up a good point that it can be very difficult to actually utilize the skills in the moment. I found that during my internship, a client I was working with could conceptualize how to use the skill very well in session but then wouldn’t remember to use the skill in the heat of the moment. Often times in my own life I can reflect back and think that I could of used a CBT technique earlier that day when I experienced a strong emotion. With clients, I tried to brainstorm some ways that could help them remember to practice the skills in the moment, whether that was keeping a coping card with them or writing little notes on their calendar. I think it could be beneficial for me to brainstorm ways I can remind myself to use the skills throughout the day for my own emotional reactions rather than just reflecting back after the fact. I love your point that as therapists we can learn to appreciate the effort it takes for clients to practice these skills by doing them ourselves. This mindset would be helpful for me to have with clients rather than becoming frustrated when they don’t use skills in the moment!

      Reply

    • Taylor Schiff
      Jun 23, 2018 @ 13:45:23

      Kat,

      I am the same way on my days off! I feel like there is so much I could be getting done, and yet I basically waste the whole day away, and ultimately end up angry at myself for being so unproductive. I actually found the mood diary in conjunction with activity scheduling to be really helpful in this instance. My thought process before was that I’m always ‘go go go’ so when I don’t have work (or other responsibilities) all I want to do is take a breather and essentially do nothing. However, I wasn’t aware that in all actuality ‘doing nothing’ was actually making me feel worse. Instead, I chose to schedule a few necessary activities during that time space (e.g. housework) and reward myself with activities that I actually enjoy thereafter. I think the activity really helped me to connect how big of an influence my behavior (or non-behavior) has on my mood, and therefore allowed me to make some changes. My guess is that it would be similar for you as well (:

      Reply

  6. Liz Bradley
    Jun 21, 2018 @ 13:17:29

    As a therapist in training, I think it is so important to continue to practice our CBT skills on ourselves. By practicing the techniques on ourselves, not only do we become more familiar with the general process of the technique, but we also are able to understand what it is like to actually use the techniques. At times, CBT techniques can be anxiety provoking when we would rather avoid thinking about particular problems. I think having a personal knowledge of this initial discomfort helps us empathize better with our clients when they express hesitations to engage in the activities themselves. I think it also provides us a better framework to be able to explain the skills in alternative ways when something is not making sense for a client. If we have only learned about the skills through reading about them in a book about CBT, we don’t have the same level of intimate awareness with the skills to be able to really reconceptualize the skill for a client. As beginners, I think it is especially important to practice these skills regularly to sharpen our skills as therapists. Above and beyond familiarity with the techniques, I think we are better therapists when we are more aware of and able to work through some of our own issues through using these skills. Whether we use them for problems with our “therapist self” or our “personal self” I think there is a lot of benefit to the practice.

    The VAS activity was particularly helpful for me. Although it is a seemingly minimal activity, I had never really approached it exactly the way the book suggests. I use intensity rating scales with my clients all the time, but have often felt they are too subjective to really provide much meaning. By personalizing the process this way and eliciting specific examples of both psychological and physiological stimuli which accompany the major points along the scale, the process seems to provide a lot more information about the state a client is in. For myself, I found breaking it down using these specific verbal illustrations of how I feel at a 0, 50, or 100% intensity rating was really beneficial and provided a lot of insight and helped me accurately label the intensity of the problem I was working on in the module.

    Reply

    • Allison Shea
      Jun 21, 2018 @ 20:21:45

      Liz, I agree with you that practicing CBT skills on ourselves helps us to become more familiar and better able to teach the skill. I hadn’t thought about your point that practicing the skills ourselves can help us experience negative emotions that clients might feel when completing homework assignments. It will be important to communicate with clients that they may experience anxiety practicing these skills as it brings the distressful thoughts to the forefront. Having this conversation with clients will better prepare them for the experience so that they don’t become discouraged. I also agree with you that practicing these skills will not only benefit our work with clients but will likely impact our own mental health in positive ways. The skills will help us to become more self-aware which is an important characteristic for a therapist to have.

      Reply

    • Taylor Schiff
      Jun 23, 2018 @ 13:10:12

      Liz,

      I tend to use subjective ratings scales quite often as well, but like you said a lot of times it’s difficult to establish context for the client. Why is a 5 a 5 and not a 4 or a 6? Therefore, asking clients to cite specific instances in the past in which they were feeling depressed or angry or what have you can help to give them a comparison to what they are currently experiencing. Essentially, the goal is to help them to establish how they are feeling along a continuum or using a range. Further, having clients use these self-assigned scales can highlight that there are in fact fluctuations or variations in their emotions (many individuals cite that they are depressed ‘all day’ rather than acknowledging that there may be discrete changes throughout the course of the day). I just wanted to say that I think you are right in that we should better appreciate the value of this seemingly ‘small’ technique and the different purposes it can serve.

      Reply

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Adam M. Volungis, PhD, LMHC

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