Topic 7: Experiencing CBT Self-Reflection {by 3/16}
Based on the readings due this week consider the following discussion point: (1) What technique/exercise from Bennett-Levy et al. (2015) 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 3/16. Post your two replies no later than 3/18. *Please remember to click the “reply” button when posting a reply. This makes it easier for the reader to follow the blog postings.
Dr. Adam M Volungis 
Mar 12, 2023 @ 12:20:00
I enjoyed learning about self-practice/self-reflection (SP/SR) from the Bennett-Levy readings. I believe that the most helpful techniques/exercises will be the self-reflective writing and taking care of yourself. I can see how doing this with another person will be helpful to really think through the prompts and get yourself to fully commit to it. When the text talks about self-reflective writing, this is something that I have always wanted to do, but I get frustrated with my handwriting and if my hands get tired. So, I think that I can do this exercise using a keyboard, which is what I am most comfortable with. I especially like the idea of writing just to write and not for an audience. This is huge and something that I actually teach in my groups at my internship. As for taking care of your needs, I believe that this one is what I most need to work on. When it states, “reflect on your needs,” this is something that I do not always strategically do or ask myself what I need in this moment. After a long day or when I am very stressed, it might be something that could be a bit too much to have to think about doing. However, I could see doing this the next morning when I have been able to sleep. This will also help me reflect back on what I needed at that moment to take care of myself and if there was anything I could have done differently to slightly lessen that stress. This is significant and ties into the idea of practicing what you preach and preaching what you practice. If we expect our clients to do this while they are stressed out, why don’t we also do it for ourselves and remember to follow our own advice?
Mar 15, 2023 @ 14:23:04
Hi Jennifer
Self reflective writing is something that I haven’t done a lot of in the past – totally hear you on getting frustrated by it! Typing is a great option I think maybe for me as well, something to try out. Identifying needs is a skill as well, and something that all of us in grad school especially those who are working as well may struggle to do. Practicing what type of self care and self monitoring / awareness that we are asking clients to do is so important, completely agree. We should not expect someone else to make changes and utilize tools we aren’t using ourselves.
Mar 15, 2023 @ 16:37:15
Hi Jen!
I really like the idea of self reflecting writing as well. I do like the physical act of writing, however, I get nervous about the security of my journal because of past experiences. This might be helpful for you since you prefer typing — I use an app called MorningPages, and I write in it daily in the morning! It’s great and you are able to download and save it if you choose to.
I have found myself reflecting on what I need in the moment lately. Sometimes it can be difficult to figure out. But lately it seems like what I have needed most is rest. I try to be self compassionate and give myself rest when I need it. And I totally agree, it’s all about practicing what you preach. We all need to listen to ourselves and be kind. I try to think about what advice I would give to a friend or a client and it helps me to gain perspective.
Mar 15, 2023 @ 18:09:18
Hi Jenn,
I like the point you made about reflective writing and writing in general that’s not for an audience. It’s great to hear that you’ve thought about the ways you could modify that activity in order to better suit it to your preferences and needs, such as with typing instead of physically writing it! I also appreciated how you mentioned that reflecting on your needs both in the moment and at a later time through this writing can also help you to recognize both your strengths and what you could’ve done differently in those moments, which seems so beneficial both for self-care generally and working as a therapist specifically.
Mar 15, 2023 @ 20:28:28
Jenn,
You made a great point about how reflecting on your needs and reflection, in general, may not happen in the moment or even on the same day as something that occurs. However, I like that you mentioned how regardless, you still make a point to do so. I think a lot of times we are reminded of the need to make time for self-care and, as this SP/SR model suggested, taking the time to practice and reflect, but I feel like this is almost expected to happen in the moment. When in reality, it may be counterintuitive to do so and waiting for time to pass might actually be more beneficial. This was a great thought and provided me with some insight I had not thought about before!
Mar 16, 2023 @ 09:30:58
Jenn,
I agree taking care of yourself/figuring out what you need can be so hard in the moment when you really need it and are feeling stressed out. I like the idea of coming back to it once you’ve gotten some sleep – in a way it seems like letting yourself sleep it off is actually pretty in-tune with your needs (needing to get some rest and turn your brain off!) I find it’s also helpful for me to stick to a self-care routine, with certain things I try to do everyday, so when I have a difficult day, it might be trying to do a little more self-care, but it’s not coming up with a whole routine on the spot.
Thanks for sharing,
Katie
Mar 14, 2023 @ 13:20:46
When looking at the techniques and exercises in the workbook, I feel as though the exercise for maintenance cycles would provide me with significant insight and information about myself as a therapist and individual in general. Specifically, the example about perfectionism resonated with me because I tend to strive for perfection and get down on myself when I don’t meet those standards. I have noticed this pattern of thinking at times with clients as well and feeling like I am not doing “enough” for them or doing it “well enough”. Another technique using the SP/SR model that I believe would provide me with insight and be effective is the process of reflective writing. I enjoyed that there were prompts that went with the different modules because I feel like something I might do is feel like I wasn’t reflecting on the “right” things or doing it in an effective way (there’s the perfectionism). So, having a guideline would be beneficial for me and I think would allow me to gain the most benefits. Journaling is something that I have enjoyed in the past but has been something that I have put on the back burner for a while, and I feel like this way of reflecting might allow me to get back into journaling again. Overall, I liked the different writing exercises of just being able to brainstorm personal qualities whether it be cognitive biases, safety behaviors, or unhelpful repetitive thinking, and being able to almost just dump them onto the page. I enjoyed reading about the process of self-practice and self-reflection and will definitely incorporate this into my “self-care” as a clinician.
Mar 15, 2023 @ 14:31:01
Hi Kaitlyn
I relate a lot to your point about feeling like you aren’t doing enough or not performing well enough, particularly when working with clients at internship, I experience a lot of the “imposter syndrome” and feel self conscious or doubtful about my skills. Being a perfectionist can be a really great quality as long as it doesn’t lead into any black and white thinking. Journaling is another great way to process and maybe address some of these beliefs. Love your point too about self reflection being a part of self care for the clinician.
Mar 15, 2023 @ 16:02:11
Hi Kaitlyn!
I also found that journaling is something that I have put on the ‘back burner’ for a while, but something I want to get back into. I also completely agree that I can struggle with perfectionism in the sense of the right way to do things. That is especially where I can struggle with journaling! That is why in my post I mentioned being able to type it out because I hate my handwriting!
Mar 15, 2023 @ 17:41:57
Hi Kaitlyn,
I also really resonated with the maintenance cycle in the book that pertained to perfectionism. I think it’s great that you recognize these thought patterns in yourself already as well, especially when it sounds like it relates strongly to how you may feel about your performance as a therapist and your work with clients. I also think you made a good point about the benefits of reflective writing, and was inspired by your post in implementing this as a regular activity for myself as well to use this as a way of self-care related to work.
Mar 16, 2023 @ 08:59:54
Kaitlyn,
I can relate to a lot of your points and I understand how difficult it can be when you’re a perfectionists in many aspects of life. I think it can be particularly difficult in this field because of the unpredictability of human behavior and emotions. We spend such a short amount of time with clients each week and there are so many other variables that will effect them, even if you’re doing everything in your power to support them. It’s important for us to remember there’s no perfect way to do therapy and give ourselves some grace.
Mar 15, 2023 @ 14:11:22
I enjoyed the exercises in module 2 – particularly the steps that involved creating a problem statement followed by identifying strengths and using those to create a strength-based problem formulation. Sometimes I feel like I can become overwhelmed emotionally and can work on having a better problem solving system, defining the problem you are experiencing and getting organized in the chaos so to speak feels like a really important skill to develop as a clinician and just as a human. In the next module they discuss activity scheduling which is something that I have had to get better about since 708, and have found this helpful to stay organized and schedule in self-care where I am able to. We all know that self-care is so important for any clinician to have so that we aren’t in a position to get burned out and experience compassion fatigue or allow our stress to have a negative impact on clients. I think a lot of the exercises in this book are helpful to review and its been nice to try to integrate these concepts into the way I think more and more going through this program.
Mar 15, 2023 @ 16:08:05
Hi Lexi!
I love how you mentioned the activity schedule! We also must use these techniques and exercises because of our busy schedules! It can be difficult to find time to do something for ourselves during this time, so that was a really great point! Burn out is very high in this field, so we have to focus on taking care of ourselves as well!
Mar 15, 2023 @ 16:43:46
Hi Lexi!
I also enjoyed the exercises in module 2. The strengths based problem formulation really made me feel great honestly, and more capable of working with my fears. The organization helped me as well, and I think I really needed to write things down in this way and look at it. This is a great refresher since 708, and I am enjoying working through the exercises again.
Mar 15, 2023 @ 20:25:12
Hi Lexi,
I like that you brought up the importance of using a strength-based approach and how it is useful not only as a clinician but also just in general. I think as humans we tend to focus on the negative side of things, so reframing and looking at problems, and even life in general, from this perspective, is helpful. I also liked that you mentioned taking a look at these skills from time to time is beneficial as a way to refresh our memories, but to also put the skill to use.
Mar 18, 2023 @ 15:24:15
Hi Lexi,
I agree that taking a strengths based approach to solving problems can be so helpful, not only for ourselves but especially for our clients. Understandably, it can sometimes feel like the main focus of therapy is what is “wrong” with our clients. I know every session I make sure to check in about issues with eating, sleeping, socializing, mood, etc. I don’t always think to ask if they’ve had any recent successes or about the positive things they have going on. Taking a strength-based approach can go a long way for shifting focus from the negative things ourselves or our clients want to change, to the positive things that we can use and build upon.
Mar 15, 2023 @ 16:30:03
I think that the most helpful techniques from the readings for me personally, were the five point formulation from module 2, and creating a strengths based problem formulation. I have a pretty intense fear of flying, and I recently just took a trip to Costa Rica. In anticipation of flying again in a couple of months, I have been feeling a little uneasy about it. Looking at my fears on paper really helped me to work through some of the emotions, thoughts, and behaviors that affect me when I am feeling afraid. Using a strengths based lens was super helpful because I realized how resilient I am, and how I am able to be brave in triggering situations. Even though it is still going to be pretty uncomfortable to be on a plane again, I have endured it in the past and know that I will be okay the next time as well. Overall, something about writing it down and documenting my experience in an organized way was really helpful.
Mar 15, 2023 @ 23:23:34
Lindsay,
I think that you bring up a very good point in using a strength-based approach. I think that using a strength-based approach can be empowering for clients and increase engagement in treatment. Also, hope you enjoyed your trip in Costa Rica once the anxiety came down! Thank you for sharing.
Mar 16, 2023 @ 09:34:24
Lindsay,
Thanks for sharing your flying experience! I’m glad this is helping so far. I find that when I’m overwhelmed with a situation, my mind seems to perseverate on my weaknesses or what’s overwhelming me, instead of my strengths. One thing I’ve always tried to do informally is look at the past experiences I’ve had and know I’ve always gotten through them – why is that? How did I get through those other things before? Combining that with the strengths-based problem solving method seems to be a good way to not get too overwhelmed or feel out of control/like I can’t handle whatever stressor it might be.
Thanks for your insight!
Katie
Mar 15, 2023 @ 17:14:57
I feel that the exercises from Module 4 provided me with the most insight about myself both as a person and a therapist. I feel like first in identifying my common cognitive biases/distortions I had already previously realized that I tended to gear towards catastrophizing, fortune telling, and overgeneralizing. In reflecting on my cognitive biases related to my clinical work and being a therapist specifically, this exercise helped me to also realize that the same cognitive biases apply to myself as a therapist as well. For some reason prior to this exercise I didn’t think deeply about how my typical cognitive biases may apply to myself in a therapist role, so this realization in itself was very helpful in understanding my self-doubts and imposter syndrome at my internship/in a clinical role. Aside from this, I’ve always enjoyed exercises related to behavioral activation, such as in Module 3 and various self-monitoring assignments throughout the program, as I feel like these activities provide me with a lot of insight into my own behavioral patterns as a person generally. Reflecting on my own experiences with behavioral activation with respect to activity and mood diaries helps me to gain significant perspective in how to frame the concept of behavioral activation to clients when introducing it to them, as well as how to address various obstacles that are met with trying to engage in these activities seeing as I have experienced several of them myself especially related to amotivation.
Mar 16, 2023 @ 20:17:05
Hello Valerie,
I shared a similar experience with module 4. I found that it was helpful to realize and bring to awareness these negative behaviors to start cognitive restructuring through socratic questioning. Also, behavioral activation is important to start a routine and desired behaviors that can reduce burnout or achieve goals.
Mar 18, 2023 @ 15:29:06
Hi Valarie,
I love the point you make about how by engaging in behavior activation ourselves, we can better understand the challenges our clients may face. As someone who is always making a schedule for almost every day, I find scheduling out activities to be extremely helpful, if not vital for me to manage my responsibilities. Because of this, I have always felt I could genuinely share the benefits of activity scheduling with my clients. However, when actually reflecting on this experience rather than doing it habitually, I noticed I can feel really disappointed if I didn’t get through all of the tasks I had planned for a day. This reflection helps me to remember how important it is for us to help our clients to set reasonable expectations, and to have compassion for themselves when they don’t meet their goals.
Mar 15, 2023 @ 20:56:29
From the readings, one technique I used was cognitive reconstructing my unhelpful thoughts that provided me more insight about myself and my automatic thoughts. I found that mind-reading and labeling are speaking to me. At times, I catch myself thinking that my internship supervisor thinks that I am not doing a good job as a therapist as I case manage most of the time and have used many CBT techniques twice only.However, I felt better after completing a thought record and using socratic techniques that gather information that modify my thoughts like I have great therapeutic relationships with my patients and I have a job offer to continue after the internship.
Mar 15, 2023 @ 23:25:58
Moises,
I am glad to hear that I am not the only one that has found it super helpful to use some cognitive restructuring on yourself, and challenge some of those negative automatic thoughts. I think that it is important to practice what you preach, since it gives us insight about the techniques we use with our clients.
Mar 16, 2023 @ 09:03:03
Moises,
I also found the excerpts about automatic thoughts useful. I often forget to engage in my own metacognition and self-reflection even though it’s something that we ask of clients. It can be difficult to get into the habit of but it’s great that you recognize the importance of it and already have made in effort in engaging in those tactics.
Mar 16, 2023 @ 14:28:35
Hi Moises,
I shared with you my experience and implementing CBT forms/techniques to identify negative automatic thoughts while at the internship. I personally do decastrophizing, the negative thought record, and the Beck Institute Testing your Thoughts; this one is my favorite form. I also find myself labeling and being extremely judgmental with my work; the forms help me to be more patient and kind. Keep it up with the forms!
Mar 15, 2023 @ 23:19:31
I think that one of the chapters that stood out to me was module 4 on identifying unhelpful thinking and behaviors. The reason why this reading stood out to me is because I at times have a difficult time with helping clients identifying unhelpful thoughts and behaviors. I noticed that sometimes when I try to explore these areas, I may come across as confrontational, and in a way that I am calling out the client, or make the client feel bad about themselves for pointing out the negative core belief, automatic thought, cognitive distortion, or unhelpful behavior. I am working on this skill and trying to be more gentle in my approach. I think using a thought record is a great way to help the client do this work on their own without me getting overly involved.
Mar 16, 2023 @ 08:52:39
Based on the reading, I felt that Module 4 stood out to me the most. It is important to consider reflection processes that are helpful on both a professional and personal level. I think that I’ve made a lot of progress on my own mental health in the last few years but accurately recognizing cognitive distortions is something that I could still benefit from. This process is important for my overall wellbeing but it will also improve my therapeutic skills over time. It is also important to look at the interactions between therapists and their clients and how the therapist’s own mental processes will affect their approach, and therefore the client’s success.
Mar 16, 2023 @ 09:28:33
Some of the exercises which I thought were most helpful to me are identifying my own cognitive distortions/cognitive restructuring and reflective writing. In everyday life I tend to catastrophize and magnify the negatives while minimizing the positives. Identifying my own biases and reflecting on them gave me insight into what my clients might be going through doing the same thing, helps me understand a bit more some of what they might be feeling while doing the exercises, and also opened my eyes to how these distortions affect myself as a therapist. I have caught myself thinking the worst of a situation between sessions with a client and I have had the experience of the client coming back just fine and realizing just how bad I was making it in my own head. Likewise, I find myself minimizing my successes and perseverating on the small things I could’ve/should’ve done “better.” I find reflective writing to be very helpful at prompting me to think about some things I may not have otherwise, but also like that it gives me the space to think through my thoughts and get them down on paper, which is sometimes easier than talking about them out loud, or just continuing to think about it.
Mar 16, 2023 @ 09:58:33
I personally gained the most insight about myself both personally and as a therapist from module 4. When doing the reading, I went through this module thinking from both perspectives and I think it was really helpful to see the differences in my thoughts and behaviors depending on the situation or role that I’m in. As a therapist, I think it’s important to recognize and identify situations that may be uncomfortable that could be resulting in avoidance, safety behaviors in regards to sessions, and even unhelpful thinking that may occur. Right now, this unhelpful thinking is something that I’m working through with my own therapist – especially in regards to feeling that imposter syndrome from time to time. The exercises in module 4 are also ones that I do with almost every client I see (unless they’re like under 9), so it was nice to get some additional practice going through the step by step process. On a lighter note, I think my therapist will enjoy having this to look at in session tomorrow!
Mar 16, 2023 @ 20:32:55
Hello Francesca,
I like how you mention module 4 and the work you are doing with your therapist. I find this interesting as I was thinking that the exercise was done independently. However, I found that having a therapist will provide you with great insight and outcome for unhelpful thinking.
Mar 16, 2023 @ 12:26:08
Before engaging in the exercises, I found the description of the process of reflection to be very helpful. Specifically, the idea of remembering to remain compassionate toward myself when engaging in self-reflection since I am someone who can be very hard on myself. I tend to only consider the negative while disqualifying a lot of the positive. Because of this, I found module 5 provided me with the most insight about myself as a person as well as a therapist. I feel like I am able to identify a lot of my cognitive distortions but I definitely struggle with modifying them. I have realized the importance of evaluating all of the evidence, not just the negative, which has been helpful for remembering to be less hard on myself and more compassionate toward myself.
Mar 18, 2023 @ 21:07:17
Hi Giana –
I’ve also been finding it helpful to tackle some of that negative self talk. I like your point about reminding yourself to be compassionate towards yourself, and think that’s something I have a difficult time with too. It can be hard to make changes to those cognitive distortions when we aren’t perceiving ourselves in a positive way.
Thanks for sharing!’
Mar 16, 2023 @ 13:04:50
After the readings, I decided to work on Module 2, identifying a problem and preparing for change. I formulated a basic problem that interfered with my sessions. The scenario is that I have sessions where it comes to mind “a specific form or educational material” that I want to provide and work with the patient immediately because I believe it answers the patient’s needs. Then, I asked for a few seconds to my patient to wait while I found the excellent form that I wanted to share. Of course, I cannot find it, ending up putting out much material (that I have not well organized yet) on my desk and being frustrated and having negative automatic thoughts.
I took this scenario and implemented the following techniques to formulate the problem and prepare for change; (1) the five-part formulation, (2) my strengthen based formulation, (3) my first smart goal, (4) and strategies to achieve my goals.
During and after the exercise, I have the following insights. First, I realized some negative automatic thoughts I had when sharing with my patient, such as “I am sure that you are thinking right now that I am totally disorganized.” While I was thinking, “my patient may think, “if she cannot even find her material, how will she help me.” Second, I evaluate the situation as an opportunity to address my organizational skills. In other words, even if I am extremely busy with the system, I need to take a step back and plan my sessions with the patients, not only with patients that I am already doing CBT therapy but for those who come for updated quarterly assessments. Third, I have pending since November 2022 to organize my CBT material; then, the smart goal technique will help me to concrete these goals towards steps to make it happen. For example, to re-organize my CBT material in binders with sheet protectors about MDD, GAD, and SUD/AUD to have it handy when planning my sessions. Also, it was helpful because I blocked my calendar for a couple of hours to make it happen and printed out several copies of the Therapy Session Worksheet and put them in a folder to give a start. Finally, after implementing these techniques, I realized that the same situation would happen in one of my in-person sessions, and I could intervene in my behavior on time.
Mar 16, 2023 @ 13:10:45
I found Module 3 to be an extremely helpful exercise. With how busy this past year, and even more-so this semester has been, I have found myself more and more overwhelmed by tasks. For me, that has usually meant struggling to find any energy or motivation to do anything, even the things I know I would usually enjoy. Although we learned about activity monitoring and scheduling, it has been a long time since I took a look at my daily activities through a CBT lens. I realized that I am getting stuck in a cycle of being so burned out, that I shut down and put things off. This leads to me being behind on tasks, and then having to overwork myself to stay on track, ultimately leading to me being even more burnt out and tired. While in this behavioral cycle, I also noticed self-criticism and blame which tied into Module 4 as well. In my case, I know my stress, lack of energy, and lack of motivation are situational. Once I have graduated, I will have a massive reduction in the amount of responsibilities I have. This exercise did help me a lot personally in understanding the ways my thoughts and behaviors are not ideal, and how they can contribute to worsening in my day-to-day functioning. However, this also gave me a lot of insight about how my clients likely feel. For a depressed client, they may not have one temporary life situation they can blame for their negative spiral. Instead, they may feel hopeless and have even stronger negative or critical thoughts about themselves. Having this experience allows me to empathize with my clients and validate how difficult it can be to engage in behavioral activation when you feel tired, overwhelmed, or unhappy. Understanding what I am asking my clients to engage in will help me to have a more genuine and compassionate approach.
Mar 18, 2023 @ 10:37:05
Hi Christina,
What you mentioned in your post made me think about how difficult it is to implement for patients diagnosed with Depression, CBT behavioral activation, and pleasurable activities. When tying personal experience to understanding how patients diagnosed with depression may feel and how challenging those exercises are for them is an excellent insight. I have found that implementing CBT techniques in my personal life and bringing this experience to the clinical practice helps a lot. For example, I shared with the patients that I have done these exercises/techniques before (not the content), and I perceive how motivated they are to apply them. In addition, the educational part is more accessible, and referring to potential challenges based on your experience helps too.
Mar 16, 2023 @ 18:52:36
The module that gave me the most insight was the module on Behavioral Activation. Just this morning I assigned to a client creating a Weekly Activity Monitoring Log and I asked her to rate her pleasure and accomplishments on a scale of 0-10. She was willing to comply as it she was avoiding certain situations and activities that would most likely give her pleasure in her daily life and choosing to isolate instead. I found my mind wandering to what I would put on my schedule for this week and if I am scheduling pleasurable activities as well. Next week I have scheduled 14.5 hours for client appointments, including two new intakes. I am beginning to feel overwhelmed that I only spend time doing things specifically for work or school. Scheduling in time for enjoyable tasks and activities is important for increasing my productivity during busy moments as well. Therefore, I began scheduling in time for hanging out with my friends and treating myself to self-care. I should practice what I preach when I use evidence-based practices in sessions.
Mar 18, 2023 @ 20:57:52
Hi Tim –
Kudos to you for scheduling out those self care activities during your busy day. I think that’s something that gets overlooked with our insanely packed schedules, and therefore falls to the wayside. I know right now I’m seeing clients back to back and don’t have time between sessions to take a bathroom break. Definitely will take a page out of your book with this one!
Thanks for sharing!