Topic 6: Writing a CBT Group Session Outline {by 10/15}

The reading for this week is to review the Coping Cat CBT Group Manual for Anxiety. The Beck library has the full version and I have also posted a couple chapters on my website. Although the target population is children/adolescents, the goal here is to get an understanding of creating a CBT group session outline. Address the following discussion point: (1) Envision yourself as someone who has been asked to run a group using the Coping Cat manual. Based on reading parts of this manual, what about the session outlines (e.g., content, structure, etc.) do you think would be most helpful when it comes to actually implementing the group? Your original post should be posted by the beginning of class 10/15.  Have your two replies no later than 10/17.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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22 Comments (+add yours?)

  1. Sarah Gagne
    Oct 14, 2014 @ 23:12:14

    The coping cat chapters provide a clear, outlined manual for therapists to follow that will facilitate an effective group. I find it helpful that the content is concise and to the point in a guided manner so that it is easy to follow and adopt into practice. It’s helpful that the manual utilizes both in-group techniques and homework suggestions. Specifically to chapter 10, the tips provided are helpful for the entire group process. I like that therapist is given tips on how to address “problem” situations so that therapist is not just thrown into group with tasks assuming they will go well. It also gives reasons on why certain measures are used so that the therapist is not blindly using SUDS ratings, for example.

    I appreciate that the manual suggests tailoring the tasks to the group members. For example, making exercises specific to group circumstances rather than having set out examples that may not apply to the group. The manual provides instruction but also allows the therapist to utilize their own input. I like that the manual suggests the therapist get involved in the exercises to act as a model for group members to follow. This allows for the therapist to have a more active role in the group rather than just incorporating psychoeducation and lecture.

    Reply

    • Jessica
      Oct 15, 2014 @ 11:28:44

      I liked your comments about the therapist’s role in the group. The manual even suggested the therapist self disclose a time when he/she was anxious and what strategies he/did to overcome it to facilitate the group to self disclose about their own experiences with anxiety. This gives a real life example and role model to the kids. It shows the importance of careful input from the therapist that goes beyond didactic instruction and reiteration of the manual.

      Reply

    • Gil
      Oct 15, 2014 @ 13:00:55

      It seems like there’s an ongoing balance of having specific evidence based techniques, yet tailoring the treatments to match the individual or group. Clinicians want to replicate the tested techniques used in research, but sometimes the techniques are not a one size fits all. Even when the techniques are done as they were in the research, there is always a portion of individuals that are left without results. I like the structure mixed with fluidity, so that the therapist can tailor the materials to match the group.

      Reply

    • Sarah-Eve
      Oct 15, 2014 @ 13:19:31

      It’s important to remember that though there are great guidlines provided within the coping cat manual, every group is different. I appreciate that you pointed out tailoring the tasks to the specific group members and using what is appropriate in group at those times, rather than blindly following the structure. These are guidelines that may not suit all groups.

      Reply

  2. Sarah-Eve
    Oct 15, 2014 @ 08:38:55

    When it would come to actually implementing the group, using the Coping Cat Manual is extremely helpful and exemplifies the structure and progression of the group session. It lays out which activities and lessons to implement and in which order they would be most efficiently taught. The structure helps to give a linear progression to the goals of the group, and makes the goals more manageable and thus attainable. Breaking down the group and the sessions into parts helps identify what and how things should be covered; it also indicates what to do in case group members do not progress as quickly as necessary. The content provided in the manual allows for the therapist to identify what skills the clients should already know, what skills and lessons they should be prepared to learn about, and what skills and techniques the therapist should use while implementing the lesson.

    Reply

    • Angela Vizzo
      Oct 15, 2014 @ 21:49:51

      Sarah, I agree with your comments, the manual does a good job building upon previous sessions and the skills that were learned in preceding sessions. The lay out and break-down of the manual also does a nice job explaining exactly what should be learned at the end of each session that allows for that progression.

      Reply

  3. Richard Hisman
    Oct 15, 2014 @ 09:37:57

    First thing that stands out is the language used to define the group. It is clear what the intended participants are to consist of. That carries over to the goals which are written for their intended audience. It is explained at a level that the average parent would understand, utilizing terminology that a parent with anxious children would be familiar with. It is especially refreshing to see the way anticipated difficulties are detailed to both child and parent. It first talks of the sequencing and then lays out that sequencing in the index very clearly. One can pick up the manual and readily understand the overall process that is to be followed. For the therapist, it is a very hands on manual to step even the novice through the regime.
    There are clear instructions on how and when to vary the type of exposure, along with signs that it is needed. Tips from the trenches is especially interesting to me. Having not run groups before, the insight of what to expect, do, and do not do is helpful. It is quite clear on what to expect while introducing exposure and clear things to avoid. Finally there is in-depth look at the empiricism of the therapy process.

    Reply

    • Gil
      Oct 15, 2014 @ 13:04:10

      “Tips from the trenches” I might have to steal that. I think you’re on point; the general theories and approaches are important to learn, but sometimes its the nuances that make therapists great. A tweak in how an intervention is worded or a small change in order can make huge differences. Having real-world examples is critical for effective therapy.

      Reply

    • Michelle
      Oct 15, 2014 @ 19:06:57

      Richard, you are right. Not only is the manual user-friendly, but so is the workbook that accompanies it. Counselors, parents, and the children will all have available to them a program that is easily understood, and also, very usable in that it clearly and concisely addresses goals, clearly moving toward them both within and between sessions.
      I too found the Tips from the Trenches very useful. It seems that there is so much information that can be considered during the therapy process, and especially that may be useful to consider for a particular population. Because I’m so new to the counseling profession, I feel like a sponge, as I try to absorb as much information as possible that can prepare me to later deliver the best possible outcomes for my clients. The tips section provides the counselor with a resource that may be useful to do just that.

      Reply

  4. Paige Hartmann
    Oct 15, 2014 @ 10:39:56

    Utilizing the Coping Cat Manual when implementing a group is helpful because it provides structure and specific content for each session. Each session has goals clearly defined that are addressed through the specific tasks and activities. I particularly found the tips provided at the end of each session outline to be helpful. For example, in Chapter 2 the authors mention that when working with lower functioning children, they may have difficulty identifying situations in which they experience anxiety. The authors suggest utilizing stories about an imaginary group of children within a stressful situation to help the children identify anxious feelings. When it comes to implementing a group, these tips provided at the end of each session outline would provide insight on how to handle specific situations or clients.

    Reply

    • Jessica
      Oct 15, 2014 @ 11:52:57

      I liked the tips at the end too, and the strategies suggested for working with lower functioning children. I imagine this strategy could also apply to any child who is resistant to talk about an anxious situation; maybe the child is so anxious about it that he/she avoids talking about it, and/or the child could fear being reprimanded or embarrassed by disclosing a situation he/she is anxious about. Talking about how this situation might make someone else anxious may be an easier way for the child to ease into talking about his/her own anxiety.

      Reply

    • Michelle
      Oct 15, 2014 @ 19:00:40

      The tips that the Coping Cat manual provided really did add substantial value. It is important for us to gain as much insight as possible, so we can be better prepared to address the needs of a particular population. By provisioning for alterations in the way that group members may respond, or by different strategies and considerations, the manual becomes more fully rounded. Not only does it provide a great basis and plan for work, but also addresses other issues that can come up along the way, thus adding the human element.

      Reply

  5. Jessica
    Oct 15, 2014 @ 11:05:34

    The coping cat is very useful in many ways. It provides structure and appropriate therapeutic activities for kids while gradually building on skills and increasing exposures (from imaginal exposure starting at session 2 to in vivo exposure at session 10). I especially liked how many of the activities to introduce the kids to labeling and acting out emotions seemed like fun while still teaching a skill, such as the role playing and the “feelings dictionary” activities. I also really liked the “teaching from the trenches” sections that provided useful tips. The authors do not expect everything to be smooth sailing in group and plan for that: the guide provided strategies to work with kids who have difficulties describing or labeling emotions or anxious situations, and/or are hesitant to try the exposures. Including information like this makes such a guide more useful to the real world application in group.

    Reply

    • Sarah-Eve
      Oct 15, 2014 @ 13:12:29

      Groups may hit some obstacles at some point during treatment, planning for those types issues is important. Having a plan in place for when that issue arises makes it easy for the clinician to follow a certain protocol. When these issues are anxiety provoking, it’s easier to follow steps in a stressful situation rather than just improvising. Not only that, but some individuals may learn at a slower pace, and having these plans in place can aid in furthering their progress.

      Reply

    • Richard Hisman
      Oct 17, 2014 @ 09:58:07

      The teaching from the trenches was my favorite part. It made me feel like this is something I could learn to do. It would help me deal with problems promptly and appropriately. It would also help to cut off possible problems as they begin. To me chapter 10 thru 16 is where there is the greatest possibility for the group to get stuck as a whole. The tips from the trenches could be vital in order to keep them going.

      Reply

  6. Gil
    Oct 15, 2014 @ 12:55:56

    The coping cat manual helps take theoretical approaches to turn them into more tangible exercises. Learning the theory behind exercises is extremely important in order to tailor principles to different individuals. Nevertheless, reading about actual exercises helps translate these theories and vague concepts to see how exactly these can be delivered. For example, I know that identifying emotions is an important step in evaluating thoughts. However, I am not always sure of a concrete technique in helping individuals identify emotions. The coping cat manual offers the idea to cut out pictures from magazines to use those as models to aid the child in defining emotions. My creativity is sometimes lacking, so the ideas from others can sometimes spark my own ideas and ensure that my ideas are not out in left field. When I know my ideas cover the same principles as the concrete examples listed in the manual, this give me more confidence in my delivery.

    Reply

    • Paige Hartmann
      Oct 16, 2014 @ 19:02:16

      As beginning therapists, we may struggle with determining specific techniques or activities to utilize within treatment. I agree with you that the coping cat manual is useful in providing specific techniques that can be used. These techniques and examples are helpful to integrate into our own practice.

      Reply

  7. Michelle
    Oct 15, 2014 @ 18:54:38

    Following the CBT mode of therapy, treatment, and individual sessions are planned, one session building on tasks learned and practiced during prior sessions and homework. The manual first begins by providing a treatment session framework. Group members may benefit from knowing what lies ahead, and what issues will be discussed and covered. The clinician may find that using an organized approach will help the group to stay on target for group and individual goals, and give the counselor a basis to prepare for each week. Each session identifies goals and tasks of the session, and related homework. Using this manual as a point of reference, may be beneficial by providing framework that aligns well with CBT, through the use of shared therapeutic goals, session agendas, and anticipated homework. Use of lists that describe each activity and the related purpose will be helpful as well, and serve to remind the counselor to ensure that therapeutic goals remain the focus. The specific layout of the manual is appealing, and easy-to-follow. Each section identifies the purpose, goals, and tasks, in a very user-friendly way.
    Although agendas provide a great map for therapy, plans don’t always go the way intended. Additional issues can be identified, members may not respond as expected, or the therapist may find opportunities to move in directions that aren’t aligned with the agenda. The Coping Cat manual allows for some flexibility, by giving options for several activities that can be chosen from. Allowing for flexibility helps to allow for the unexpected, and to promote group choice, as well as to practice improving and emerging skills.

    Reply

    • Angela Vizzo
      Oct 15, 2014 @ 21:27:49

      Michelle, I like your discussion of how the Coping Cat manual utilizes a CBT group therapy framework. I also like how you pointed out that the manual allows for some flexibility, as this can be important in any group as different things may arise or certain personalities may influence how receptive the group is to different activities. This is especially important with a group for children as they can be harder to keep on task, and keeping things fresh will allow their attention to be retained.

      Reply

  8. Angela Vizzo
    Oct 15, 2014 @ 21:20:16

    The coping cat manual provides a detailed outline of how the sessions for a group therapy program can be structured. There are many useful parts included in the manual that will be useful in implementing the program. For example, I like how the sessions each have clear goals to be reached and different tasks to be accomplished in order to meet each of those goals. The “tips from the trenches” sections also gives good advice to use when implementing different tasks or explaining different concepts. It is also useful how each session begins by reviewing homework (or STIC tasks) and ends with assigning a new task. Finally, the very last thing done in group is a game or a fun activity which is especially good for children’s groups as it can encourage them to come back the next week.

    Reply

    • Paige Hartmann
      Oct 16, 2014 @ 19:16:01

      Angela, I agree with you in how useful the coping cat manual can be due to its detailed structure for each session. The manual is very specific and clear with the goals that are in place for each session and explains the techniques used to meet the goals. Utilizing the coping cat manual will help to effectively run a group therapy program as the objectives for each session are clearly described. I also found the tips section to be particularly beneficial for approaching different or difficult concepts.

      Reply

      • Richard Hisman
        Oct 17, 2014 @ 09:44:03

        The detail is very functional and is most important to the ability of the clients parents understanding of what will take place in therapy. The manual has been placed at a reading level that affords this understanding. This is not an easy task to complete. When reading psychology articles I sometimes feel that the writers are trying to prove their ability to explicate the influence of one’s vocabulary to intellectual superior of the species that the average peon not need understand. Yeah using words as a demonstration of their educational superiority. I need to remember this when we write or sections on the actual sessions for our papers.

        Reply

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Adam M. Volungis, PhD, LMHC

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