Topic 2: Cognitive Theories {by 1/26}

There are three readings due this week (Beck, A. T.; Beck, J. S.; Volungis).  For this discussion, share at least two thoughts: (1) What is your understanding of Lazarus’ and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT?  (2) What are your initial impressions in your ability to understand and consistently apply the basic principles of CBT as a therapist?   (I realize many of you do not yet have any therapy experience.  However, now is a good time to start thinking about being a CBT therapist.  Many of you will be starting your practicum next summer!)

 

Your original post should be posted by the beginning of class 1/26.  Have your two replies posted no later than 1/28.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

55 Comments (+add yours?)

  1. Tiana Faulkner
    Jan 20, 2023 @ 15:05:47

    Cognitive appraisal is the way an individual responds to and interprets stressors in life. This response is based largely on the individual’s past experiences. There is process going on within the individual to evaluate whether the particular stressor, event, or encounter with the environment is relevant to the individual’s well-being. There are primary appraisals, which has to do with the individual’ well-being and secondary appraisals, which is what can be done about the stressor or encounter with the environment and the coping methods used. Coping is the individual’s cognitive and behavioral efforts to manage any demands that are appraised as difficult. Cognitive appraisal and coping sort of work together. When using CBT one of the goals is to work on coping mechanisms, if the individual is confident in their ability to handle stressful situations and use positive coping mechanisms, then they are more likely to succeed.
    I honestly am not sure. I understand the basic principles of CBT and theoretically I understand how they would be used within therapy. But I really am not sure about my own ability to apply them correctly and consistently. I feel like I will not have too hard of a time, you can just never be sure until you do it.

    Reply

    • Whitney Andrew
      Jan 24, 2023 @ 21:32:50

      Hi Tiana!
      I really liked how you brought in primary and secondary appraisals into the conversation about cognitive appraisals. It is super important to differentiate the two and I wish I would have brought that into my response too!
      In terms of CBT and practicing, you so got this! I feel the same way, but I know that by the end of this program our response to this question will be WAY different 🙂

      Reply

    • Jack Halliday
      Jan 25, 2023 @ 08:40:19

      Hey Tiana, I liked the emphasis you put on the individual’s past experiences. When it comes to the process of cognitive appraisal, especially how it related to therapy, it is important to keep in mind where they originate from. Additionally, the emphasis you placed on the primary and secondary appraisals is also something that is very important and something that I overlooked when writing my response. As for your comments regarding your confidence, if it makes you feel any better I’d say that all of us are in the same boat, but if one of us can do it then we all can do it!

      Reply

    • Becca Boucher
      Jan 25, 2023 @ 08:45:12

      Hi Tiana, you did a really great job summarizing what cognitive appraisals and coping methods are as well as showing how they relate to one another. I like how you used the definitions of primary and secondary appraisals to introduce the term coping before defining it, because it not only helps your writing flow, but helps to explain how the two are connected without being too disjointed. I also agree that you can’t be too sure of your ability to use CBT in therapy until you do it. I feel like I understand the principles of CBT as well and I understand from what I’ve learned so far how they apply in a therapy session, but I worry about being able to properly apply and stick to CBT in practice early on.

      Reply

  2. Jack Halliday
    Jan 20, 2023 @ 15:19:25

    Cognitive appraisal, as laid out by Lazarus and Folkman, is relevant to CBT because it has an impact on the nature and degree to which our environment, and how we perceive our environment, affects how we feel. Not only the environment, but it also helps to make sense of how our own thoughts and feelings influence our behavior. Basically, it is just another theoretical framework that helps us to understand the CBT triangle, and the complicated interconnectedness and relationship between the individual and the environment. Similarly, to the appraisal process coping, as defined by Lazarus and Folkman, is another piece of the puzzle that is our cognitive efforts in relation to internal and/or external stimuli. They’re definition of coping is how we as individuals manage certain demands, whether they be internal or external, that we perceive as an issue. This relates to CBT because it is another way through which we perceive the world, how the world has an impact on us, and how we impact the environment. Basically, these two ideas further our understanding of the complex nature of out thoughts, behavior, and the environment.
    My initial impressions in my ability to understand and consistently apply the basic principles of CBT as a therapist are more positive than I thought they would be. Counseling Principles and Practices was a good introduction to the basics of therapy, but it also helped to raise my self-efficacy in terms of the foundations of therapy. Reading your book and Judy Beck’s book have also helped to increase those feelings of self-efficacy in terms of breaking down the concepts into very digestible terms. I realize that there is a long way to go between where I am now and where I need to be in order to be a therapist, but the foundation for the basic principles of CBT seem to be more straightforward and understandable than I thought they were going to be.

    Reply

    • Tiana Faulkner
      Jan 21, 2023 @ 14:18:08

      Hi Jack! I really like the way you worded your response to the first question. The interconnectedness of the three, cognitive appraisal, coping, and CBT becomes super clear. I like how you had stated how the two ideas further our understanding of the complex nature of out thoughts, behavior, and the environment. In reading your response you can really see how this is the case. I also am happy to hear that you have a higher self-efficacy after the class we took last semester. I have to agree the class was super helpful and did make me feel a lot better. However, I am still just nervous, you never know how it is going to go until you try it in a real world setting.

      Reply

    • Becca Boucher
      Jan 25, 2023 @ 08:51:06

      Hi Jack, I like how you focused on connecting cognitive appraisal and coping to CBT. I also really like that you mentioned that coping is another way through which we perceive the world because our coping mechanisms have an effect on our internal state, which impacts our environment, which further impacts us. I’ve never thought of coping mechanisms quite in that way, but it was very helpful in tying them to CBT. Obviously in CBT, coping mechanisms are important for managing symptoms, but your explanation was a really great way of showing how coping mechanisms can help to manage symptoms. I also agree that I have a pretty good foundation of knowledge that I am comfortable with but that there is still a lot I want to know in order to feel truly comfortable as a therapist. I also want to be able to start practicing because that’s how all the things we have learned in class are going to consolidate and really take shape when in therapy with clients.

      Reply

  3. Becca Boucher
    Jan 20, 2023 @ 16:42:14

    My understanding of Lazarus’ and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT is that appraisal is the process of analyzing an event that occurs in our environment to determine if the event should require a stress reaction or not. According to Lazarus and Folkman, cognitive appraisals take place continuously and it are focused on evaluating the meaning or significance of every experience to ensure that no value, need, or commitment of the individual is going to be effected, and if one is going to be effected, if it will be positive or negative. Coping, according to Lazarus and Folkman, is a constantly changing cognitive and behavioral effort that aims to manage external and internal demands that have been appraised as taxing or too much for the individual to currently handle them. Coping changes with the environment and the stressors the individual faces, and can look different not only person to person, but each person has different coping mechanisms for different situations as well. These changes occur because of the continuous appraisals and reappraisals of a person’s shifting environment, and as the new appraisals come in, the individual must cope accordingly to this ever-changing information about their environment. There are also two types of coping: emotion-focused coping and problem-focused coping. Emotion-focused coping focuses on controlling an individual’s emotional reaction to an appraisal, while problem-focused coping tries to control or get rid of the environmental appraisal that has caused the individual a threat or challenge.
    Lazarus’ and Folkman’s concept of appraisal and coping are similar to the structure of the CBT triangle, where there is reciprocal effects that aren’t quite linear. While appraisals and coping is more linear than the CBT triangle, as an appraisal must technically occur for coping to happen, it is a bit different, but the coping outcome and continued appraisals and subsequent coping are also not that linear, as they effect one another. Overall, appraisal and coping are another example of how the environment and the individual effect one another, and how our response to the environment can shape our future experiences and reactions, the same way that our behaviors, thoughts, and environment interact in the CBT triangle.

    Reply

    • Jack Halliday
      Jan 25, 2023 @ 08:45:08

      Hey Becca, I thought the emphasis you placed on the fact that the affect from the cognitive appraisal process can be positive or negative, because I feel like that’s a really important aspect of the cognitive appraisal process that can be easily overlooked. The way you tied coping into the cognitive appraisal process was also very thorough and it shows a good understanding of the concepts. Great post!

      Reply

  4. Becca Boucher
    Jan 20, 2023 @ 16:45:37

    I forgot to address the second part in my first response, but my first impression of my ability to understand and apply the basic principles of CBT as a therapist are pretty good. I understand the basics so far, and they feel very natural. Especially with my own experience with anxiety, I have been able to see how much of a difference reframing your thoughts can have, and so I feel more confident having had that experience.

    Reply

    • Tiana Faulkner
      Jan 21, 2023 @ 14:12:41

      Hi Becca! I obviously agree with your response to the first question considering it is pretty much a definition of the two. You have a lot of very good details in your response. I like how you had stated that appraisal and coping are an example of how the environment and the individual effect one another. This is very true and a great way to look at it. For the second question, I agree with you and am also glad that you feel that way! I have a good grasp on the principles of CBT but my experience using it in a clinical setting is limited.

      Reply

  5. mikayladebois
    Jan 23, 2023 @ 18:05:26

    My understanding of cognitive appraisal is that one’s perception of an event will dictate actions, feelings, and coping mechanisms used in relation to the event. These appraisals are split-second judgments about the event that is happening and then what the organism can or should do to deal with such an event. If we think something is good for us or will promote our well-being, it is unlikely that a stress response will occur. Seeing a loved one who has never presented a threat to you will be judged as a “good” or safe event. Then the secondary appraisal will consider how to react, with a smile, a hug, or a fist bump. On the other hand, seeing a person who has taken your lunch money and given you a black eye in the past would not be a welcome sight. The first appraisal would tell us that we are in danger of being victimized again, and the second would lay out some options to deal with the discomfort. Reappraisals happen as we continue in the event and are used to check one’s progress and current standing in the situation. If something that was previously a nonissue suddenly changes and is now a problem, we would not want to continue thinking we are safe based on the first judgment we made. Within CBT, appraisals would help explain one’s emotions and behaviors. If someone is prone to sensing danger or anticipating danger in situations that do not warrant such reactions, they likely are dealing with anxiety in their life. Learning to reevaluate the situation and being realistic in one’s appraisals can help individuals who are constantly on alert or feeling fearful.
    Coping as defined by Lazarus and Folkman is seen as a process that takes place in an event that has been appraised as either causing a problem or could become one. This process does not have to happen in a specific set of stages but goes through constant appraisals and reappraisals. Specifically, coping looks at how to mitigate a threat or threatening situation. This can be done by addressing the emotions of the individual or the situation itself. Emotion-focused coping is likely to be done when one has appraised the situation as resistant to change or if they feel like their impact on the environment will be minimal. Instead of getting rid of the problem, the person will change how they react to the problem or how much of it they will acknowledge. Problem-focused coping addresses the issue directly, so they are likely to believe that the situation or environment is changeable, and they have the capabilities to do so. The “behavior” in CBT is often concerning the coping skills someone uses as they navigate their world. Unhealthy or unhelpful coping skills can lead to a lot of the issues that we as therapists will see and it is imperative that effective skills are taught in sessions so that when new problems arise, the client is able to handle it without reverting to coping methods that didn’t actually help them.
    As far as using and applying CBT in the future, I feel somewhat confident though that may be due to the fact that I don’t know everything that it will entail yet. I found in the readings that I had done some of the techniques that were talked about when working even though I was not in the role of a clinician. I also understand that we are just starting to learn what it is we are actually going to be doing in session so I’m trying to keep my expectations realistic.

    Reply

    • Taylor Poland
      Jan 25, 2023 @ 17:54:50

      Hi Mikayla,
      I think your examples of cognitive appraisal were really helpful for my understanding of the concept. Your connection between CBT and cognitive appraisal clarified my understanding as well. I think it is very important that the client gains awareness of these appraisals during therapy sessions to best help them outside of therapy. In regards to becoming a therapist, I agree that it is best to be realistic at this point in our education. We cannot expect to know everything about CBT with only one semester of classes completed.

      Reply

  6. Esther Konadu
    Jan 23, 2023 @ 18:54:28

    From my understanding, cognitive appraisals are a review system to see how much of an impact a situation has on a person & what they could do to respond to the situation. The reading talked about this concerning anxiety, which made it a bit clearer for me to understand. When I get anxious, I can trace it to a specific situation (presenting in class, talking with certain relatives) – a primary appraisal. Then, the secondary appraisal is my approach to dealing with what I am feeling (either knowing that I can face it and give it a try or just feeling sick to my stomach about it). This plays into what coping mechanisms that can be utilized to address the appraisal and the intensity of those coping mechanisms. In CBT, appraisals and coping skills are usually discussed to see what a client has done in the past that either worked or did not for them. Asking these types of questions lets therapists know how to guide the conversation. There is no point in suggesting something to a client that does not work for them, that could damage the therapeutic relationship & the rapport built. On the other side, knowing how a person copes in reaction to certain events or stimuli is very useful when coming up with potential skills to introduce. In the end, knowing all of this boils down to hearing & respecting all aspects of a client and using what they have shared to come up with an action plan that they would be open to trying.

    My first impression is that I think I underestimate my ability to apply these principles. I get stuck in my head and think that I would be terrible. Reading about and hearing about how terrible some therapists are, gives me a good sense of fear. But thinking about it and taking stock, I think I could apply these principles. Especially realizing how everything we have learned is fitting together, makes it seem more approachable than it did when we first started last semester.

    Reply

    • mikayladebois
      Jan 24, 2023 @ 12:25:12

      Hi Esther!
      I totally agree that a lot of my worries about doing CBT are unfounded. I feel like as we continue to take this class specifically we will grow in confidence. I also agree that hearing about less-than-impressive therapists makes me worried about what my first years will be like.

      Reply

    • Whitney Andrew
      Jan 24, 2023 @ 21:37:10

      Hi Esther!
      I really liked the anxiety example too and it helped to see these concepts applied to an example many of us can relate to.
      I also am right there with you in that I underestimate my ability to apply these principles. It is super scary to hear about the awful therapists in the field, but you definitely will not be one of them! You have done amazing so far and you so got this!

      Reply

    • Maria Nowak
      Jan 27, 2023 @ 19:43:34

      Hi Esther!
      I like how you made your examples of primary and secondary appraisals to you. I feel like we can better understand concepts when we are able to apply them to ourselves. It is also great how you were able to apply the coping skill to the therapeutic relationship. It is so important to figure out the best coping skills for our clients so they are able to get better and for us to build the therapeutic relationship stronger.

      Reply

    • Ashley Millett
      Jan 28, 2023 @ 09:20:43

      Hi Esther,

      I like your example of cognitive appraisal using primary and secondary. I think it is always easier to understand a term when we can use it or can relate to it in our daily lives. I also agree that knowing someone’s coping skills is easier for the therapist to understand to make potential skills for the client. I also underestimate my abilities to apply the CBT principles. I think once we keep practicing them, I think it will be easier down the line. It also does not help that there are some terrible therapists out there but we can learn from them along with the program we are in!

      Reply

    • rena yaghmour
      Jan 28, 2023 @ 10:33:20

      Hi Esther,
      I feel the same way when it comes to the thought of using CBT. I constantly like myself out even though I use a baby amount of it at work and it goes completely fine. I think the idea as a whole is a bit scary especially because we are now getting into the nitty gritty of it but the more, we learn about it and the skills and techniques I am sure we will do just great!

      Reply

  7. Olgena Pano
    Jan 24, 2023 @ 13:56:24

    1)My understanding from the readings and the lectures is that appraisal is the process of evaluating the perceptions we perceive /receive of the feelings linked with a certain situation. Based on Dr.V lectures, this process was also described as the part between the situation and the response/reaction of the individual. In addition, during this process we as individuals examine and evaluate our perceptions based on past-event’s experiences that could be positive or negative ones. In other words, the process where we evaluate and perceive this primary appraisal as a threat or a challenge, determines how our emotions and feelings would lead us to with adaptive or maladaptive coping techniques.
    I think that lectures provided great examples linked with adaptive and maladaptive coping strategies such as:
    o (Taking an exam) For instance when perceived as a challenge an appraisal could lead to adaptive coping strategies. For instance, the individual could perceive the stressor as a motivation to work and study harder, expand is knowledge, show his skills etc.
    o On the other hand, when perceived as a stressor the appraisal process could lead to negative emotions and feelings, that could lead to greater levels of anxiety, and therefore maladaptive coping strategies.
    However, based on the examples given in the lecture/readings I think that is important to remember that the outcomes of these perceptions also depend on how accurate or relevant they are.
    Lazarus’s and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT is that similarly both these approaches highlight the importance and the origin of thoughts (positive or negative ones) and how these thoughts interact with the environment and the individual’s behavior. In addition, both theories are focused on the importance or
    o tracking the situation or the event that causes the stressor
    o evaluating the emotions and feelings perceived by this trigger,
    o exploring and identifying the adaptive or maladaptive copping strategies that the individual uses
    o adopting new coping strategies
    2)The real first impressions I had of CBT started last semester, where we had to practice various role plays and got introduced with the different stages of the therapeutic process. At the current point I feel confident that by learning, reading, observing professionals, using the right sources, not forgetting the principles and ethical codes, and always improving the skills I have will be the key for a successful future of applying CBT. I am confident that with hard work I will be able to expand my abilities, but I am also aware that I lack experience practicing with clients. Currently working as a behavior therapist(paraprofessional) I try to apply the best way I can all I am learning, so that my client benefit and experience as much as possible the therapeutic benefits during their sessions. Even though that I believe that I have skills, I always keep in mind that two minds are better than one, and I aware of my limitations, that I hope to reduce as I gain more knowledge and experience in the future.

    Reply

    • Esther Konadu
      Jan 27, 2023 @ 16:02:58

      Hi Olgena,

      As you were saying, many different outcomes are depending on how someone perceives a stressor. It all depends on how you look at it and your response to a stressor. And working with you last semester and practicing some CBT skills, showed me that you are talented! You always made sure to address the said and unsaid things in our practice and it made me trust and believe in you. I hope it all goes well for you!

      Reply

  8. Ashley Millett
    Jan 24, 2023 @ 20:05:12

    I understood cognitive appraisal as almost taking a risk for a situation. Lazarus’ and Folkman talked about cognitive appraisal as the individual evaluating a certain situation as being useful to their wellbeing. For me to understand it, I thought of it as taking risks about a situation. “Will I take this risk to hopefully benefit myself or will I take this risk and have a drawback in my life?” With also evaluating the situation, the individual would also need to see how beneficial or detrimental it can be to their life and well-being. An example of this could be if someone wants to dye their hair a color outside of the usual norm. The individual would evaluate the idea and see if it is relevant to their well-being. For the individual, it could potentially harm or benefit their self-esteem. The individual might also evaluate if their friends and family like it or hate it. This also boosts or deflates someone’s self-esteem because the opinions of their friends and family might matter to them. However, someone might be obsessing over these opinions or self-esteem which can cause stress in the individual’s life. Cognitive appraisal relates to CBT because it can change distorted thinking that are causing issues in their life. For a positive side of CBT and cognitive appraisal, it can help the client fully process what is going to happen during each situation. Someone can evaluate what might happen in a situation but CBT will allow them to evaluate the situation inside and out. I understood coping as someone trying to take their mind off either a stressful situation or their mental disorder. An individual would try to either reduce, minimize, or tolerate either the situation or mental state by using coping. There are two types of coping; problem-focused and emotion-focused. Problem-focused is trying to cope due to a stressful situation such as an exam, something at work, or trying to finish homework. This could be taking breaks, getting more sleep, eating healthy and more. Emotion-focused is trying to cope due to inner emotions being overloaded. This would include having a panic or anxiety attack, a depressive episode, and more. Some who cope with this will do activities such as grounding techniques, deep breathing, coloring, and much more. Coping is relevant to CBT because coping is a big part of CBT. Therapists will teach their clients coping skills just in case a stressful situation starts to arise. Clients will learn how to help themselves during stressful moments or stressful well-being.
    I kinda feel confident in my ability to understand and apply the basic principles of CBT. I am still new to the whole world of CBT. Though it was taught in undergrad, it was not fully defined. With graduate school, I am now able to dive deep into CBT and how to apply it in the future. Luckily, I will gain the necessary experience I need through Assumption and real life experiences. Something I have always said is that with enough practice (real experience and classroom), I would then begin feeling more confident with CBT.

    Reply

  9. Whitney Andrew
    Jan 24, 2023 @ 21:29:25

    Cognitive appraisal, as outlined by Lazarus and Folkman, is an individual’s response to stimuli to determine whether or not that stimuli should illicit a negative emotion, usually stress. This is related to the concepts of CBT as it is reminiscent of reciprocal determinism in a way. The individual, with cognitive appraisal, is able to decide how they wish to react to the stimulus at hand that is presented through the environment and affects their behavior for a response.
    Coping is then defined as responses to stressful appraisals that attempt to manage external and internal environments. This adjustment of thinking is relevant to CBT as it is all about changing thinking to better response to life events. Coping is specific in focusing on just taxing stimuli, which is why it is set aside from other CBT practices.
    My initial impression when prompted with this question is that I am not ready to be thrown in with all of what CBT has to offer, but I do feel comfortable with smaller aspects of it that I find myself using in my everyday life. I do feel very positive and hopeful about my abilities growing but I am very aware that there is much work to be done to not entangle everything when practicing therapy.

    Reply

    • Emily Forde
      Jan 25, 2023 @ 16:28:19

      Hi Whitney! I really like how you brought up how cognitive appraisal is very reminiscent of reciprocal determinism. As I was writing my response, this was not something I immediately thought of but can see the similarities between the two. In both reciprocal determinism and cognitive appraisal, the areas that impact an individual’s life are observed and connected to the person’s feelings and behaviors. Regarding our comfort level with CBT, I also mentioned that I have noticed myself naturally using some of these skills in my work and daily life. As we increase our awareness and knowledge about CBT, we are able to better identify our confidence and utilization of these skills.

      Reply

    • Maria Nowak
      Jan 27, 2023 @ 19:36:07

      Hi Whitney!
      You made really good connections with cognitive appraisal and CBT. I like how you described both cognitive appraisal and coping with two different examples of how they connect to CBT. It is important because cognitive appraisal and coping are two different concepts. They do go hand in hand but it made me understand the two different connections better in a simplistic way.

      Reply

  10. Lucy Rising
    Jan 25, 2023 @ 08:48:16

    Cognitive appraisal is the process in which an individual judges/evaluates their situation and how to effectively respond (either behaviorally or cognitively) to that situation. This relates to our understanding of CBT so far in that it puts emphasis on the interaction between a person’s cognition and their environment. It also shows how when a person becomes distressed it is not, necessarily, the environment or their feelings that is the issue, it is an incorrect cognition (that is, an overvaluation or undervaluation in cognitive appraisal). It is when the evaluation of going to the grocery store is overvalued to be extremely dangerous in anxiety patients, or the undervaluation of certain risk taking behaviors in bipolar patients that causes the distress and should be the focus of treatment. As we’ve said in class many times already, feelings are always valid, but thoughts aren’t always. Coping is the process in which an individual deals or manages with stimuli that are stressing. This relates to CBT in that it is another way we conceive of ourselves as being related to our environment, thoughts, and feelings, and how that triad interacts with our conception of self.
    When it comes to learning cognitive behavioral approaches to therapy I feel like I am being thrown into the deep end. I’m not just learning how to do therapy, I’m learning how to do a more specialized and, as a result, more difficult form of therapy. And having never been in that type of role before, I am very nervous for my first few weeks in sessions with clients. All the history and theory stuff I feel very strongly that I know and understand, but theory does not translate to practice. I am a pretty anxious person to begin with, so I cannot tell if my anxiety is justified or is just an overvalued cognitive appraisal. I’m hoping this class and CBT assessment for adults class this semester increases my self-efficacy for this summer.

    Reply

    • Emily Forde
      Jan 25, 2023 @ 16:29:01

      Hi Lucy! I really like the point you made reading cognitive appraisal that the distress is not a result of the environment, but rather is a result of an incorrect cognition. I think this is important because it provides the opportunity for change and growth. There are some environments present in an individual’s life that cannot be changed. Because of the emphasis on the incorrect cognition rather than faulty environment, the client is able to feel like they can change and are not stuck. As far as us using CBT in session and our comfort level, I agree that it is very stressful. I think it is totally normal to be nervous for the first few sessions, so I would say your anxiety is justified. It is nerve-wracking to start something new, especially when others are involved. I have no doubt you will be a great therapist and will become more confident as we learn more and practice our skills throughout internship.

      Reply

    • Taylor Poland
      Jan 25, 2023 @ 17:37:19

      Hey Lucy,
      I really like your explanation of cognitive appraisal and its connection to CBT. The examples you provided also helped me gain further clarity on the connection between the two ideas. Our mind is very interesting as our perception/cognition has the ability to give a deeper or different meaning to something which plays into the overvaluation or undervaluation in cognitive appraisal. As for how you are feeling about becoming a therapist, I totally understand where you are coming from. I feel as if I have a good understanding of the material but no clinical experience in a therapeutic setting to apply my knowledge. I think that you are a very capable individual and should trust in your education/knowledge to help you through the first few sessions of therapy. You got this!

      Reply

    • Stephanie Lugo
      Jan 26, 2023 @ 17:26:23

      Hi Lucy,

      I totally understand where you are coming from about feeling lost in regard to CBT. I also feel like we have been learning so much in such a short period of time, yet it doesn’t seem like stuff we are able to actually apply when we are sitting in front of a client for the first time. I also feel relatively confident in the assessments and diagnosis and theory of CBT, but in regard to the actual counseling, I am still nervous about it. I am very much a hands-on person, so I am hoping I will become more confident as we actually start to practice and work with individuals who do this for a living. I can’t wait till I can actually sit in on and observe a CBT counseling session. I think that this will give us a better view and understanding of what we are supposed to do. No matter how many videos we watch, books we read, or mock therapy sessions we complete we will never feel a hundred percent confident with it till we work with our clients. Learning, growing, and making mistakes in the field are what will help us learn.

      Reply

  11. Emily Forde
    Jan 25, 2023 @ 14:24:43

    In relation to CBT, cognitive appraisal is the way that we perceive and respond to stimuli in our environment and its impact on our behaviors and emotions. In CBT, perceptions play a crucial role by influencing our behaviors and emotions and are simultaneously influenced by these same things. Coping, based off the Lazarus and Folkman readings, is the ability of an individual to manage stressors in their life. I think it is important to understand that coping only plays a crucial role in one’s mental wellness if they define the stimuli as a stressor. If the stimuli is something the individual is used to and is not distraught by, coping skills would not be as pertinent because this stimuli is not a stressor for this individual. Each person has a different set of coping skills, that are formed due to a number of influences, such as environmental stressors.

    As I have learned more and more about CBT, I am starting to feel slightly more comfortable in applying the principles in therapy. I am hoping to become more confident in utilizing these skills and putting the principles in practice as I learn more about the principles and as I practice doing actual sessions in internship. I feel like I often underestimate my skills, but it is reassuring to learn more about these skills and observe how they tend to feel pretty natural to me. Now that I am aware of some of the main ideas of CBT, I feel like I am noticing them more throughout my work and my daily life and the way that I interact with people.

    Reply

    • Gitte Lenaerts
      Jan 26, 2023 @ 08:32:13

      Hi Emily, I like your response on coping as it is a way to manage stress. I completely agree that coping is a crucial role in one’s mental health. It is how we handle stressful events and appraisals. It is important to find and use effective coping skills as they are many coping skills that can be damaging such as oversleeping, drug or alcohol use, avoidance, etc. I also agree with your statement on noticing the main ideas of CBT in your personal and professional life. I have noticed that with myself as well! It definitely makes me think more about the people in my life and my work. Great post!

      Reply

    • Magdalen Paul
      Jan 26, 2023 @ 16:56:31

      Hey Emily, I like your point that coping is more relevant for people after appraising an event/situation as a stressor. Therefore, it is crucial to understand the nature of a cognitive appraisal to determine if coping is actually indicated. When a cognitive appraisal is positive and not suggesting a stressor or threat, coping skills will likely not result. Though, it is the mismatch between appraisal and reality that can bring about coping skills, whether adaptive or maladative, that present within the individual and can cause further unnecessary stress OR be helpful.

      Reply

    • Stephanie Lugo
      Jan 26, 2023 @ 18:58:39

      Hi Emily,

      I really like how clear and concise your definitions are for cognitive appraisal and coping. These two terms really do go hand in hand. It is essential for individuals to learn how to use coping mechanisms when they are responding to stressful situations in the environment. Both terms relate to CBT because without one you really can’t have the other. You make a great point about every individual having different coping mechanisms. Not all coping skills will work for every individual. That is why it is essential to offer a client multiple different types of coping mechanisms that they can try during stressful situations. Having options allows the client to try multiple skills during the time when they are experiencing a stressful situation. This will give them many options to try till they are able to find one that works for them.

      Reply

    • rena yaghmour
      Jan 28, 2023 @ 10:28:01

      Hi Emily,
      I think it is so important for individuals to recognize that coping skills don’t necessarily work all the time especially in the cases that someone is using a coping skill for a stimuli that is not a stressor! I like how you mentioned that everyone has different set of coping skills because majority of the time coping skills for one wont work for someone else. In therapy it is so important to find what works for the individual and what doesn’t so they are able to work on their mental health.

      Reply

  12. rena yaghmour
    Jan 25, 2023 @ 15:04:00

    My understanding about cognitive appraisal is how a specific environment or situation impacts an individual and it is more so dependent on how the individual interprets the situation they are faced with. Though these appraisals are put into two categories primary and secondary appraisals. Primary appraisal refers to the situation at hand that either makes the individual feel safe or stressed. The reaction that follows is considered the secondary appraisal. Depending on how the individual feels in the primary stage is what leads them to react the way they do. If an individual has a fear of public speaking and has to present in front of a whole auditorium their secondary appraisal might be how anxious they get and not feeling well whereas if another individual likes public speaking and is asked to do so they might show excitement in their face and body language. An individual who experiences threatened, challenged, or stress are typically suggested to use some sort of coping skill. Coping skills are used to help reduce the threat, challenge, or stress an individual might experience that comes with cognitive appraisal. Each person has their own coping skill that is designed to work for them and by identifying shopping skills that work best for them that’s what allows them to work on reducing the stressor in their life.

    My initial impression is I am not quite sure how well or effectively I will be able to apply CBT into my sessions. However, the more I learn about it the more I tell myself it isn’t that bad and might not be that hard. I might just be siking myself out especially when I do slight cbt work with some of the kids i work with now.

    Reply

    • mikayladebois
      Jan 25, 2023 @ 20:49:03

      Hi Rena, I liked your explanations of appraisals and coping skills! I think we feel similarly about using CBT in our professional lives. I will sometimes read the theories or tactics and see that I already do something like that when interacting with students and friends. Having that early practice will hopefully make things easier in our practicum and internship!

      Reply

    • Ashley Millett
      Jan 28, 2023 @ 09:28:54

      Hi Rena,

      I like your explanations of appraisal while using primary and secondary. It definitely gave me a better understanding of the two. I also like the example you used as well! I also agree with what you said about coping skills being different for everyone. Everyone is different and we all react differently to certain things. Though we can suggest something, it may or may not work well for some. I also agree with what you said about the more we learn about CBT, the easier it might be later down the line.

      Reply

  13. Taylor Poland
    Jan 25, 2023 @ 17:26:53

    I understand cognitive appraisal to be the process of categorizing an encounter by evaluating its meaning and significance. This evaluation helps the person determine if a stress response is required to handle the stimuli or not. These appraisals are separated into two different categories: primary appraisal and secondary appraisal. Primary appraisal involves determining whether the stressor is a threat whereas secondary appraisals involve evaluation of the stressor to determine the strength and quality of the reaction. The idea of cognitive appraisal is related to CBT because perception is a key aspect of both concepts. How one interprets a situation has an effect on their thoughts, emotions, and environment. Based on the readings, coping is the process of managing stressful external factors. In CBT, we want the client to learn effective strategies to help them cope with the stressors in their lives. We all have different coping strategies to minimize one’s stress such as listening to music, working out, painting, or talking to a friend.

    As I have learned more about CBT, the less stressed out I feel about becoming a therapist. During the first few weeks of the fall semester, I doubted my ability to effectively help clients. However, now that I have a semester under my belt, I feel much more confident in my ability to apply the basic principles of CBT as a therapist. In her book, Judith Beck brought up a good point for new clinicians entering the field; do not compare yourself to experts in the field or your professors- they have years of experience over you. If you compare yourself to anyone, you should instead compare yourself to peers in your class as they are at the same point as you developmentally. By no longer comparing myself to individuals with years of prior experience over me, I started to feel a bit better about where I am at with CBT.

    Reply

  14. Abby Sproles
    Jan 25, 2023 @ 18:07:51

    Lazarus and Folkman conceptualize cognitive appraisal as the process of perceiving, judging, and choosing an emotional or cognitive response to an external stimuli. Individuals experiencing the same stimuli may have different reactions due to differing cognitive appraisals. One’s primary appraisal helps us assign value to a stimulus. If someone appraises a stimuli to have positive outcomes, this will produce positive emotions; however, another person can appraise the situation as a threatening stimulus based on their perception and personal experience. In relation to CBT, cognitive appraisals demonstrate thought patterns that, in turn, influence our thoughts, emotions, and behaviors. Secondary appraisals cause individuals to evaluate potential coping strategies toward the stimulus. The authors describe coping as the process of regulating internal or external stressors. Like cognitive appraisals, coping strategies toward similar stressors may look differently across individuals. Depending on the context, an individual may use an emotion-focused coping skill to help regulate their emotional response. On the other hand, one may utilize a problem-focused coping strategy to manipulate the stimulus itself. In CBT, it is important for therapists to understand the client’s commonly used coping strategies, and determine if they produce sustainable reductions of distress. By identifying the relationship between one’s cognitive appraisals and coping strategies, the client can work toward practicing adaptive thought patterns and coping mechanisms.
    My first impression of CBT is that I feel confident yet intimidated in applying the principles within the therapeutic process. While the cognitive theories of Bandera, Lazarus, and Folkman are complex, I feel that I generally understand the connection between our thoughts-emotions-and behaviors. I feel that I will become more confident in these cognitive theories once I see them play out when working with clients.

    Reply

    • Esther Konadu
      Jan 27, 2023 @ 16:36:18

      Hi Abbey,

      I feel like with most things, putting CBT skills into practice and using them regularly will make you feel less intimidated. And I know you already have a bridge to working with people in career counseling, so I know CBT is just another supplemental layer to what you already know. I am nervous too, but I certainly think that you will do amazing once you get into the habit.

      Reply

  15. Gitte Lenaerts
    Jan 25, 2023 @ 19:29:01

    Cognitive appraisal, from my understanding, is how we assess and interpret situations. How I see it, is that a situation occurs and before we respond and act, we take time to appraise the moment. This includes evaluating, thinking, feeling, judging, etc. It is after appraising a situation that we react and have a response. Following that, coping can act as a response to our cognitive appraisals. Coping is how we handle stressful appraisals, cognitively and behaviorally. This process is consistently changing and adapting to relieve stressful appraisals and events. Coping skills help either restore, block, or work through negative moments. Both cognitive appraisal and coping skills link with CBT as they work with our thoughts, emotions, and behaviors. Furthermore, coping skills are a fundamental point of CBT, and allow clients to learn how to manage their feelings, thoughts, and behaviors. Similarly with cognitive appraisals, as it is the mediator between events and responses, shows how our thoughts and feelings link with our behavior.

    One of the reasons I applied to Assumption is the emphasis this program has on CBT. This attracted me to the program as in my undergrad experience, my professors talked a lot about evidence-based practices and CBT. With that, the residential program I work at is built on CBT. However, this is the first time I am really getting an in-depth look at CBT and completely dissecting it. Though there have been a lot of readings, they have actually been very interesting to read. It almost feels like I’m not doing homework! I feel like I understand the basic principles of CBT and am excited to learn more. I do get the occasional, “this is a lot of information, how am I going to constantly apply this and not forget it” thoughts, but this is only my second semester and I have so much more to go.

    Reply

  16. Melissa Elder
    Jan 25, 2023 @ 20:44:12

    My understanding of Lazarus and Folkman’s conceptualization of cognitive appraisal and coping in relation to CBT is that cognitive appraisal is the process of evaluating and understanding situations. When in a situation you start by evaluating and processing the situation to know how to respond. Depending on if one’s thoughts are positive or negative can impact how an individual responds and copes with the situation. Although all of these thoughts are occurring within a few seconds the individual is always impacted in some way. For instance, I have thought so badly about a situation to the point where I made myself sick to my stomach because I was so anxious, when it ended up turning out fine and if I had just had positive feelings around it to start with, I would have been able to enjoy myself rather than stressing the entire time. Coping occurs after the situation has happened, this can look different depending on the individual and how they cope. Some individuals may cope with their emotions while others might be in problem-solving mode. Cognitive appraisal relates to CBT due to both emphasizing the importance of our thoughts no matter if they are positive or negative. How we think relates to how we interact with the environment around us and how we behave. This can help understand how individuals deal with certain situations and can assist in the treatment process.
    My impressions of my ability to understand and consistently apply the basic principles of CBT are moderate only because of the applying portion. I do feel like I am really understanding the basics of CBT, especially within this past week’s reading, however, I don’t know how much I could necessarily apply it if I had clients to apply it to. I am more of a hands-on learner. I need to observe and then apply myself, that is how I learn best. I am hopeful that my practicum and internship will really make me confident in using CBT skills.

    Reply

  17. Maria Nowak
    Jan 25, 2023 @ 20:44:46

    There are 3 different types of appraisals that include, primary appraisal, secondary appraisal, and reappraisal. Primary appraisal can be described as when a person puts meaning to an event or potential stressor. Secondary appraisal is when an individual is trying to cope with a stressful event. Reappraisal is when an individual further assesses the situation and will likely be thinking more clearly. For example, in the event that your job has to close for a day due to routine maintenance. This can be evaluated as good, bad, or indifferent. During primary appraisal the situation would be assessed. It can be good because you have an extra day off, bad because you are losing out on money, or you can feel indifferent about it. Secondary appraisal for this situation would be coping. In this case it could mean trying to figure out a way to make up the money for a missed day at work. Reappraisal for this situation would be to reevaluate likely after doing some thinking on how to best handle this situation. This is related to CBT because it involves our feelings, behaviors, and environment interacting with each other. The basis of CBT is to change thinking and behavioral patterns. It also involves learning coping techniques to be able to deal with life stressors in a more effective way.
    My initial impressions in my ability to understand and consistently apply CBT as a therapist is that I have some confidence. I understand that our personal factors, behavior, and environment impact each other. I also believe that the more I utilize CBT the more I will feel comfortable doing it. After this semester when we start our practicum is when we will truly learn how to utilize it effectively because we are physically doing it.

    Reply

    • Abby Sproles
      Jan 26, 2023 @ 15:21:33

      Hi Maria, your example helped me understand the interactions between primary, secondary, and reappraisals. It is important for counselors to understand that an individual may have different simultaneous primary appraisals of a stimulus, thus causing a variety of reactions. In your example, the person may have first appraised their day off as positive, creating positive emotions, but soon appraised the situation as a stressful challenge, making them motivated to find an extra source of income. Therapists should assess the client’s cognitive reactions/appraisals toward stressful stimuli to understand the motives behind coping strategies.

      Reply

  18. Megan VanDyke
    Jan 26, 2023 @ 08:17:27

    My understanding of cognitive appraisal in relation to CBT is how we perceive an event, thus shaping how we respond and choose to cope with it. The primary appraisal reminds me of automatic thought processes, in that we immediately detect the event as a threat or challenge, then consider how to respond appropriately in the secondary appraisal to create a change in the reappraisal. Coping happens in the secondary appraisal and focuses on changing the thoughts and feelings in the primary appraisal. CBT is similar in that it involves a conscious effort to alter harmful thoughts and feelings to change behaviors that lead to maladaptive outcomes. For instance, at first glance, large assignments seem overwhelming and often lead me to experience the “stressful-threat” primary appraisal. Most often, my natural secondary appraisal is to panic and cope by lessening emotional distress (pretending it doesn’t exist), but that does not help me cope with the fact that the assignment is still there and has not changed. When I’m emotionally ready to handle the “threat,” I use cognitive reappraisal to view the large task as several smaller tasks broken up over time to rationalize it as a more manageable assignment, thus modifying the primary appraisal.
    As of right now, I’m becoming comfortable with being able to apply CBT principles consistently. Of course, it’s easier said than done, but I’m working on changing my perception of the idea of being “the perfect therapist.” Between this and last semester, I’ve learned that being “good enough” is what is expected of me, and that learning CBT is a lifelong process. Judy Beck recommended the use of worksheets and practicing CBT with oneself to enhance growth in skills. I’ve used CBT worksheets from Therapist Aid with individuals served at the group home I work in. Still, to increase my confidence in teaching it to clients in therapy sessions, I’m going to try using them on myself more regularly.

    Reply

    • Gitte Lenaerts
      Jan 26, 2023 @ 13:19:54

      Hi Megan, I like how you explained cognitive appraisals in relation to CBT! I agree, primary appraisals are similar to automatic thought processes as we assess the event as either a threat or challenge. As you mentioned this leads to secondary appraisals which is where we begin the coping process. I appreciate you sharing your example with school! That was a great way of showing the motion of this process in a relatable way! Great post!

      Reply

  19. Magdalen Paul
    Jan 26, 2023 @ 14:04:53

    Lazarus and Folkman explain that a cognitive appraisal reflects the unique and changing relationship that takes place between a person with distinct characteristics and an environment whose characteristics must be predicted and interpreted. Further, it is not simply the stimuli or physical environment that necessarily determines one’s physiological response, but one’s evaluation of these stimuli. This relates closely to the CBT concept that emotions and behaviors are influenced by how we perceive situations. It is not the event or stimuli alone that produces physiological responses/emotions/behaviors, but rather largely how an individual interprets that event or stimuli. Similarly, coping is described as the constantly changing cognitive and behavioral efforts to manage internal or external demands appraised as taxing or exceeding the resources of the individual. Therefore, it appears that one’s cognitive appraisal within an environment more or less leads to the process of coping. As with CBT, depending upon one’s perception of an environment/event/stimuli, emotions and behaviors adjust more or less adaptively to help the individual cope—though, depending upon the nature of the perception/appraisal, emotions and behaviors may present as maladaptive.

    I feel that I have a growing knowledge in the basic principles of CBT. When learning about these principles and basic concepts, they grow more and more applicable, and the ease with which you can practice on yourself seems to grow. As Judith Beck explained, applying the knowledge to yourself and practicing some of the exercises yourself that you would offer to a client, helps solidify the concepts and enhance understanding. As far as applying CBT principles as a therapist, I think that with time it will come naturally to speak in “CBT terms” after repetition and exposure. It is interesting how the internal dialogue, even explaining to myself what CBT is and practicing with my own thoughts, feels simple. When trying to explain CBT principles to other audiences, simply verbalizing what I know to friends/family, it feels less natural. With time and practice, I am excited to witness my increasing comfortability with CBT.

    Reply

    • Abby Sproles
      Jan 26, 2023 @ 15:13:10

      Hi Magdalen, I completely agree with your impressions of CBT. In the first chapter of Judith Beck’s book, I appreciated her description of her growing confidence in CBT, as it took her many years to become comfortable with applying the principles of CBT into the therapeutic process. Just like our future clients, we may have negative automatic thoughts that tell us that we are incapable of being a good therapist, but with practice, applying the principles of CBT will become second nature to us, and we will challenge the validity of these thoughts.

      Reply

  20. Grace Ling
    Jan 26, 2023 @ 15:02:41

    Cognitive appraisal is the process of interpreting an event in the environment which results in a response to the event that occurred. There is an element of momentary psychological evaluation of the event that may determine one’s response. Primary appraisals are interpretations of events that determine whether one is in a situation that is beneficial or advantageous. Secondary appraisals involve whether a response can be made to either overcome an upcoming threat or benefit from a positive encounter. Another related concept to appraisals is coping. Once a response has been made to an event, coping allows for individuals to manage the aftereffects of stressors. Within the context of CBT, it is important to understand clients’ differing cognitive appraisals and the methods they use to cope after experiencing stressful events, or events they consider to be stressful. Those with maladaptive functioning may perceive events with no implications for their well-being as potentially stressful threats and may cope differently from those with more adaptive functioning.

    I think my first impression of CBT was that everything lines up and makes sense theoretically. I think I may struggle more with applying the principles because I tend to psych myself out. It may have to do with me wanting to stick to the principles and being a little but rigid in performing everything to the T. But I think once it is time to face clients and really get into the field, the skills will come more naturally with more practice.

    Reply

    • Magdalen Paul
      Jan 27, 2023 @ 14:11:00

      Hi Grace! I totally agree that, especially at first, we may experience some rigidity in our performance and application of CBT. I find it possible, at least for me, that I may overthink the various tenets of CBT and “get in my head” at times while trying to help a client. Though, after more practice, I believe that we will be able to apply the principles with more ease and confidence. It is exciting to think that eventually (even if far down the road) CBT will feel more or less like a second language to us. From there, it will be neat to explore the art of counseling/therapy with more flexibility in meeting clients’ needs (like integrating the various subforms of CBT listed in Judith Beck’s book).

      Reply

  21. Jonas Horan
    Jan 26, 2023 @ 15:52:34

    (1) Cognitive appraisal, as discussed by Lazarus and Folkman, is the cognitive process of assessing stimuli (primary appraisal) while also assessing our coping abilities and resources for dealing with stressful stimuli (secondary appraisal). Stimuli are categorized as benign, stressful, or irrelevant. Furthermore the authors break down our appraisal of stressful stimuli into things that are perceived as harm or loss, things that are perceived as an active threat, and things that are perceived as a challenge to be overcome. These categories are important to CBT because they involve rapid assessments that are not unlike automatic thoughts. Our beliefs about ourselves, our goals and values, play a significant role in our appraisal of situations and how we relate to them. For example whether we view a situation as threatening or challenging depends not only on our resources but on our self-efficacy.

    Lazarus and Folkman also discuss coping. Coping with stress and challenge is an important part of life and CBT. The topic seems especially relevant in regards to coping resources. Resources mentioned like social and problem solving skills, and positive beliefs, are often points of contact for CBT interventions. CBT is always concerned with bolstering clients in these areas by practicing skills, strategizing, and reframing maladaptive beliefs in a more positive light.

    (2)The recent reading on the basics of CBT has been encouraging. I know that there is a lot to it but having it broken down to its fundamental principles makes it sound easy and simple! I really appreciate how systematic it is. I expect that the structure of it will be helpful when I’m learning how to apply the principles! Generally CBT seems like something that is easy to learn but difficult to master. I look forward to being able to practice.

    Reply

    • Melissa Elder
      Jan 27, 2023 @ 15:25:04

      Hi Jonas,
      I like how you started off with explaining cognitive appraisal and breaking it down into primary and secondary. I totally neglected to put that into my post, you provided a better way of understanding appraisal so thank you. I really appreciate you saying that CBT seems easy to learn but difficult to master, I find that true. I am also very eager to begin to practice it.

      Reply

  22. Stephanie Lugo
    Jan 26, 2023 @ 17:10:07

    1)
    After listening to the lectures and reading the assigned readings I understand Lazarus’ and Folkman’s conceptualization of cognitive appraisal in reference to CBT as a way for an individual to analyze and assess any stressors and events that occur in the individual’s environment. It also helps the individual understand why we perceive certain feelings linked to different environmental situations. In regards to CBT, this concept helps individuals determine if the stimulus they are experiencing is stressful enough to elicit negative emotions. This allows an individual to determine how they should react to given situations. Once an individual develops these skills they will be able to learn coping mechanisms. Coping is defined as any thoughts and behaviors that the individual uses to manage internal and external stressful situations. Coping mechanisms allow an individual to calm themselves either during or after a stressful situation. Both cognitive appraisal and coping are extremely important in CBT. CBT is all about changing the way you think and in turn how you behave to certain situations and stressors that arrive in your life. Both are important to be able to deal with the different situations that are bound to arise in your life.

    2)
    As of now, I feel okay with my knowledge of CBT and its basic principles. I currently work as a Registered Behavior Technician so I am not worried about rapport building with the client as I have to currently do that with the clients and families I work with. I am more nervous about knowing how to communicate with clients from all different backgrounds. My Internship starting this summer is going to be in an inpatient setting so I know the population will be more diverse than the group I work with currently. I would feel more confident if we have done more mock CBT sessions. We did a few in my counseling class, but other than that we have not don’t that much. I do feel relatively confident in the assessment aspect of CBT and diagnosing certain disorders. I am someone who learns more when I am hands-on and actually practicing the skill. That is why I am very excited to start the practicum this summer and learn real hands-on experience.

    Reply

    • Melissa Elder
      Jan 27, 2023 @ 15:19:15

      Hi Stephanie,
      I really enjoyed reading your understanding of cognitive appraisal and coping. I wish I had gone into more detail surrounding coping in my post as it is an important aspect of this whole process. As far as applying CBT I understand 100% what you mean about dealing with a very diverse population. I also am a huge hands-on learner so this practicum and internship will be huge for my learning process. I wish you luck on your internship, I am sure you will do great!

      Reply

    • Jonas Horan
      Jan 28, 2023 @ 12:29:36

      Hi Stephanie. Even though you’re only working with a specific client group, I’m definitely jealous of your experience! It sounds like a tough job but I still wish that I had more experience in the field before practicum.

      Reply

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Adam M. Volungis, PhD, LMHC

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