Topic 3: Therapeutic Relationship & Session Structure {by 2/2}
There are multiple readings due this week (J. Beck – 3 chapters; Volungis – 2 chapters). For this discussion, share at least two main thoughts: (1) What is your understanding of the therapeutic relationship in CBT (include collaborative empiricism in your discussion)? (2) Why is it important to have session structure for effective CBT?
Your original post should be posted by the beginning of class 2/2. Have your two replies posted no later than 2/4. *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 
Jan 27, 2023 @ 15:00:23
In CBT, a good therapeutic relationship is essential to achieving the goals of therapy and keeping patients engaged. People believe that the therapeutic relationship is not important within CBT however, obviously this is not the case. This relationship is a fundamental part of CBT. Another important piece of CBT is collaborative empiricism. This can be enhanced when clients view their therapists as trustworthy and within a positive light. This requires the client and therapist to work together to figure out the issues being presented by the client. Collaborative empiricism involves the sourcing of information, offering client choice and involvement in decision making, as well as seeking client feedback. It is also the building block for Socratic dialogue and as stated earlier, maintaining that relationship. The collaboration part aims to shift more control over to the client rather than the therapist.
Having session structure for CBT ensures that the patient and therapist are on the same page and the process is clear and concise for the client. It can also help with using the session time efficiently. These structures can involve identifying problems, setting goals, and assigning homework.
Jan 30, 2023 @ 09:15:06
Hi Tiana! It is so true that having session structure for CBT keeps sessions concise and efficient. It maintains the expectation that therapy is intended to be exactly that–not just a conversation with a friend. Psychoeducation, identifying problems, setting goals, and assigning/reviewing homework, as you stated, are the goals within session–while strengthening the therapeutic alliance. Light conversation and checking in with the client is important, too, but session structure reinforces the purpose of actually implementing the necessary elements of CBT therapy.
Jan 31, 2023 @ 21:38:48
Hi Tiana! I absolutely agree that the therapeutic relationship is a fundamental part of CBT, without it I don’t think that client would see any change come to fruition at all. As for session structure, I did not even think about it being a useful tool to stay on the same page, so great point! It is definitely helpful to show the client what you are doing and where certain skills may take them in the process, so it’s good to make sure they can follow you every step of the way.
Jan 28, 2023 @ 22:19:47
My understanding of the therapeutic relationship in CBT is that the client and therapist are both active participants and work together toward mutual goals. More specifically the therapeutic relationship can be described by collaborative empiricism; this is an action oriented therapeutic alliance driven by research that integrates, tests, and works to modify clients’ thoughts and behaviors. I would consider a strong therapeutic relationship to be a significant contribution to positive treatment outcomes. In contrast, a negative therapeutic relationship can hinder a client’s progress and potentially make a client worse. In addition, it is important to note that while the client and therapist have mutual goals, the therapist’s role is to guide the client- not tell them exactly what to do. This is established to promote the client’s independence from the therapist.
Session structure is important for effective CBT to promote a stronger therapeutic alliance early in the relationship. Organized therapy allows both the client and therapist to stay focused on presenting problems and goals. Additionally, it promotes attractiveness, expertness, and trustworthiness. These aspects all contribute to developing a strong therapeutic relationship.
Jan 29, 2023 @ 15:13:54
Hi Maria! I agree with everything you said. The therapeutic relationship is super important and as you stated a significant contributor to how positively or negatively the treatment process will go. The structure of the sessions is also a helpful indicator for how the sessions will go. The organization helps create an environment for the client to successfully work and stay focused while also showing the client that the therapist is competent and trustworthy. If there is no structure, too much is left in the air and that can have serious consequences.
Jan 30, 2023 @ 13:45:48
Hi Maria! I really like your point here. No matter how well you “know CBT” in academic terms, the knowledge is likely far from sufficient to help a client, when the therapeutic relationship is poor or nonexistent. The alliance is the foundation on which CBT skills and interventions are able to flourish and resonate with clients. Without that solid foundation, the client may not care whatsoever what skills or help you propose to them. If they don’t trust you, respect you, or feel safe with you, they may not wish to engage at all. Therefore, establishing and maintaining the therapeutic alliance ought to be a top priority in therapy.
Feb 02, 2023 @ 14:07:10
Hey Maria,
I agree with you that having a strong therapeutic relationship is important for positive treatment outcomes. I really liked that you pointed out that having a negative therapeutic relationship can make the client worse. It is important to point out that without a good therapeutic relationship the treatment process as well as the client is at risk, it is essential for the client to have full trust and feel comfortable with the therapist for the best outcome as the client can fully express themselves and their thoughts. I agree with your ideas of the importance of session structure without CBT, I am wondering what you think would occur throughout the treatment process if session structure was not applied?
Feb 05, 2023 @ 19:17:59
Hi Maria,
Great post! I liked how you described how a structured sessions shows organizational skills of the therapist, and helps both him/her and the client to focus on achieving the treatment goals effectively. In addition, I think that having a structured session, makes the difference of a therapy session and a “random conversation”. Since CBT sessions are meant to be structured and not lasting for a long time, this factor should not be neglected, in order to have a beneficial therapeutic experience.
Jan 29, 2023 @ 20:00:37
The therapeutic relationship is a critical element in CBT. Having a strong therapeutic alliance sets the foundation for mutual collaboration toward setting goals and working to achieve them. It is also the platform through which a client is more likely to express themselves honestly to you as the therapist, which ultimately allows you to better understand the client and plan treatment accordingly. Collaborative empiricism is an action-oriented therapeutic alliance driven by research that integrates, tests, and modifies clients’ thoughts and behaviors. Therefore, collaborative empiricism is a form of alliance to ultimately strive for. This alliance rests on the ideal that a client ought to eventually become autonomous and capable of applying the tenets of CBT which the therapist helped teach and scaffold throughout the alliance. The therapeutic alliance encourages the client to play an active role in therapy, through a give-and-take with the therapist. The client and therapist work together to identify that which is troubling the client, and those goals which can be attained through treatment interventions. The client shifts from more reliant on the therapist for guidance as the alliance begins, and with time, it is intended that the client will become more autonomous and capable of “guiding” sessions with less influence from the therapist. This is all possible through a strong, honest, respectful, well-informed, trusting, and empathic therapeutic alliance.
It is important to have session structure for effective CBT because most clients, as well as therapists, want and need structure. Clients attend therapy because they are seeking assistance from that which is troubling them, and may even be unsure if therapy is “right” for them, which places them in a vulnerable position. Having structure from the initial session can put a client’s mind at ease, while instilling hope and comfort, and conveying your competence as a therapist. Further, as a therapist, structure will be helpful as it encourages you to enter therapy with a focus and “guide” for the session—which allows you to focus on the more important topics at hand, rather than trying to “figure out what to do next.” Consistent session structure keeps you focused on the most relevant concerns, and also helps better facilitate psychoeducation and collaboration. While some flexibility can develop within the session structure, it is important to enter a session prepared with a focus so that both you and your client feel that the session has a purpose and logical flow. Without this, you may feel unprepared, “frazzled”, less confident to conduct the session, and less able to facilitate the therapeutic alliance and subsequent interventions. The client would likely feel these things as well, and this could ultimately lead to poor treatment outcomes as comfortability and confidence in therapy would likely decline.
Jan 31, 2023 @ 21:44:34
Hi Maggie! I totally agree with your discussion post. I love how you brought up that a strong therapeutic relationship facilitates honesty. Even if the therapist is putting their full effort into the therapy, the therapy will not be effective if the client does not feel comfortable telling the truth. I found your point about session structure being a guide throughout session interesting. I think this point highlights that the time in session is limited so it is essential for both the therapist and the client to make the best of their time, which is easiest to do when there is a guide and both parties are not brainstorming what to do next on the fly.
Feb 02, 2023 @ 14:13:25
Hey Maggie,
I really liked that you pointed out that therapeutic alliance sets the foundation for mutual collaboration towards goal setting and working to achieve them. It is important that the client understands they must play an active role work towards their goals and that their therapist is there to guide them not telling them what to do or how to live. I like that you added in with time the client will become more independent and not need the therapist as much, this is important to note as the ultimate end goal of therapy is to eventually not need the therapist. I agree with everything you mentioned regarding session structure. Without structure, the client can feel confused, lost or even overwhelmed and when coming to therapy you want the client to feel comfortable and confident in being able to accomplish their goals.
Jan 30, 2023 @ 22:40:09
A strong therapeutic alliance within CBT can promote positive therapeutic outcomes for the client. It is important for the therapist and client to create goals in the early stages of the therapeutic process in order to set expectations for a collaborative approach. Collaborative empiricism is the process of the therapist and the client working together to modify maladaptive thoughts and behaviors by assessing the validity and evidence for and against them. When the client has an active role in the therapeutic process, they may be more engaged and motivated to reach their goals.
A session structure, such as mood checking, setting an agenda, prioritizing the agenda, and reviewing the action plan, is important to CBT as it ensures that the client is able to discuss issues that are pertinent or urgent. Without an agenda, the client may go on tangents and neglect to ‘work’ on maladaptive thoughts or behaviors. In addition, session structure creates a routine that makes the process of therapy clearer for clients. By instilling a routine within the session, the client may be more likely to apply the strategies learned to their lives outside of session.
Jan 31, 2023 @ 10:41:27
Hi Abby! I definitely agree with your response on the first question. There is so much good that can come from this therapeutic alliance. I also like your response to the collaborative empiricism, it is all about working together, giving the client an active role in their treatment and working through these maladaptive thoughts and behaviors. I also really liked your response to the second question as well. As we know session structure is good for the therapist and the client to efficiently make it through everything that needs to be worked through, giving both the client and therapist a clear organized session every time. However I did not necessarily think about the client just completely neglecting the work that needs to be done specifically. I figured there would be more chatting rather than productive work being done, however the client absolutely may no longer be as likely to apply the strategies learned in session if there is no structure.
Jan 31, 2023 @ 21:35:16
Hi Abby! I definitely agree that it is important to create goals for the early stages of the therapeutic process, something we talked a lot about in counseling principles last semester! I really like that term ‘active role’ to describe a client in the therapeutic relationship and think it’s important to encourage that as the therapist. I think sometimes clients may get caught up in being passive during the action stage for problem solving, when that portion is still collaborative.
I also really like the way you laid out the steps of a session structure to help paint a better picture. The mood checking being first on the list is a great idea to see how the client is feeling and whether or not the agenda should be changed based on this response.
Feb 01, 2023 @ 11:51:24
Hi Abby! I like that you mention that when a client is more engaged in their therapy that they may be more motivated to reach their goals. I agree with this, and think that part of why they would be more motivated is that through collaborative empiricism a client can learn about themselves and build some self-efficacy in a safe space that they can then apply to reaching their goals. I also like that you mentioned mood checking as part of session structure. I really enjoy this idea and think it can be helpful to center clients when they come into therapy on the here-and-now and help them to be more focused during session on what they’re working on instead of things that are bothering them outside of session that aren’t part of the agenda that day, or that don’t need to be therapeutically addressed.
Jan 31, 2023 @ 21:29:58
My understanding of the therapeutic relationship in CBT is a mutual and collaborative effort to adapt behaviors in order to reach the goals set forth by the client, coining the term collaborative empiricism. The stronger the relationship is built up by the rapport between client and therapist, the more positive the potential outcome of CBT will be. A lack of a strong relationship can be detrimental to the client’s outcomes, little to no collaboration cannot bring the client to reaching their goals.
As for session structure, this is just as important as the therapeutic relationship. Without structure, there is no guarantee that the session will remain on track to accomplish the goals set forth by the client within an adequate timeline. On top of that, an unstructured session sends the message that the therapist is unorganized and unreliable in performing effective strategies.
Jan 31, 2023 @ 21:39:37
Hi Whitney! I really like your point regarding the stronger the relationship, the more positive the outcome will be. The research behind this is incredible and really shows the importance of starting off therapy with a strong relationship. Due to the collaborative nature of CBT, I think this relationship is even more important because the client and therapist need to feel comfortable giving each other feedback and correcting one another. Additionally, I think it takes strong rapport to have session structure and to tell your client that there are things that need to be focused on. I also agree with your point that an unstructured session sends the message that the therapist is unreliable and unorganized. Sending this message can harm the therapeutic relationship and can negatively impact the client’s views on the collaboration and the effort of the therapist.
Feb 01, 2023 @ 10:44:20
Hi Whitney, your discussion on the importance of session structure was very helpful! I had not considered that an unorganized session may demonstrate incompetence or unreliability. This reminds of the discussion we had in 504 discussing the importance of the therapist’s perceived attractiveness, expertness, and trustworthiness. If the therapist and client jump from topic to topic without exploring them deeper, this provides no help to the client. A therapist can demonstrate their expertness by educating the client on the structure of CBT, setting an agenda at the beginning of a session, and prioritizing topics to be discussed. This may promote greater therapeutic outcomes if the client is given the time to explore each topic deeper.
Feb 03, 2023 @ 12:20:59
Hi, Whitney! I like how you pointed out that unorganized therapy sessions may look bad on the therapist’s part. It connects to how a good therapist must show trustworthiness, attractiveness, and expertness in practice. If a therapist comes off as disorganized or forgetful, the client may feel like the therapist does not know what they are doing, thus decreasing expertness and attractiveness. As a result, collaborative empiricism is negatively impacted, and, as you stated, a weak therapeutic relationship can lower the client’s outcomes.
Jan 31, 2023 @ 21:34:15
Within CBT, it is essential to have a strong therapeutic relationship so the client can feel comfortable and motivated in session. Due to the collaborative nature of CBT, it is necessary that the therapist and the client are working together to meet goals, rather than just the client or the therapist doing the work. This is known as collaborative empiricism and requires both the client and the therapist to be an active participant in therapy. Within collaborative empiricism, there is a need for the understanding that one another is motivated and is going to follow through and put the work in. This is a two-sided relationship that requires both parties to be actively involved and striving towards the same goal. Due to this collaborative relationship in CBT, it is important that the relationship is strong so each member can give each other feedback. When the therapist and client feel comfortable giving feedback to one another, they can better work together and meet their common goal.
It is important to have session structure in CBT to hold the therapist and client accountable. Due to the collaborative aspect of the therapeutic relationship, it is important for each party to hold each other accountable and feel comfortable that one another is going to put in the necessary effort. With session structure, accountability is more likely to be stressed. In addition, having session structure is important to make sure that specific goals are being focused on and achieved. If sessions have no structure, it is likely that the discussion will get off topic causing progress to be limited. To increase goal achievement, structure and accountability are necessary.
Feb 01, 2023 @ 10:02:09
Hey Emily, your emphasis on the client feeling comfortable and motivated is really important because those are two essential aspects of the therapeutic relationship that can lead to positive outcomes in therapy. The inherent nature of CBT really emphasizes this connection between the client and the therapist because it is so collaborative, and you hit that nail right on the head. The strength of the therapeutic relationship is essential due to the fact that both parties in therapy need to be working towards the same goals which is a really concise and accurate way to perceive the therapeutic relationship. Also, accountability is a great point in terms of session structure and one that I overlooked when typing out my response. Great job!
Feb 03, 2023 @ 08:03:18
Hi Emily,
I like your description of a therapeutic relationship. It is very necessary to have the therapist and the client work together in a collaborative setting. If either or did most of the work, there may be conflict that emerges. Both the therapist and the client have the same end goal. In order for them to obtain that goal, they would need to work together rather than working separately. I also like what you said about having a strong therapeutic relationship that will help the client feel comfortable and motivated. As therapists, we would want our clients to feel comfortable with us so we can get their true selves during sessions. This is also where trust comes in handy. Clients would want therapists that they can trust in order to get their true selves.
Feb 01, 2023 @ 09:47:42
The therapeutic relationship in CBT is very important to develop and maintain throughout sessions with clients. Throughout sessions, both the therapist and the client would need to collaborate on different techniques, methods or more. It is very important to establish a relationship or a bond early in sessions. Clients want to be able to trust the therapist with their information. If the therapist breaks that trust, then it will be difficult to create a bond with the client. Everyone has the same end goal. Both parties would need to be collaborative and understanding of each other throughout sessions. It will also make sessions go more smoothly and efficiently if there is a bond between the two. Collaborative empiricism is a key factor to achieving a therapeutic alliance. It allows the client and therapist to set goals, work on different interventions and overall change the client’s thoughts and behaviors. Stated before, both the client and the therapist have the same end goal. Throughout sessions and with collaborative empiricism, they are allowed to develop a mutual understanding of each other. With this, they can work together in order to achieve that end goal.
When it comes to therapy sessions, structure is very important. It is not only important for the client but also for the therapist. Structure allows things to be set for that session. It gives consistently to the therapy sessions. It keeps the client focused on the specific problem/issue for a certain period of time. Structure is also important because without it, sessions would be chaotic.
Feb 01, 2023 @ 09:58:41
Hey Ashely, I liked your emphasis on the trust that is shared between the client and therapist via creating that strong bond. Trust is the most crucial aspect of the therapeutic relationship and it’s so important that we as therapists not act in a way that breaks that trust between us and our clients. I also liked how you mentioned that a good therapeutic relationship can help the sessions to run more smoothly, which is another very important aspect to not only collaborative empiricism but also it highlights the importance of session structure as well. Great job!
Feb 01, 2023 @ 11:47:12
Hi Ashley, I really liked your description of collaborative empiricism! It’s so important for clients and therapists to work together to set goals, determine which interventions to use, and work on changing thoughts and behaviors. This is where it’s also really important for feedback for both parties on how things are going so that as one goes through therapy they can work with their therapist to tailor therapy to their needs. I also agree that consistency across sessions is really important because it helps clients be more comfortable with therapy. It is also nice when approaching new or scary topics to be able to rely on the things in therapy that the client can count on, like the consistent structure.
Feb 03, 2023 @ 13:55:28
Hi Ashley,
I agree with what you said about session structure. The structure is needed to give consistency, get things accomplished, and keep focus. I agree that therapy sessions would be chaotic without structure. However, I think we need to find a fine balance between too much structure and not enough. If we are overly structured in session we may not allow the client enough time to share their thoughts on certain topics that are important to them because we feel as though we need to rush through to check things off. On the other hand, if we do not provide enough structure, the session may not be productive due to going off-topic. I think offering structure is important and we as future therapists need to be aware of the structure in session to make it the most beneficial for the client.
Feb 01, 2023 @ 09:55:33
A strong therapeutic alliance is crucial to positive therapeutic outcomes for the client when practicing CBT. The collaborative approach is important when setting treatment goals with the client, and it increases the likelihood that your time together will be successful and yield the most positive results. This concept of active engagement by the client is the idea behind collaborative empiricism and it is crucial so successful outcomes in therapy. By having the client be an active participant in creating treatment plans and goals you increase the likelihood of success because you increase the levels of engagement and motivation.
Session structure is important for CBT because it helps the process of therapy flow smoother. Not only that, but many clients that we see will likely be lacking structure in other aspects of their lives, so it could be something that they are longing for. Additionally, structure can help put the clients’ minds at ease if they are unsure if therapy is the right fir for them and/or they are in a particularly vulnerable mental state, as many of them will be. Session structure can also help increase the clients’ perceptions of your expertness, trustworthiness, and attractiveness, which as we all know, are three essential factors of creating a strong therapeutic alliance. Additionally, session structure ensures that important topics that should be addressed are not looked over. If an individual just wants to go on tangents about their life, then CBT isn’t for them. Session structure helps to emphasize important areas that should be covered and assists in making sure they do not go overlooked.
Feb 01, 2023 @ 10:59:07
Hi Jack,
I enjoyed your discussion on the importance of a session structure in CBT, specifically its ability to provide temporary relief to clients in distress. When reading your post, I immediately thought of young clients who are attending therapy because there is a lot of parental conflict at home, community violence, or previous trauma. The child may appreciate the presence of a consistent adult in their lives, that provides structure into their unstable life. Session structure may help the child create positive expectations for therapy, which in turn, can promote positive therapeutic outcomes and an increased likelihood of returning to therapy in the future.
Feb 04, 2023 @ 22:02:44
Hi jack,
I agree! I think it is very important for therapists to implement structure within their sessions more for the clients sake. I think if the client doesn’t necessarily have structure in their everyday life having structure in therapy at least once a week is something and could be the beginning of something. like you said, it is important to touch upon the more important topics that can’t necessarily wait so the clients are able to make progress and work through their struggles.
Feb 01, 2023 @ 11:41:59
My understanding of the therapeutic relationship in CBT is that it is incredibly important as a foundation for therapy to occur. The therapeutic relationship builds trust, shows the client that the therapist wants to help them, and provides the client with unconditional positive regard. These are all things a client would want to have established with their therapist before opening up about some of their deepest, darkest, most distressing thoughts. The relationship is also important because it creates the space for collaborative empiricism rather than a therapist-run therapy structure. Collaborative empiricism is important because the main focus of CBT is to help clients help themselves. Through collaborative empiricism, some of the responsibility is placed on the client to not only put work into their mental health, but work into each session. This way, we can work together with our clients, receiving and providing feedback to tailor therapy to their needs and find a way that they can learn to support themselves to the degree that eventually they no longer need us.
Session structure is important because a large part of CBT is ensuring that the client is comfortable and willing to be open to change. Therefore, by setting an agenda and having a consistent, reliable structure to sessions is one way to help clients feel more comfortable in therapy. It also helps to facilitate the collaborative empiricism because without structure one could get caught up in one subject or one person talking more than the other and lose the important client/therapist balance.
Feb 03, 2023 @ 07:56:20
Hi Becca,
I agree with you that it takes trust in order to build a therapeutic relationship. It is true that you would want to trust someone with their deepest and darkest thoughts. You essentially want someone to be in your corner when you are confessing what you are feeling. As a client, you would want to be able to know that your therapist is on your side rather than feeling/thinking otherwise. I also agree with the client putting in the work on both their mental health but also during sessions. In order to get the work put into their mental health, the work also would need to get done during sessions. I like what you said that session structure can help the client be comfortable and be willing to be open to change. It puts in more control rather than letting the sessions turn into chaos.
Feb 01, 2023 @ 13:13:43
Having a strong and positive therapeutic relationship with the client is important for CBT. With a strong therapeutic relationship it allows the client to be more comfortable, open, and honest with the therapist. It allows them to collaborate together on creating and setting goals to work on and working to achieve them. Working together can also be seen as collaborative empiricism where clients work with the therapist to modify their thoughts and behaviors for more positive ones. As I mentioned before, it is important that clients are comfortable with their therapist because that will ensure they will be engaged and willing to put in efforts in working towards their goals.
Session structure is important as it ensures the client will stay focused and allows the necessary agenda to be touched upon rather than the potential of steering off and not working on what needs to be worked on. This will also cause a delay in progress and could potentially get the client used to not coming in and working on the set of goals that were initially created. Creating that sense of structure may instill the idea of structure in their daily life as well. In addition, the therapist not creating structure within their session may seem like they are unorganized to clients.
Feb 02, 2023 @ 11:55:16
Hi Rena. I agree that structured sessions can help the client focus on one thing at a time. For clients who are easily overwhelmed or have anxiety, seeing a physical plan and knowing what the next hour is going to look like will be very helpful!
Feb 03, 2023 @ 13:46:47
Hey Rena,
I agree with what you said about session structure. It is definitely hard to make progress over time if the sessions lack structure (ie. setting goals, staying on topic). If clients notice the lack of structure, they may not find therapy to be helpful and stop coming altogether. I really like how you said the session structure may also translate to their life outside of the session. By demonstrating the importance of structure in the session the client may want to implement structure in their own lives.
Feb 01, 2023 @ 18:30:34
In CBT, the therapeutic relationship is extremely important for positive treatment outcomes. When the client can trust and feel comfortable with their counselor this allows for them to speak freely without feeling like they could be judged while also being able to be honest with the counselor regarding the treatment and how things are going. This promotes better outcomes as the counselor is loaded with information about them which helps towards planning the treatment while also being able to receive honest feedback and make changes. Although providing assessments can assist with tracking treatment process, I feel that communication directly from the client is huge. Collaborative empiricism is an action-oriented therapeutic alliance driven by research that integrates, tests, and modifies clients’ thoughts and behaviors. It is essential for the counselor and the client to work together towards the client’s goals. It is important for the client to understand that they are the expert of themselves and as a counselor we are there to guide and support them, rather than telling them what to do. With the client being an active role in the process this can help with the client’s motivation to reach their goals. The intended outcome of therapy is to eventually not need your counselor therefore the client must practice some independence throughout the process.
Session structure is needed for effective CBT as it allows for a full understanding for both the client and counselor of what the goal is and what the steps that will be taken are to meet that goal. This also allows for an agenda for each session. For example, for class we are provided a syllabus with a schedule of what’s happening in class and what is due every time we meet. That helps us stay on track and feel comfortable or confident in what is coming ahead the same way session structure would within therapy. As we learned in previous courses it is very important for a client to view their counselor trustworthy, attractive and as an expert, applying session structure can help the client have these views. Sessions that are unstructured can be confusing or frustrating to the client and can influence negative views of their counselor.
Feb 02, 2023 @ 00:03:55
To my understanding, the therapeutic relationship is so vital to CBT. Without a good therapeutic relationship, it is nearly impossible to be in a shared space with someone who does not trust you or respect you as a therapist. Likewise, it would be hard for a client to be present in a session with a therapist who thinks that they are not worth their time. Respect and treating each other like humans always goes a long way. And to me, collaborative empiricism is brainstorming together with a client in the session. Both of you are trying to reach a common goal (assuming that the client is in the stage of therapy where they are open & willing to action), and come up with possible ideas that would work for the client. It might be called different things in different settings, but it is all about giving the client control to decide what they want to do for an action. Some clients might need some support to come up with ideas, but it is all about giving them the power at a time when they are most vulnerable.
Structured sessions are helpful & essential because it gives you (the therapist) a game plan. Knowing what and where you plan to direct the session makes it easier to be present. It would also make conducting a session less daunting since you know what points you need to address with your client. In the end, being prepared saves a lot of time and heartache.
Feb 02, 2023 @ 11:53:18
Hi Esther! I like your comment about the therapeutic relationship being used in the physical setting. It is important for our clients to feel comfortable enough with us to spend an hour together talking about sensitive issues and some clients may have a really difficult time interacting with anyone new. I think this also relates to how the client perceives us and what subliminal messages we are sending.
Feb 04, 2023 @ 22:09:04
Hi Esther,
I agree that having structure in session makes it easier to be present. I also think it gives the client a “schedule” to follow. It provides a sense of structure that the client might not have anywhere else which can keep them in line. as I have said in my post, I think its important for structure because it makes sure the most important topics needs to be addresses and keeps the level of conversation on track as well (granted there may be some steer off)
Feb 02, 2023 @ 08:27:06
In regards from a CBT perspective, therapeutic relationships are a vital part of the therapeutic process. Without a strong working and collaborative relationship, CBT will not be as effective. As we know, CBT is a collaborative process that involves active participation from either side. Without a collaborative therapist, clients will not be able to receive full support. Without a collaborative client, therapy will be more challenging to provide. Building a positive and engaging rapport with clients will help facilitate a more productive course of treatment. As for collaborative empiricism, the focus is on collaboratively identifying maladaptive cognitions and behaviors while using specific key factors such as therapist-client activity level, client-specific factors, and conceptualization and treatment. These factors are important to utilize throughout the therapeutic process. We want to work with the client and build a therapist-client alliance. We also want to keep the client in mind and their specific factors such as their symptoms, stressors, and sociocultural influences. This will help gain a better understanding of the client and have the client feel heard throughout therapy. Additionally, we want to assess the client properly and curate a specific treatment plan that will be effective for their treatment.
Another vital part of therapy is session structure. Therapy is a place to work on yourself and gain the skills needed to adapt to challenging parts of life. With that, it is important to provide a session structure to meet those needs. Many clients attend therapy due to the lack of control they have in cognitions, behaviors, and their environments. Hence why coming into an environment that is structured on gaining support is beneficial for treatment. Not only does this provide direction but it also allows room for the client to gain a better understanding of CBT, which can build onto the therapeutic alliance. Having the client understand CBT is vital for their growth and treatment.
Feb 03, 2023 @ 15:08:57
Hey Gitte, you made an important point in describing the necessity of session structure. For our clients, order and structure may be something they do not the capacity for due to their given distress(es). So by providing that in our sessions for them it provides a good model that they can then take and apply outside of session. This works especially well since our session, as you pointed out, are collaborative, which has us teaching them this skill and practicing it in session with us.
Feb 02, 2023 @ 09:21:02
It is important to develop a strong therapeutic relationship early on in the therapeutic process. Validating the client’s emotions, showing that you are actively listening, expressing care and concern for the client and their issues/problems, instillation of hope. These are a few ways early in therapy that a counselor can help foster a stronger therapeutic relationship. We want to create and strengthen this connection, especially early on, because in a CBT framework of treatment we are going to be working collaboratively with our clients to develop session structure and treatment goals. This type of collaboration requires a sense of comfortability from the client in order to open up about their issues and be willing to take suggestions on how to correct their problems. An environment devoid of judgment must be created so that the client feels like they are able to receive psychoeducation and skill training from the therapist without feeling like they are being condescended to. A strong therapeutic relationship has been shown to increase treatment results.
Session structure is important for a few reasons. For one it can provide a sense of expertise coming from the clinician which, as we have seen and talked about before, can help instill hope in the client and strengthen the therapeutic relationship. It also adds to this sense of collaboration with the client. Having them pick and set the agenda for the session lets them feel in control over what they talk about as opposed to the counselor leading the session to where they think would be useful. Plus, it can be a good teachable skill, showing them how to structure a thing they need to get done. It also makes sure that what is discussed in session pertains to their therapy goals and doesn’t veer too off course to things that may be unproductive in session.
Feb 03, 2023 @ 11:45:15
Hi Lucy, it is vital to build a strong therapeutic relationship through validation, active listening, empathy, etc. I agree with your statement on creating a strong connection early due to the CBT collaborative framework. This way the therapist and client can start working on the treatment plan soon after intake. Additionally, you mentioned how this type of collaboration requires a sense of comfortability from the client, which is why it is so important to build that relationship early on. During therapy, clients tell their darkest secrets to us, so it is important to make them feel as comfortable as possible while working together. Nice post!
Feb 02, 2023 @ 10:10:30
One of the most critical aspects of the therapeutic relationship in CBT is that without it, the client’s symptoms may not improve as significantly. Therefore, a strong alliance between the therapist and client must be developed early, so the client feels safe and free to discuss their issues openly. To do so, one must be empathic, genuine and show high positive regard. This means that therapists must be able to place themselves in their clients’ positions, show optimism about change, and refrain from judging the client, no matter what they say or do in the session. The client wants to be treated as a human being and deserves to be treated as such. To many, we, as therapists, will be the client’s greatest confidante. To show that a therapist is capable of being a confidante and an ally, one must also convey that they are trustworthy, attractive, and an expert in their practice to promote collaborative empiricism and drive therapy sessions to the utmost effectiveness. Collaborative empiricism stresses that both the client and therapist are experts in different ways and can work together to develop an individualized treatment plan that is both appropriate and effective. Moreover, collaborative empiricism describes the dynamics between therapist and client regarding control over the session in the sense that the therapist begins by facilitating the first few sessions. Still, ultimately, the client facilitates the ending sessions.
It is essential to have session structure for effective CBT because it provides a sense of stability for the client. After the intake, the client knows the plan when walking into the session. In addition, the therapist and client are aware of the significant problems to focus on, which can increase how quickly someone responds to and improves from treatment, as going off track can delay the therapeutic process.
Feb 04, 2023 @ 13:30:55
Hi Megan,
As you said, maintaining the relationship is so important to the therapeutic relationship. Having that foundation allows the client to be present in sessions without worrying about what they can and cannot say. Knowing that therapy is such a safe space provides some extra reassurance. Everything that goes on is meant for the client’s benefit and to help them get to where they would like to be.
Feb 02, 2023 @ 10:58:03
(1) Based on my understanding, the therapeutic relationship in CBT is collaborative, founded on empathy, and aimed at promoting client independence. Basic Rogerian skills such as genuineness, unconditional positive regard, and empathy are the foundation of this relationship, but there are other factors. The basic Rogerian building blocks create a space where more difficult work can be done, such as socratic questioning and collaborative empiricism. The relationship needs to be strong enough and the therapist tactful enough that maladaptive thoughts and behaviors can be deconstructed. A good therapist expresses and inspires a genuine curiosity about the client’s thoughts, feelings and behaviors. They are able to question and test the usefulness and validity of the client’s thoughts while validating the client’s emotional experience. A good therapist is able to do this collaboratively with the client, and encourages them to develop their skills until they can function independently.
(2) CBT is a time sensitive therapy. Although it is important not to rush, having a good session structure and remaining focused means that we get the best results with the time that we have. Many people only meet with a therapist once a week and we should do our best with this relatively limited time.
Perhaps this is less of a concern for more experienced therapists, but session structure also gives you less to think about during the session, and allows you to focus on the task at hand. Having an idea about the structure and flow of the session gives you something to fall back on, and makes it easier to focus on empathy client rapport and.
Feb 04, 2023 @ 23:09:57
Hi Jonah, You make a great point that it takes practice to establish a sense of fluidity in session and that doing so can help you to stay on task as the therapist. I also agree with you when you say that CBT is a time sensitive style of therapy, especially because it requires collaboration from both the client and therapist throughout sessions. Nice job!
Feb 02, 2023 @ 11:50:44
Within CBT the therapeutic relationship is used as a vehicle for the treatment of the client and additional support within that person’s life. The changes that the therapists are asking to clients to make can be difficult and without a strong bond between the two, the client is much less likely to make the effort. The communication needed to build that bond can also be used when setting the agenda within a session and any overall goals that the client may want to accomplish. It is important for the therapist and client to work together because the client is the expert in their own lives. They know which problems are causing the most distress for them and what needs to be taken care of first. The therapist may have an idea and have experience with those issues, but ultimately the client knows what needs to be fixed.
The structure of a session is important for a few reasons. The therapist needs to know what they are going to do and when within the session. If there was no plan, it would be difficult for the therapist use any intervention and the client may not have their needs addressed beyond the one task they first worked on. Importantly, the therapist may want to return to a topic or tactic used in the last session to make sure the homework was really done. If there was no plan to come back to or no homework given, the effectiveness of CBT would be incredibly diminished.
Feb 04, 2023 @ 13:43:46
Hi Mikayla,
You mentioned something so vital. I think some therapists forget that the client knows what is going on in their lives the best, so they cannot assume (complete) control in sessions. The client needs to be in the driver’s seat, and therapists are supposed to be helping them get where they need to go. Providing that assistance to clients would also strengthen the therapeutic relationship too since they know someone is on their side advocating for them.
Feb 05, 2023 @ 10:55:16
Hi Mikayla,
You made a great point about the importance of session structure. If the client and counselor ever want to make progress having a set structure and routine is important. You mention an important point about the counselor using tactics and making sure they don’t repeat these tactics. When a counselor has a set plan for what they will talk about with the client it gives them a sense of direction when it comes to different ways to communicate and work toward collaborative goals. As you mentioned all of these points are essential when it comes to using CBT with the client.
Feb 05, 2023 @ 19:26:49
Hi Mikayla,
I enjoyed reading your description of therapeutic relationship. You reminded me the importance of awareness and consideration that the therapist must have when challenging clients behaviors. While sometimes it might seem easier to reach a potential goal, for someone else might be more difficult to leave his/ her comfort zone. I’m these cases it’s important for the therapist not only to review the whys of the methods he is using with the client , but also evaluate the relationship stays , trustworthiness, and the confidence that the client might have toward him/her. Great post!
Feb 05, 2023 @ 20:45:22
Hi Mikayla,
I enjoyed reading your description of therapeutic relationship. You reminded me the importance of awareness and consideration that the therapist must have when challenging clients behaviors. While sometimes it might seem easier to reach a potential goal, for someone else might be more difficult to leave his/ her comfort zone. In these cases it’s important for the therapist not only to review the whys of the methods he is using with the client , but also evaluate the relationship stays , trustworthiness, and the confidence that the client might have toward him/her. Great post!
Feb 02, 2023 @ 15:02:24
Clients with a strong therapeutic relationship are more likely to have positive outcomes in therapy. Facilitating a strong therapeutic relationship is important in CBT to help establish collaborative efforts to work towards clients’ goals. Collaborative empiricism involves working together with clients in a systematic process to observe clients’ maladaptive thoughts and behaviors. Together, the client and therapist test the validity and efficacy of the clients’ thoughts and behaviors. An important aspect of collaborative empiricism is that this process is action-oriented thus working to allow the client to be more and more autonomous. In beginning sessions, the therapist may be taking the lead in the therapeutic alliance but there is a slow transition to allow more responsibility and autonomy for the client. This may be seen after the client has learned and developed skills to help them be more aware of their maladaptive thoughts and behaviors.
Session structure provides both the client and therapist an outline to clearly tackle the most important issue brought to the session. It is a means to use the time effectively as clients most likely will only see therapists for an hour out of the week. Additionally, session structure can be seen as a grounding tool. Clients’ lives may be so hectic and chaotic this structure may help organize some thoughts and be a relief that there is something guiding them.
Feb 03, 2023 @ 10:36:31
Hey Grace, I like your focus and emphasis on the collaborative aspect of CBT and the therapeutic relationship. It seems that for us as future cognitive-behavioral therapists this collaborative dimension to our sessions is what separates us from other modalities that take a more “hands-off” approach when working with clients and letting them take the lead throughout treatment. It seems that this collaborative element works well because it helps set structure and expectations to the clients about the treatment process. Working along side them also can make them feel like they are not alone in their treatment and help instill hope when we take more of an active role with them.
Feb 03, 2023 @ 12:39:24
Hi Grace! I like that you compared the session structure to a grounding tool. An organized session can help the client feel like they are gaining a sense of stability in their life. Moreover, with the action-oriented setup of therapeutic sessions, clients gain the control and confidence to apply the skills they learned to their daily lives to make their routines more structured independently. Great post!
Feb 05, 2023 @ 12:35:53
Hi Grace,
You make a great point about Collaborative empiricism. As you mentioned it is essential to have the client and clinician work together and make these collaborative goals. Having both the client and clinician on the same page is essential to make positive progress. As you mentioned these goals should be action oriented. This is essential because it makes the client actually take action in their life and work toward the goals that have been set. As you mentioned the goals should be geared toward helping the client become more aware of their maladaptive thoughts and behaviors. Doing so will give the client much more control over their life and in turn help them heal from some of their traumas.
Feb 02, 2023 @ 16:23:51
1)
Therapeutic relationships are essential when it comes to building rapport and trust with clients, especially when using CBT. When you begin a counseling session with a new client, taking time to build that therapeutic relationship is fundamental. A client will need to feel comfortable with their clinician and trust them before they are willing to open up fully. A positive therapeutic relationship between clinician and their client will display a collaborative relationship, also known as collaborative empiricism. This is where both the clinician and client are participating in the treatment plan and collaborating to establish and work toward common goals during the course of treatment. Both the clinician and client will work together to understand, solve, and treat any of the client’s presenting problems. Without a good therapeutic relationship and collaborative empiricism, the client and clinician will never be on the same page.
2)
The session structure is absolutely essential when it comes to the effectiveness of CBT. Having a structured CBT session allows the client and clinician to be on the exact same page. This makes the entire therapeutic process much less stressful for both parties. Another benefit when it comes to having a session structure is the fact that it gives both the client and clinician forward progress and momentum. Having this structure allows the client and clinician to stay focused and motivated to continue working toward the client’s therapeutic goals. Session structure will give the client and clinician a much stronger therapeutic bond and lead to a better overall therapeutic experience.
Feb 04, 2023 @ 21:55:34
Hi Stephanie,
I really like how you brought attention to the importance of the client and counselor working towards establishing and following through with common goals. Although it may seem obvious, if a therapist us unable to build rapport and trust with their client, there could be a chance that their goals involving therapy may be slightly different. More importantly, this could have a detrimental effect on client growth. This is particularly relevant to CBT because of the way it requires work from both the client and therapist. To your point, I also agree that session structure allows for the client and therapist to remain on the same page. Similar to the way in which establishing rapport is important for common goals, session structure is as well. Great job!
Feb 02, 2023 @ 18:52:50
Based on the lecture material and this week’s readings from Beck and Volungis, my understanding of the therapeutic relationship in CBT is that it serves as a foundational function to client (and clinician) growth. There are three major domains in establishing the therapeutic relationship between client and clinician; empathy, unconditional positive regard, and genuineness. Although these domains constitute broader forms of therapy, they are particularly important in CBT. CBT is a treatment that involves collaboration from both the client and therapist. In order for collaborative empiricism to work in an effective manner for treatment within CBT, the three domains within the therapeutic relationship described earlier should be present as well. From my understanding, collaborative empiricism encompasses test, assessment, and treatment results that are best fit for a client. Additionally, CBT works through interactions between the therapist-client relationship and the factors of a client’s thoughts, feelings, and behaviors. Although some clients may experience universal similarities between negative automatic thoughts, for example, collaborative empiricism promotes the ongoing and interactive process individually.
In addition to collaboration in CBT, session structure also plays a considerable role in the progress of a client. An important aspect of session structure is that it provides clients with familiarity and stability in terms of the session itself and the therapeutic relationship. Another reason why session structure is important in CBT is that it allows clients to have a general idea of what to expect in session and can help motivate them to come back. In addition to providing structure in treatment, allowing a client to have a good understanding of what a session will entail can help to reduce anxiety surrounding talking about their thoughts and feelings, and in turn, changing maladaptive behavior. For example, when applying or getting hired for a job, an interviewer will provide an interviewee with a general idea of what tasks they may have to partake in. From personal experience, providing structure similar to those within a job interview helps to alleviate anxiety around competence.
Feb 05, 2023 @ 15:48:56
Hi Aly, I like that you mention session structure encourages clients to come back. It can be daunting for some people to begin therapy and session structure can provide them with an idea of how they are going to receive help. The structure can provide some insight in helping the client meet their goals. Though therapists should be prepared to slightly alter session structure if clients come in crisis. It is also important to understand when it may be time to be more flexible and alter some of the structure by adjusting to client needs.
Feb 02, 2023 @ 19:20:10
1.When hearing the word alliance while reading about the therapeutic relationship, the first thought that comes to my mind is union, where different elements or individuals have a cooperative relationship. Listening to the video lectures, and the assigned readings this thought was strengthen by understanding this concept as: the relationship that the client and therapist must mutually contribute to achieve the therapeutic goals, especially when talking about CBT. In contrast to other therapeutic methods, in CBT this alliance is crucial for a successful therapeutic experience. While the CBT interventions are supported by empirical interventions and assessments, it is important that each case is treated as unique, and the client provided by the clients is taken into consideration. Therefore, by carefully considering these elements the therapist would be able to decide using his/her best clinical judgment. My understanding is that collaborative empiricism is importantly linked with the alliance or the collaboration between the client and the therapist throughout the entire therapeutic experience. According to the readings, it was described how these concepts are linked to the client ‘s trust regarding the methods used during the treatment and the therapist approach. It is important to mention that even though that the client trust toward these elements is necessary, he/she is allowed to give feedback and share his/her thoughts/emotions/experience/ while working on interventions that are empirically based in order to modify specific behaviors.
2. Having a session that is structured it is not only beneficial for a successful CBT approach, but also it an element that shows the client various skills that his/her therapist is showing professionally such as competency and effort. Therefore, having a structured session, helps the therapist provide a good ‘model” to the client, and organizational skills that are important to build especially when working on behavioral challenges.
Feb 03, 2023 @ 11:01:06
Hi Olgena, I like that you mentioned how the therapeutic relationship can relate to a union. I completely agree, the therapeutic alliance is a collaborative process where both sides are actively participating. Having therapy be collaborative makes it so there is more room to learn and grow for both parties. Without collaboration, therapy can be more challenging and less effective. I also agree with your statement on session structure! It does show professionalism and competency, which are things we want to display during therapy. Great post!
Feb 03, 2023 @ 13:34:43
The therapeutic relationship is very important in CBT. It is important to have good rapport between the client and the clinician as it builds trust and may determine how much an individual is willing to share with you. In addition, if the client trusts and has a strong therapeutic relationship, the more likely they are to listen to suggestions and try something difficult that is out of their comfort zone. Building this type of bond begins during the intake session. The therapist should have an agenda or some sort of structure to the session to ensure a productive meeting. Expectations for the sessions should also be discussed very early on to ensure that the client knows what to expect moving forward. The client and the clinician should work together in a collaborative manner. If the clinician does all the talking during sessions, the client may feel like they are not being heard or they may feel like they have no say in their treatment. If the client does all the talking, the session may go off-topic and lack the clinical perspective they are there for. It has been proven that there is a strong relationship between the therapist-client relationship and treatment outcomes, so it is important to create a strong therapeutic relationship with your clients.
The session structure is really important in CBT. Setting an agenda and having structure will likely make the session more productive. Furthermore, the session structure demonstrates that the clinician is organized and competent to some extent. If the clinician appears to be competent in their field, the client is likely to feel more comfortable and be more open to suggestions.
Feb 05, 2023 @ 16:49:21
Hi Taylor, I definitely agree with your point in needing to find a balance between how much time is being used in session from both parties to talk. That is why session structure is important. It can help provide a framework and establish the bounds in making the therapeutic relationship a collaborative one. Connecting this to collaborative empiricism, the therapist may have a little bit more control of the pace in early sessions before slowly passing more of the control to the client. This process provides the clients with more autonomy as they continue to learn and practice skills taught by the therapist.