Topic 3: Therapeutic Relationship & Session Structure {by 2/3}

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 2/3.  Have your two replies posted no later than 2/5.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

43 Comments (+add yours?)

  1. Victoria Cestodio
    Jan 31, 2022 @ 12:50:50

    Before even starting this program, the one thing ingrained in my brain was how the therapeutic relationship within CBT is very collaborative. Like Dr. V mentioned in the lecture CBT does give a ‘teacher-student’ type of relationship. There are points in therapy where the therapist is more ‘active’ and times where the client is. The relationship is crucial in CBT if you do not have a good relationship with your client, it is likely the client will not get what they fully want out of therapy. The therapist is really there to guide the client and point them in the right direction, but the therapist is not there to do the work for them, the client has to do that and put in the work. Giving the client support during your time together is super important. If the client does not feel supported they may feel judged, or looked down upon and it may influence their progress in a negative way. This is why collaborative empiricism is such a big part of CBT and the therapeutic relationship. Collaborative empiricism stresses that the relationship is an alliance and tries to have the client actually put their skills into action. Having the collaborative effort between the therapist and the client is what makes CBT so effective.

    It is extremely important to have a session structure for effective CBT because having structure especially at the beginning of therapy will make the client feel much more comfortable and at ease. It will also make them more likely to open up and be vulnerable within the first few sessions when it’s crucial. If a therapist goes into a session with absolutely no structure it may make the client feel as though they are being looked past, or not that important, which is something we obviously do not want the client to feel, because that can hurt the relationship a lot. Having structure makes the client feel more at ease, and makes them feel as though you really do care; therefore having that time before the session to review their notes and to recall if there’s anything to bring up or ask them about is very helpful; like “how was that exam last week?”. It reassures the client you are really remembering things about them and are conscious of the different things happening in their life. Overall, having a structure makes the therapist and client feel more at ease and have a sense of what will happen over the course of the session. Having a set structure will definitely make your relationship much stronger, as the client knows what to expect each session from you.

    Reply

    • Monika
      Feb 01, 2022 @ 10:23:54

      Hi Victoria,

      Great post this week! I love how you started with a brief introduction and then moved on to talk about the importance of therapeutic relationships in CBT. I agree with you a hundred percent that the therapist is there just to guide the clients and not do the work for them. A lot of people go to therapy unaware of this and just seeking answers for their problems from the therapist. And sometimes for some clients, it can be hard to see what they are going through and we may be tempted as a therapist to provide the answers or insight so it’s always good to remember that we are just there to guide them. Lastly, I like your explanation of why a session structure is important for CBT. Clients feeling that they are being looked past is the worst thing to happen in therapy, and even if the clients feel like the therapist actually doesn’t care can really negatively impact the therapeutic relationship and therapy outcomes.
      Good Job! Thank You.
      Monika.

      Reply

    • Vanessa Nichols
      Feb 01, 2022 @ 13:23:30

      Hi Victoria,
      Great post again this week. I totally agree with you that before even starting this program, I was very aware of the collaborative nature of CBT. However, now that we have begun learning about CBT, I finally understand why it is so vital for CBT and all therapeutic relationships. Collaborative empiricism emphasizes the collaborative nature of CBT. Without a good relationship, there will be no trust, communication, or faith in the therapeutic process. Without a good therapeutic relationship, the client might have a hard time participating as much as they should, and the therapist might have a hard time trusting the client. Lack of therapeutic relationship can even lead a client to seek therapy elsewhere or stop therapy altogether.

      I can totally understand why session structure is so important. I feel like we have to do so many things in one session without structure, nothing would get accomplished, and the client would not make as much progress as they would have. The structure helped organize what is important and what they can put on the backburning. It really helps focus the client and the therapist and make sure everyone stays on track.
      Great post again this week!!

      Reply

    • Will Roche
      Feb 02, 2022 @ 10:44:08

      Hey Victoria,

      I think you make some great points regarding both the collaboration in CBT and the importance of structuring sessions. I liked the point you made about how in CBT, sometimes the therapist is engaged in the more active role during a session, but the client should also be regularly engaged in the more active role as well. It really is a collaborative effort, and as cliché as it may sound, teamwork makes the dream work in these relationships. There are many stages of therapy that will require a collaborative effort between the therapist and client, therefore making it integral that the therapist is able to create such a rapport with each client.

      I also liked the comment you made regarding how structuring and organizing sessions may help the therapist remember more details of a client so that when the client returns for their next session, remember these details might create a stronger rapport or trust. Your example of the therapist remembering about the exam, might make the client much more comfortable knowing that their therapist actually cares and is cognizant of these problems they have even after not seeing them for a week. While this works with structuring sessions I also think that this works in building a better relationship with the client. Great work!

      Reply

  2. Monika
    Jan 31, 2022 @ 14:03:07

    The foundation of a successful treatment is a solid therapeutic relationship. A good therapeutic relationship is built on the basis of trust and rapport, we now know having a positive therapeutic alliance contributes to positive therapy outcomes. Having a good therapeutic relationship helps the clients feel safe, respected, understood, and cared for. Clients who have serious mental health conditions will need a stronger therapeutic relationship. For establishing a good therapeutic relationship the therapist needs to demonstrate counseling skills like empathy, genuineness, and positive regard. But these skills need to be adjusted depending on the client. Collaborative empiricism is the key therapeutic alliance factor that fosters the overall empirical effectiveness of CBT. Collaborative empiricism’s main goal is to identify maladaptive thoughts and actions and then “test” them for empirical validity and/or benefit. This process leads to more adaptive cognitions and actions, as well as a decrease in the intensity of symptoms and an overall improvement in quality of life but it depends on the phase of therapy. In addition to this, it’s also important to consider presenting symptoms, environmental stressors, and sociocultural factors while building a therapeutic relationship based on collaborative empiricism. CE also involves getting accurate information from the client which will depend on whether the client has enough trust in the therapist which in turn is an important part of a good therapeutic relationship. Attention to these principles can help us build productive therapy sessions.

    Regardless of the presenting condition, following a fixed session framework helps maximize efficient use of time during therapy and makes the therapeutic process more transparent for the clients. The aim of CBT therapists is to conduct therapy efficiently, so it helps clients feel better as soon as possible. Following a standard format helps a therapist achieve this goal. Also, having a structured format helps the therapist be organized and know what exactly to do in specific sessions without wasting any time. It provides directions to the therapist along with clients. Organized therapy sessions increase the therapeutic efficiency which is crucial for minimizing client distress. This becomes important while working with managed care systems where the number of sessions you have with clients is limited. From the very first session, the structure instills comfort and hope that treatment could truly be able to help them. It also indicates the therapist’s expertise, dependability, and attractiveness as a professional, all of which are significant factors in forming a therapeutic partnership. Clients are generally familiarized with CBT through a consistent session pattern. This involves demonstrating how to address and handle problems involving client distress in a natural way. Session structure, in particular, allows you to model the collaborative character of CBT, from conceiving clients’ problems and defining appropriate goals to hearing feedback and making required therapy revisions. Having a structured session and explaining to clients what they can expect from a session, allows them to make use of their time wisely and prepare for each session. Structuring is orienting clients to their role and responsibility in the relationship and to the role and responsibility of the therapist. The nature of structured sessions will depend on which phase of therapy a client is in, early phases require more structured sessions while late phases of therapy require less.

    Reply

    • Vanessa Nichols
      Feb 01, 2022 @ 13:35:35

      Hi Monika,
      Great post this week
      I totally agree that the foundation for a successful treatment is a solid therapeutic relationship. Having a good relationship makes the collaboration easier because the client will feel more comfortable and trusting in opening up. Having this collaborative nature and a solid therapeutic alliance will allow the client to take chances, speak their mind, give feedback without feeling like the relationship is in jeopardy.

      I totally agree with you that fixed sessions and planned treatment action maximize efficiency. Maximizing efficiency is very important for good therapy because normally, therapy is limited to a certain number of sessions (due to insurance). Without a plan, the therapist would waste valuable time and hurt the client’s chances of successful outcomes. I agree with you that structure and order can provide comfort to clients, especially clients who feel they have no structure or order in other aspects of life.
      Thank you!

      Reply

    • Victoria Cestodio
      Feb 01, 2022 @ 20:38:11

      Monika,
      I really like how you mentioned that you need to base your skills off of your client/ dependent on the client because it is so accurate. No client will be the exact same and being able to switch up your skills and techniques is crucial. CE really does depend on the client feeling as though the therapist is trustworthy and they feel as though they can be vulnerable, without the client being vulnerable successful CBT probably won’t happen.

      In regards to structuring, I love how you mentioned that structure is so important so we do not waste any time with the client. 45-50 min every week in the grand scheme of things is not that much time. Therefore, having a structure does help us not get off track and makes us sure we are using the clients time wisely and ours.

      Great post!!

      Reply

    • Tressa Novack
      Feb 02, 2022 @ 14:43:21

      Hi Monika,
      Great post. It is great how you point out the interpersonal skills needed for a strong therapeutic relationship and that the skills need to be adjusted for each client. Being malleable so that we can adjust to what works for each individual client is essential in building strong relationships with each of them. I like how you point out that the point of session structure is efficiency. Efficiency is so important in CBT, because as you said we want our clients to get better as quickly as possible, and we have limited time with our clients. Structure is important to the therapists and the client because it keeps both parties from getting lost during the session. You made so many great points!
      Tressa

      Reply

  3. Vanessa Nichols
    Feb 01, 2022 @ 10:50:43

    The therapeutic relationship is essential for any therapy, especially for CBT. The therapeutic relationship can be built off empathy, compassion, Rogerian qualities (such as respect, dignity, etc.), and Interpersonal skills such as expertness, trustworthiness, and attractiveness.
    The quality of the therapeutic relationship can negatively or positively impact the client’s well-being—the more substantial and better the therapeutic relationship, the more successful the therapy. Without the therapeutic relationship, a therapist will have a more difficult time having clients do homework, trust them, or share information. Without a solid therapeutic alliance, clients are more likely to end therapy early, seek therapy elsewhere or stop treatment altogether.
    CBT is based on a collaborative approach between client and therapist. Collaborative empiricism is the process of therapist and patient working together to establish common goals in treatment. Collaborative empiricism identifies maladaptive cognition and behaviors and then tests their empirical validity or utility. This is one of the primary change agents in cognitive-behavioral therapy and contributes to desired outcomes, improved mental health, and overall quality of life. Collaborative empiricism has three core components therapist-client activity level, client-specific factors, and conceptualization and treatment.

    Session structure seems very important for successful CBT because a lot is going on. Structure from the first session allows you to instill comfort and hope that this therapy might provide relief. It also allows you to model the collaborative nature of CBT (conceptualizing client problems, identifying appropriate goals, receiving feedback, treatment modification). There must be structure to attack those goals and make effective changes systematically. The structure provides direction for both the client and therapist and increases efficiency. Efficiency is important because the less time the client is in distress, the better. Structure is essential in all stages of therapy. However, it does fluctuate, meaning in the beginning, there will need to be a lot of structure; however, once treatment gets going, and the client gets more comfortable in an active role, less structure will be necessary. The structure is also vital because you shouldn’t be doing the same stuff in session 1 as in session 12. Knowing this and having a layout helps to make sure therapy is moving how it should be and that the client is making the progress they should in the time they should be. I liked the therapy session worksheet provided in Dr. V’s book. I like how it breaks down all the essential components of a therapy session. I also really liked that later on, the client fills out one. I think this emphasizes the collaborative nature of CBT.

    Reply

    • Monika
      Feb 01, 2022 @ 18:15:07

      Hi Vanessa,
      Great post as always, I agree with you a hundred percent that therapy can be built off of empathy and compassion, personally, I believe a therapist should be compassionate because you deal with so many clients with serious mental health issues and if you are not empathetic or compassionate, not only is that hurting the client but you yourself won’t be able to keep up. You did a good job explaining why it’s so crucial to have a good therapeutic relationship and how it affects the clients, a client who ends therapy early and had a bad experience probably will never seek therapy again even when they really need help. So, it’s a moral obligation on our part that we make sure to have a strong therapeutic relationship. I like that you added the three core components of collaborative empiricism. Also, I like the point where you mention session structure helps attack treatment goals and make effective changes systematically and not repeat the same conversations from earlier therapy sessions.
      Thank You,
      Monika.

      Reply

    • Victoria Cestodio
      Feb 01, 2022 @ 20:45:30

      Vanessa,
      Great post!

      You touched on great points. One being that if the client feels as though there is no therapeutic alliance they are more likely to end therapy early, seek it somewhere else, etc. This is why the relationship in CBT is so important and necessary for the client to receive the help they need. We need to put our best foot forward and really build that relationship, however the client does also have to put effort in too.
      Structure in CBT as we know is one of the key elements. I think it really gives the client a sense of relief and stability having structure and then in turn leads them to be more successful in therapy. I also loved the worksheet in Dr. Vs book! Knowing all the different components that Dr. V finds it really helpful and insightful!

      Victoria 🙂

      Reply

    • Will Roche
      Feb 02, 2022 @ 10:37:53

      Hey Vanessa,

      I think you did a great job explaining in detail the importance of a therapeutic relationship with a therapists’ clients. There are a multitude of qualities that can help secure a better relationship with a client and the more a therapist is able to execute in a genuine manner, the more trust and dependability that the client will have that the therapist is guiding them towards better behaviors, emotions, coping skills etc. You also did a great job illustrating how important that collaboration between the therapist and client is. Both therapist and client are working towards a specific goal. The therapist is working towards creating better thought patterns and environments for the client, while the clients is working towards bettering themselves with the guidance of a therapist. To do this, teamwork is necessary so that these goals can be reached. Great job!

      Reply

  4. Will Roche
    Feb 02, 2022 @ 10:30:35

    Establishing a therapeutic relationship and therapeutic rapport with a therapist’s clients is arguably the most important aspect of counseling. There has been plenty of research to reaffirm the notion that without a strong therapeutic alliance, the counseling itself will not be very effective. Similarly, the better the therapeutic relationship, the better the overall outcome of the therapy will be. In order to build this therapeutic rapport, therapists need to embody qualities such as empathy, respect and trustworthiness. Among others, these are important qualities that clients will need to see and internalize so that a strong therapeutic relationship can be formed. Collaborative empiricism is critical in CBT services because evidence has been shown that working collaboratively creates significant progress in the client’s well-being. This collaboration can include determining which goals to work on during a session, how much time to spend on these goals, which automatic thoughts, emotions and behaviors should be targeted in that session, which interventions or homework should be tried out, which self-help activities to do at home, how regularly the client should meet with the client and many other collaborative ideas. One staple of CBT is in fact working collaboratively with the client. Sometimes the therapist will “take the wheel” during a session, but a client should also take the wheel during parts of a session as well. Furthermore, if a therapist is able to be transparent with the client and elicit the notion of working as a team through sessions, this will create a collaborative effort and hopefully help embrace a stronger form of a therapeutic relationship.

    There is a strong importance in structuring and organizing a session because typically clients have multiple issues and goals to work on during a session. Being able to organize and plan out a session prior to the client entering the office is an important aspect of a successful CBT session. In Beck’s book, she illustrates what seems to be a piece of paper organizing how she would like the structure the session between her and Abe. She includes preparatory notes, the current level of risk, agenda items, and other specific details about their last session and how to work on them in the current session. I think organizing sessions like this would be vital in making sure the therapist and client are staying on tasks and are actively working towards goals if they are in this stage in therapy. Adding structure will help organize the session which then organizes both the clients and therapists thoughts, which probably makes it easier to begin tackling certain issues and focuses on working towards goals respective to the specific issues the client is facing.

    Reply

    • Tressa Novack
      Feb 02, 2022 @ 14:36:59

      Hi Will,
      I liked reading your description of what a therapeutic relationship includes. I like how you mention that in some parts of therapy the therapist should take the lead and in others the client should take the lead. It is important that clients have a say and therapists consider their input in their treatment. It was great how you point out that if the therapist is clear and upfront that therapy is a team effort, this could serve to strengthen the therapeutic relationship. That was a really good point, and something that I did not consider when writing my post. I agree with what you have to say about session structure. Since CBT is time limited therapy it is very important that therapist and client are staying on task to make sure they are working to achieve the client’s goals. Great post.
      Tressa

      Reply

    • Lauren Pereira
      Feb 02, 2022 @ 16:12:29

      Will,

      Your post included a lot of significant information about the importance of therapeutic rapport. I like how you included a few of the qualities that therapists should showcase in therapy in order to develop a better therapeutic relationship with clients. I also believe that this is one of the most important aspects in therapy because if your client does not feel comfortable enough with you, then they will not open up as much as they should which leads to poorer outcomes. You also did a nice job defining collaborative empiricism. It was great that you included that one staple of CBT is actually working collaboratively with your client.

      I like that you included Beck’s book and how it involved an illustration that included a piece of paper with how she structured her sessions. That is a great example to share. Lastly, this type of concept is extremely important in therapy because staying organized keeps individuals more on task which will be more effective in the long run for a more positive outcome.

      Great post!
      Lauren

      Reply

    • Madelyn Haas
      Feb 02, 2022 @ 16:28:28

      Hi Will,
      Great post! You described the importance of the therapeutic relationship well. To be able to make progress, the clients need to take an active role in their treatment. That doesn’t mean that therapists aren’t an active part of the process. Instead, the therapist will collaborate with the client. Like you mentioned, the person who is contributing more will shift throughout the therapeutic process. It is important to teach and empower clients, so that they build a sense of self-efficacy surrounding therapy and their cognitions and behaviors.

      I also think you did a great job explaining the importance of the structure of therapy. To be able to accomplish goals, the client and therapist need to work out the priority of concerns. This will facilitate the therapeutic process. The structure of therapy is important, especially early on, because it shows the client that you are competent and care about their treatment. Great work!
      -Madelyn Haas

      Reply

    • Lexi
      Feb 05, 2022 @ 13:36:17

      HI Will

      I really liked your take on the importance of rapport in the therapeutic relationship, I think the ability to have a collaborative relationship does to your point depend heavily on the level of empathy, trust, and respect that the client and therapist share. One of the things I think we can all appreciate about CBT in particular is that it empowers the client in the relationship and makes them a part of their own healing and I think a routine or structure to the weekly sessions can be a part of that. There is something inherently empowering about routine, because the client can know what to expect from a session and plan their involvement ahead of time. If they know the first half is always reviewing goals from last week and the second half is always about new goals and feedback – then they can essentially be thinking about how THEY want the session to go, and what points they want to bring up during those phases in the routine.

      Reply

  5. Tressa Novack
    Feb 02, 2022 @ 14:19:32

    My understanding of the therapeutic relationship in CBT is that it is collaborative and meant to empower the client. The therapeutic relationship is one where the therapist and client work together to decide what treatment plan will be best for client. This is known as collaborative empiricism, because the therapist and client are working together, while using the evidenced based practice of CBT. The therapist works to include the client in treatment decisions while still guiding them as the therapists are the experts in CBT. Also, the amount of involvement from each party will change as therapy progresses. For example, in the beginning the therapist will play a more leading role, because they will be assessing the client’s problems and coming up with an action plan to get the client started on their treatment. The therapist will also be offering the client psychoeducation by teaching the client what CBT is, how it works, and teaching the client about their diagnosis. As therapy progresses and the client improves, the client will be able to take more of a lead in their treatment and eventually become able to be their own therapist in the sense that they can problem solve and shift their thinking without so much help from their therapist. A good therapeutic relationship also requires interpersonal skills, such as warmth, understanding, and good listening skills so that clients will trust their therapists and feel comfortable opening up.
    It is important to have session structure in therapy so that therapists can make sure to address everything that needs to be addressed in a session. Since CBT is time limited it is important to have structure. For example, therapy sessions usually begin with a check in of mood, symptoms, and reviewing homework from the previous session. It is important for therapists to enter a session with a good plan, that is flexible, because things may come up during the session, so that therapists can be sure to address the client as a whole. Session structure also makes to clear to clients that therapists are taking the time to plan for them and shows that they are cared about. Structure also allows clients to know what to expect, which is always helpful for those who are anxious. Having a plan can also make clients feel empowered because they can tackle the therapy session piece by piece instead of being overwhelmed or feeling lost.

    Reply

    • Madelyn Haas
      Feb 02, 2022 @ 15:56:49

      Hi Tressa,
      I enjoyed reading your post. I think you described why the client-therapist relationship is so important well. Although therapists are the expert on mental health, they are not the expert on the client. Without collaboration, therapy will be much less beneficial for the client. For these reasons, collaborative empiricism is incredibly important. Together you and the client can work together to collect data, test “hypotheses,” and find solutions that you both think would help.

      I agree with your explanation on why the structure of CBT sessions are so important. Without structure, we and our clients will not be able to prioritize the important tasks at hand. Another reason that session structure is important is that it gives the client the perception that you are qualified, well prepared, and care about their treatment.
      -Madelyn Haas

      Reply

    • Lauren Pereira
      Feb 02, 2022 @ 16:20:51

      Tressa,

      I like how you started off by explaining collaborative empiricism and the importance it has on therapy. The therapist and client have to work together in order to find the best treatment plan that will work for them. Without this, therapy can get unorganized and not be as effective. I also like that you included how the therapist will teaching the client what CBT is, how it works, and teaching the client about their diagnosis. This is also significant in order for the client to understand the process.

      You did a nice job explaining session structure and how it is important due to the time limitation that sessions have. This also shows your client that you take time to think about their needs so they can build more trust and comfort in you, as their therapist. Having a set plan is beneficial for both the therapist and client so that everything can be discussed and important topics are covered within each session.

      Great post!
      Lauren

      Reply

  6. Madelyn Haas
    Feb 02, 2022 @ 15:50:43

    Although some people erroneously assume that CBT is a cold, uncaring practice, the client-therapist relationship is actually incredibly important. Without trust and collaboration, therapy will not benefit the client. Multiple studies have found that the quality of the therapeutic relationship predicts the outcome for the client. If the client does not believe that the therapist is capable and trustworthy, the client will not be able to make the changes they want to or need to. One important aspect of the therapeutic relationship in CBT is collaborative empiricism. Though that sounds complicated, it is actually a fairly straightforward concept. The therapist and the client need to work together to collect data (via assessments and discussions), make hypotheses (e.g., the client’s automatic thoughts are affecting their mood), and find solutions that work for the client. Without the help of the client, the therapist would not have much to work with. For this reason, it is important that the client is an active participant in their own treatment.

    CBT as a practice has a lot of merits that other forms of therapy do not. One important aspect of CBT is how structured the session are, especially for novice therapists. The structure of therapy is good for multiple reasons. First, it shows the client that you care enough to put in work outside the session. If they see the work you are doing, they may appreciate it and view you as more trustworthy/attractive. Second, it looks professional and impressive to clients. Because the client-therapist relationship is so important, your appearance as a competent and professional therapist is very important. Some clients will be surprised that therapy can be structured and not freeform because their past therapeutic experiences. Third, and finally, it allows you to pick out what is most important and focus on that. If you make a structured plan, you can gently nudge your clients back on track and work on what is most important for them. The structure of the session allows you to cover things more efficiently and make sure you get to everything you need to cover.

    Reply

    • Emily Barefield
      Feb 03, 2022 @ 09:19:48

      Hi Madelyn,

      I like how you contrasted how CBT is often perceived with reality. I also like how you emphasized the collaborative nature of CBT and the process of both the therapist and client collecting data. When the client is an active participant in their treatment, it not only gives them a sense of empowerment, but also allows them the opportunity to make progress on the goals most important to them.

      You did a great job explaining why structure is so important for CBT. It does help improve how the therapist is perceived by the client, in terms of professionalism, trustworthiness, and attractiveness. It also allows for progress to be made on agreed-upon goals. Great post!

      Reply

    • Sandra Karic
      Feb 03, 2022 @ 21:10:43

      Hi Madelyn,
      Great job explaining the importance of establishing a therapeutic relationship. I really liked how you explained collaborative empiricism as well and your use of specific examples in regards to automatic thoughts and the use of assessments. I also liked how thorough you were in explaining all the different reasons why structure is important in CBT. I definitely agree that structure can be particularly useful to beginner therapists, I know I find the structure in CBT to be helpful. Finally, I agree that providing structure can increase perceptions of competence and professionalism and lead to greater treatment efficiency.

      Reply

  7. Lauren Pereira
    Feb 02, 2022 @ 16:02:13

    One of the very first concepts I learned was the importance of a therapeutic relationship within CBT. In order to build a strong rapport between you and your client, you must form a good therapeutic relationship with them. This will help them feel more comfortable in opening up and it will develop into trust which is significant for this process to work. Without it, cognitive behavioral therapy would not be very effective. Therapists are meant to show great qualities towards their clients so they feel more welcomed and listened to. It can be a very difficult process to go through therapy and open up about several traumatic experiences, so in building a strong rapport, it will help that client feel much more comfortable and confident through each conversation. In showing lots of respect and abilities of trust, therapy can go a long way when a client is more open in sharing what is going on in their lives. Collaborative empiricism is another important aspect when discussing a good therapeutic relationship. This topic describes working together, as a team, to identify the most effective and relevant goals that need to be met in therapy. This aspect helps both the client and therapist work together and make sure they are both on the same page while being on a path to find the best outcomes. Collaborative empiricism also focuses on different thoughts, emotions, and behaviors in order to find the most fitting interventions for clients to use. Each of these aspects makes CBT one step closer to a better outcome. Overall, the better therapeutic relationship you have built, the more likely it is to see a more positive outcome in therapy.

    In order to benefit from effective CBT, it is important to have session structure. This aspect focuses on organization. It is important to plan out each session in order to organize topics that are most important to cover. Oftentimes, in therapy, different types of topics or occurrences tend to pop up so it is important to stay on task and touch base on topics that are most important to consider. This provides the therapist and client with a set structure in order to cover most of the information needed to have a successful session. The more structure that is provided in the beginning of therapy while building rapport, the more comfortable both individuals will feel as time passes and the less structure will be necessary towards the end. Lastly, it is nice to have a set plan and schedule of what your therapy session may look like in order to stay organized and make sure you are seeing progress. Being able to organize sessions will help to keep you on track. This all makes for a better and more effective therapy session.

    Reply

    • Emily Barefield
      Feb 03, 2022 @ 09:37:37

      Hi Lauren,

      I like how you emphasized the importance of trust in a therapeutic relationship. It is hard to make much therapeutic progress. Collaborative empiricism is also a very important part of the therapeutic relationship. I like how you emphasized that the client and therapist work as a team and identify goals that best help the client.

      You did a good job of explaining how structure is important for the therapist and the client to stay on track and be able to accomplish their goals. The session may be more dependent on more rigid structure at the beginning of the course of therapy and gradually shift to meet the needs of the client. Great post!

      Reply

    • Pilar Betts
      Feb 05, 2022 @ 21:35:48

      Hi Lauren,
      I liked that you talked a lot about how important it is to make the client feel comfortable and secure in the relationship which is especially essential in a therapeutic environment because the client may talk about very personal and sensitive topics. Your definition of collaborative empiricism as an important aspect of building the therapeutic relationship and making the clients experience positive and beneficial to them. In your discussion about why structure is important in a session, I agree organizing topics so that the ones of most importance stay a focal point of the session. And how this is particularly helpful when trying to gauge progress.
      Great post!

      Reply

  8. Emily Barefield
    Feb 02, 2022 @ 19:25:03

    The therapeutic relationship is an important element of CBT and is described as necessary but not sufficient for the healing process. The therapeutic relationship is different than a friendship or many other relationships in our lives because it is designed to be largely one-sided, meaning that, while it is important to be genuine and be a human, the therapist’s job is to listen, empathize, guide, and mentor the client and the client is not expected to do any of those things. Additionally, the relationship is formed to accomplish a goal, the treatment of the client’s presenting problem and the betterment of their lives. This is where the idea of collaborative empiricism is important. Collaborative empiricism is defined as a therapeutic alliance based in research that actively integrates, tests, and modifies the client’s thoughts and behaviors with the client having an important role in this process. The therapist is not simply prescribing treatment to the client but works with the client to create the best course of action for agreed upon goals.

    Personally, I am grateful that CBT encourages (or requires) a high level of structure. While it will certainly take time and practice to have a good understanding how the structure plays out in practice and how to be flexible for each client, having a guideline on how to organize sessions will be helpful when beginning therapy. Having a structure session for each session improves how the client views you as a professional. It improves your perceived expertness, trustworthiness, and attractiveness. Importantly, having structure allows for the benefits of the therapy session to be maximized. The time the client spends in therapy is significantly less than the time they spend outside of therapy, and so the session should equip the client to be able to improve outside of the time spent in therapy. By having specific, measurable goals for each session the therapist is able to track the progress the client is making and alter the goals as necessary. The client is able to have a clear understanding of the progress they have made, which can be highly motivating.

    Reply

    • Lexi
      Feb 03, 2022 @ 15:52:29

      HI Emily

      I enjoyed your discussion about the therapeutic relationship, you are so right to point out the fact that the relationship in therapy differs from relationship the client is a part of outside of therapy. Therapists should thrive to be as accepting as possible of the client, to listen to them and to speak without bias. So often in normal relationships we are only half listening or trying to “one up” people’s experiences or whatever – so in that way the therapeutic relationship is really special for clients.
      I am also grateful that there is a basic structure to the CBT session, especially coming into the field at first, I think it will be helpful to rely on the structure while building confidence in therapy. There are also the many other benefits you and other discuss about maximizing results and effectiveness of the client’s time as well.

      Reply

    • Sandra Karic
      Feb 03, 2022 @ 20:53:52

      Hi Emily,
      I strongly agree with your comments on how the therapeutic relationship is necessary but not sufficient for change. I like how you described the ways that a therapeutic relationship is unique and different from the other interpersonal relationships people experience. I think this is especially pertinent when it comes to the use of self-disclosure as a therapeutic tool, which should only be used after gaining some experience and in cases where it is clearly beneficial for the client. I also am grateful for the structure that CBT provides. I think it is going to be very reassuring to have a clear sense of the structure of CBT as beginning therapists.

      Reply

  9. Sergio Rodriguez
    Feb 02, 2022 @ 23:36:11

    (1) What is your understanding of the therapeutic relationship in CBT (include collaborative empiricism in your discussion)?
    One of the most important elements of the CBT (if not the most) is the “Therapeutic Relationship”. According to Beck, research has demonstrated that a positive therapeutic relationship is correlated with favorable treatment outcomes. Beck highlights some core components that demonstrate good counseling skills and an accurate understanding of the problem. For example, share the conceptualization and treatment plan, collaboratively make decisions, seek feedback, vary the therapeutic style, help patients solve their problems and alleviate their distress.
    Collaborative empiricism involves a collaborative effort between patient and therapist in developing a treatment plan. As well as cohesiveness between the patient and the therapist as they explore the patient’s aspects that contribute to dysfunction together through discovery and experimentation.

    (2) Why is it important to have session structure for effective CBT?
    The therapist should conduct therapy as efficiently as possible. The main reason is that when clients come to therapy most of the time, they’re going through difficult situations. The therapist’s efficiency will help relieve the patient’s suffering as quickly as possible. Following these thoughts, the structure of a session is essential because adding standards and organization to therapy. Patients do better when they know what to expect, feel part of the therapy as a team, and understand the different stages of the treatment and their anticipated achievements and progress. However, one key aspect of the structure is flexibility. For CBT, it considers multiple patient factors like symptoms, the strength of the therapeutic alliance, their stage of treatment, and, especially, the problems they put on the agenda to be treated.

    Reply

    • Jeremy
      Feb 04, 2022 @ 20:53:41

      Hi Sergio,
      I liked your discussion on collaborative empiricism and how it is a continuous process of discovery and implementation between the two individuals to work on the client’s problem. this also puts unconditional positive regard into action, as the therapist may have to check their own biases and preconceptions at the door to help the client in a way that will help them best.
      I like that you emphasized the importance of flexibility in the session structure, each client will have unique needs, and beyond that, each day and topic brings its own challenges, sometimes the content requires more time than we scheduled it, and that is okay, being able to alter and adapt the plan on the fly is greatly beneficial to starting counselors.

      Reply

    • Moises Chauca
      Feb 04, 2022 @ 21:30:02

      Hello Sergio,

      Your post is great. I like how you incorporated Beck theory and highlighted the important counseling skills needed in the therapeutic alliance. In addition, tn collaborative empiricism, it is important to highlight the use of empirical research intervention and assessments because these can help the patient and therapist create a better treatment. Furthermore, I agree with you that therapy should be efficiently as possible, and a good structure influences this efficiently. Finally, you are so right about structure flexibility because so many clients are unique that the session needs to me modified for their needs.

      Reply

    • Pilar Betts
      Feb 05, 2022 @ 22:01:27

      Hi Sergio,
      Great post!

      I liked that you mentioned how a strong therapeutic relationship is correlated with favorable treatment outcomes, because there is a misconception as mentioned the J Beck text that people thing CBT therapist are cold but that is not true considering the amount of attention to being compassionate and understanding of the client and efforts in strengthening the therapeutic relationship a CBT therapist takes. I also really liked that you mentioned how CBT considers multiple aspects pertaining to the client such as stage of treatment, strength of relationships and symptoms. I agree it’s very important to be aware of all of the factors that influence the clients progression in treatment, every client is different and as a therapist one should pay attention to to the clients social environment, emotions, thoughts beliefs, coping skills and support systems.

      Reply

  10. Lexi
    Feb 03, 2022 @ 14:19:13

    The therapeutic relationship in CBT should be first and foremost a relationship that is collaborative, with client and therapist working together towards common treatment goals. CBT treatment is most successful when the therapist is respectful of the individuality of the client, and this should be reflected in the therapist’s ever evolving conceptualization of that client. The collaborative therapeutic relationship is so important in CBT that it should be a primary goal of an effective therapist to build sound rapport in the first few sessions. The relationship should be one built on mutual respect, trust, self-disclosure, and understanding, with treatment tailored to the clients’ values, beliefs and culture. The therapeutic relationship should be characterized by its teamwork and collaborative nature. This process of client and therapist working together in establishing common goals and a tailored action plan for the client is what our books call collaborative empiricism. The practice is evidence based, empirical, and again collaborative. It is a unique type of therapeutic relationship the goal of which is to provide the clients with the skills to “become their own therapist”. The goal of the therapist in the therapeutic relationship according to CBT is not one of too much “authority” per say. That is not in the way Freud clearly considered himself to be at least intellectually superior to his clients who come to him for his answers – collaborative empiricism suggests that clients should be advocates and experts in their own treatment and hold a much more equal role to the therapist in therapy.

    Session structure – as our book points out is particularly important for new therapists. Therapy is only once a week with sessions lasting about an hour, often just 45 minutes. Having a plan and a structure for the session means that small amount of time will be used as efficiently and effectively as possible, this helps towards the ultimate goal of achieving time sensitive and effective treatment and making the clients life better. Following a specific format in sessions facilitates the objectives of helping the client feel better faster, establish goals more clearly, developing more effective action plans, etc. Judith Beck suggests that the first part of the session should be dedicated to strengthening the therapeutic relationship, collecting relevant data, and also reviewing the action plan. Beck writes that in the second part of the session you may want to discuss client issues and goals, which lead to the formation of new and better action plans / goals for the next week. During the summary at the end of session it is important to make sure the client is on board, and respond to any feedback they may have. I think the benefits to this are also that therapist and client will both become used to the flow of meetings, and it may make the process less stressful especially for an anxious client or a new therapist. Overall, I think most humans tend to appreciate a level of predictability and routine as well. If client and therapist know what to expect they can be better prepared prior to the start of session, and make better progress during the session.

    Reply

    • Sergio Rodriguez Pineda
      Feb 05, 2022 @ 21:09:30

      Hi Lexi,

      I agree with you with the awareness for the therapy session from both the client’s and the therapist’s perspectives. Also is essential that a client has an idea of what to expect for the session in most cases. I’d like to add that CBT also allows the therapist to be flexible with the order or the priority of the topics for the session, taking the situation’s needs accordingly. Sometimes new information can come up at the end of the process when the therapist can have the idea of being almost done and then the client reveals new information that bring the therapist to reevaluate and set new goals of course with all the skill and process already learned in therapy which is on of the main goal of CBT.

      Great post!
      Sergio Rodriguez P.

      Reply

  11. Sandra Karic
    Feb 03, 2022 @ 20:00:47

    One of the myths about CBT is that the therapeutic relationship is not a key part of treatment. However this is not the case–without a strong therapeutic alliance the techniques and skills used in CBT will not be effective. A therapeutic relationship can both positively and negatively influence a client so it is important to not undersell the role of the therapeutic relationship in CBT. CBT is a very collaborative theoretical orientation. Therapists have expertise in treating mental health issues but each client is the expert on their own life, so it is important that the client and therapist work together to formulate treatment goals. Some of the interpersonal factors that are relevant to forming a therapeutic alliance are the client’s perception of the therapist’s expertise, trustworthiness, and attractiveness. Rogerian factors such as unconditional positive regard, empathy, and genuineness are also important in establishing a relationship. Collaborative empiricism invokes the therapeutic relationship to maximize the effectiveness of CBT interventions. More specifically collaborative empiricism involves the client and therapist working together to identify and test maladaptive thoughts or beliefs.

    I think there are a plethora of reasons for why structure plays such a large role in CBT. For one I think having a clear and consistent (though adaptable) session structure helps set up expectations for therapy and the nature of CBT in general. I also think that without session structure it would be very difficult to touch on all the different components that need to be covered. Good session structure can even influence some of the factors related to therapeutic alliance, such as increasing the degree to which a therapist comes across as an expert. Finally, I really liked how the reading mentioned incorporating the intensity of certain topics when setting an agenda. For instance, a topic that is particularly distressing should not be left to be brought up at the end of the session.

    Reply

    • Moises Chauca
      Feb 04, 2022 @ 21:44:31

      Hello Sandra,

      I enjoyed reading your post. I totally agree with you that a therapeutic relationship can be negative and positive. This is a good point you made because I am sure that there are therapist that keep doing everything right, but there are no positive outcomes because their therapeutic relationship is not good. Another great point you mentioned was the importance of acknowledging that the client is the expert in their lives, so a collaborative approach is the best option. Finally, your explanation about the importance of structure and the therapeutic alliance has helped me understand more the topic and remind me about important factors of them.

      Reply

  12. Moises Chauca
    Feb 03, 2022 @ 21:16:23

    In CBT, the therapeutic relationship is the most significant and influential factor in therapy. It is clear for me that as therapist, we want to have a positive therapeutic relationship because it influences the treatment outcome and the client. This positive therapeutic relationship has to be like an alliance where the client and therapist work together and collaborate with each other to create and modify the client treatment plan, homework, and interventions. A therapeutic relationship without this alliance can significant affect the client treatment. In addition to this relationship, collaborative empiricism is crucial in the client treatment because interventions and assessments need to be empirically researched, so the client is getting the best treatment.
    Furthermore, session structure is crucial for the client treatment and relates to collaborative empiricism. The lecture slides mention that most clients want and need structure during sessions, so they feel more comfortable and create a positive view that the therapist is an expert, trustworthy, and attractive. These factors help develop the therapeutic alliance and promote collaborative empiricism. Finally, session structure provides the therapist and client direction on the treatment and allow for therapy efficacy when the structure is followed.

    Reply

    • Jeremy
      Feb 04, 2022 @ 17:15:17

      Hi Moises,
      Great discussion post, I really like how in CBT the therapeutic alliance is seen as a foundation on which to build a good practice, by using an alliance of the therapist empirical knowledge, and the client’s personal experience, the two of them can create goals and practices to help improve the client.
      It’s great you pointed out that clients often want or need this structure, in part, it is likely why they are seeking therapy, providing these supports is a great way to build CBT into the sessions.

      Reply

  13. jeremy
    Feb 03, 2022 @ 22:12:09

    Development of the therapeutic relationship has been a hallmark of therapy and largely is assocated with Rogerian ideals. It is often said in CBT that these base humanistic skills are necessary but not sufficient for high-quality care. A strong therapeutic relationship acts as the foundation on which more advanced skills and interventions can be built upon. In this way the therapeutic relationship is collaborative wherein the therapist is the teacher of CBT and psychological skills, and the client is the expert in themselves., over time this dynamic will shift and change as you learn more about each other, and as the client masters skills and treatments, eventually becoming a protegee of their own capable of being self-sufficient. The therapeutic relationship is unique with each individual client, as a therapist, it is important to meet clients where they are at. By collaborating the client and therapist pick SMART goals and mold CBT to the client’s needs and strengths.

    (2) Why is it important to have a session structure for effective CBT?
    A typical session of CBT crams a lot of content into a hour block of time, keeping an outline is beneficial for a variety of reasons, chiefly, it makes you seem professional, it brings order and structure, allows for better pacing of the therapeutic time. Finally, it helps ensure that the intervention is being administered correctly, without forgetting homework, check-ins, and debriefing. As a professional therapist, it is expected that you conduct yourself as an expert, having a structured process k keeps things organized, clean and professional. Beyond professionalism, session structure allows for a clearly communicated agenda for the session, helping prep for the session, and so that the therapist and client are in agreement and to hopefully avoid bombshell developments at the end of the session. In a similar vein, a session structure is a timekeeping aid for the therapist, assisting in a timely flow from open to close all within the 50-minute session.

    Reply

  14. Pilar Betts
    Feb 04, 2022 @ 01:02:50

    It’s important to establish rapport and begin developing the therapeutic relationship with the client to make the relationship seem less of a business transaction and more about connection and communication, in CBT the therapist focuses a lot on showing the client empathy and understanding. Most people feel they need to be a certain way and uphold certain expectations in their day to day lives, therapy is the one place they shouldn’t have to feel that pressure and be able to express their feelings, thoughts and emotions without a person interrupting to say their personal opinion or give advice. Establishing rapport is crucial because you want to make the client feel comfortable enough to return to future sessions and to confide in you. Everyone is their own unique person, what works for one client won’t work for the next. A simple example of this is with body language, you can’t read body language the same on everyone, but it definitely is a helpful tool to observe body language of clients, for example if you observe that a client clenches their fist everytime they talk about their encounter with a snake, you now know the meaning behind this body language for that particular client is fear and anxiety. Collaborative empiricism is a part of keeping the client actively involved in their own healing process, the therapist and the client work together to establish common goals in treatment. Collaborative empiricism’s goal is to identify the cognitions and behaviors the client has that are maladaptive. Once these maladaptive thoughts and behaviors are identified the therapist is able to help the client challenge them. This is where the therapeutic relationship comes in handy, having a strong relationship with your client means you have established trust with them, that relationship allows the therapist to be able to challenge the client’s thoughts and behaviors because the client knows the therapist is there for their own benefit and to have faith in the relationship.

    CBT sessions having structure is important because the client will feel more comfortable knowing there are set goals and a plan. It will give them peace of mind to know that the person they are going to be revealing their thoughts and feelings to is put together and isn’t going to just make it up as they go along. Even providing the client with some psychoeducation is helpful for them to feel more assured that you are able to help them. Another great thing about structure in sessions is it will help the therapist to keep track of important topics to discuss with the client, the client may want to discuss a bunch of different things but by having a structure you can keep them on track especially if they are trying to avoid talking about a particular topic by having a structure you can redirect them. Another reason having a structure is good is because it reminds the therapist to check in with the client to see where their mind is at, and based on their response it can better be dictated on what to address and work through during the session. Lastly, by providing a summary and asking for feedback to end the session sets up both the client and therapist for the next session the summary helps confirm that the therapist understood the client and was actively engaged in what they had to say. The feedback depending on what it is can be brought up at the beginning of the next session, for example if the client says they felt as if the client brushed over something and that made them feel closed off. The therapist can address it and take note of it and check in the beginning of the next session.

    Reply

  15. Pilar Betts
    Feb 04, 2022 @ 01:07:19

    It’s important to establish rapport and begin developing the therapeutic relationship with the client to make the relationship seem less of a business transaction and more about connection and communication, the therapist focuses a lot on showing the client empathy and understanding. Most people feel they need to be a certain way and uphold certain expectations in their day to day lives, therapy is the one place they shouldn’t have to feel that pressure and be able to express their feelings, thoughts and emotions without a person interrupting to say their personal opinion or give advice. Establishing rapport is crucial because you want to make the client feel comfortable enough to return to future sessions and to confide in you. Everyone is their own unique person, what works for one client won’t work for the next. A simple example of this is with body language, you can’t read body language the same on everyone, but it definitely is a helpful tool to observe body language of clients, for example if you observe that a client clenches their fist everytime they talk about their encounter with a snake, you now know the meaning behind this body language for that particular client is fear and anxiety. Collaborative empiricism is a part of keeping the client actively involved in their own healing process, the therapist and the client work together to establish common goals in treatment. Collaborative empiricism’s goal is to identify the cognitions and behaviors the client has that are maladaptive. Once these maladaptive thoughts and behaviors are identified the therapist is able to help the client challenge them. This is where the therapeutic relationship comes in handy, having a strong relationship with your client means you have established trust with them, that relationship allows the therapist to be able to challenge the client’s thoughts and behaviors because the client knows the therapist is there for their own benefit and to have faith in the relationship.

    CBT sessions having structure is important because the client will feel more comfortable knowing there are set goals and a plan. It will give them peace of mind to know that the person they are going to be revealing their thoughts and feelings to is put together and isn’t going to just make it up as they go along. Even providing the client with some psychoeducation is helpful for them to feel more assured that you are able to help them. Another great thing about structure in sessions is it will help the therapist to keep track of important topics to discuss with the client, the client may want to discuss a bunch of different things but by having a structure you can keep them on track especially if they are trying to avoid talking about a particular topic by having a structure you can redirect them. Another reason having a structure is good is because it reminds the therapist to check in with the client to see where their mind is at, and based on their response it can better be dictated on what to address and work through during the session. Lastly, by providing a summary and asking for feedback to end the session sets up both the client and therapist for the next session the summary helps confirm that the therapist understood the client and was actively engaged in what they had to say. The feedback depending on what it is can be brought up at the beginning of the next session, for example if the client says they felt as if the client brushed over something and that made them feel closed off. The therapist can address it and take note of it and check in the beginning of the next session.

    Reply

    • Sergio Rodriguez Pineda
      Feb 06, 2022 @ 00:32:13

      Hi Pilar,

      I liked how you pointed out the relationship in therapy is about communication and connection because no matter how good the thereapist is with any of the CBT techniques, the outcomes are not going to be the same without an apportite connection with the client. Challeging the client thouths and behaviors is a key part of the therapy and you described it really well.Collaborative empiricism its fundamental for the client to learn the new skills that are going to be needed when the therapy is over. Because this is a remarkable element of CBT, have the client trained in cope, behave and act in situations where they feel there are elements not working well in their lives.

      Thanks for your post!can,

      Reply

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Adam M. Volungis, PhD, LMHC

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