Topic 3: Therapeutic Relationship & Session Structure {by 9/10}

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 9/10.  Have your two replies posted no later than 9/12.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

28 Comments (+add yours?)

  1. Allie Supernor
    Sep 06, 2020 @ 11:22:08

    (1) The therapeutic alliance in cognitive-behavioral therapy is critical for long-lasting behavior change in the person receiving services. Different from other approaches in therapy, in CBT, both the therapist and clients are active participants in and out of the session. Both parties work together toward a mutual goal, identified and developed together. The therapeutic alliance is the relationship and participation of the therapist and client. Collaborative empiricism is an action-oriented therapeutic alliance driven be research that integrates, tests, and modifies clients’ thoughts and behaviors. There are many factors that influence the therapeutic alliance and therefore collaborative empiricism. There are nonspecific, or common factors, and there are CBT-specific factors. Nonspecific factors are used in most therapeutic approaches and include skills that come naturally to most therapists. The two most common and well-known nonspecific factors are Rogerian qualities and interpersonal skills. Some Rogerian qualities that play a role in the development and continuation of the therapeutic alliance are empathy, unconditional positive regard and genuineness. Whereas, CBT-specific factors contribute to the therapeutic relationship and are necessary for collaborative empiricism. These factors are catered and idiosyncratic to cognitive-behavioral therapy.
    (2) Structure implemented by the therapist helps guide the discussion and direct the therapy in session. Most clients want and need structure. Structure, beginning at session one, instills comfort and hope that therapy might provide some relief to their distress. Consistent session structure socializes clients to CBT and allows you to model the collaborative nature of the theory. It is easy to get lost or misguided in therapy, sometimes even distracted. Structure in the session enhances therapeutic efficiency by facilitating organized therapy that stays focused on the problems most relevel and their corresponding goals and interventions. Additionally, it also demonstrates your expertness, trustworthiness, and attractiveness as a therapist. Which is important for beginning therapist and their therapeutic alliance with clients.

    Reply

    • Haley Scola
      Sep 11, 2020 @ 12:01:33

      Allie,
      I thought the way you structed this response was very effective. With so much to cover in one post you did a great job at organizing the information. First, I really liked how pointed out how CBT is different from many other approaches by its collaborative approach and including that both the therapist and client are “active” participants. I thought how you went into detail about Rogerian qualities and interpersonal skills was very insightful that you explained that specific approach to CBT and explained that CBT-specific factors enhance the therapeutic relationship and are necessary for collaborative empiricism. Lastly, I loved how you pointed out (like Dr.V in his lecture) that most clients want and need structure. I think that’s something most people tend to overlook when thinking about therapy. Additionally, you also pointed out how it is easy to get lost or misguided in therapy. I went to a therapist for a year in college because of all the changes that were happening in my life. This is before I knew about CBT and the structure of therapy. I would go in and there was no structure at all, I had no idea what my goals were or any interventions, it was just me going in and talking for an hour. This sometimes left me feeling confused about my feelings and even more flustered than when I first came in.

      Reply

    • Madi
      Sep 11, 2020 @ 12:10:22

      Hi Allie,
      I agree with you that it is important that client and therapist both need to be active in CBT. This is very unique and important to CBT. I also thought that you showed a clear understanding of collaborative empiricism. I also agree with your points about structure in therapy. Additionally, think that structure decreases anxiety for new clients who are completely new to therapy.

      Reply

  2. Madi
    Sep 09, 2020 @ 13:56:09

    1. My understand of the therapeutic relation in CBT is crucial for lasting behavior change in the client. An important component to the therapeutic alliance and CBT in general is the fact that the therapist and the client are both active in the session. It is a strong alliance that helps to create and discuss the client’s goals. If there is a weak alliance, then the interventions won’t be nearly as strong. So, a strong alliance will create more successful treatment plans. A strong alliance also predicts improvement in symptoms. Collaborative empiricism is the action-oriented approach of the therapeutic alliance. Additionally, it uses research to test and modify a client’s thoughts along with their behaviors.
    2. It is crucial to have session structure for CBT because it gives the client a sense of direction. If a therapist brings the initially session with structure, then the client is put at easy so they know what to expect. Structure also allows for check-ins with goals and interventions. While structure may seem rigid, it does not need to be. Structure allows the client, and the therapist, to stay on top of what is important and not go down too many rabbit holes. It also increases a therapists expertness, and attractiveness.

    Reply

    • Allie Supernor
      Sep 09, 2020 @ 20:43:52

      Hey Madi, I really enjoyed how you noted the interventions won’t be as strong and effective with a poor therapeutic alliance. You also spoke about a reduction or improvement in symptoms, which I thought was a great way to look at it! That a measurable way to evaluate the therapy, and ultimately the therapeutic alliance. I never thought to look at collaborative empiricism like that.

      Reply

    • Alison Kahn
      Sep 09, 2020 @ 21:13:33

      Madi,

      I love how your discussion post focused on treatment outcomes and how important the therapeutic alliance is to successfully implementing CBT interventions. I would imagine that as a therapist, looking at long term outcomes for clients would be really motivating and an important thing to keep in mind during sessions to bolster self-awareness and the therapeutic relationship as a whole.

      Reply

    • Francesca DePergola
      Sep 09, 2020 @ 21:22:29

      Hi Madi,
      I liked how you talked very clearly in question one, specifically focusing on the effects a strong or weak alliance will have on the client and their outcomes. I could not agree with you more as even Dr. V noted the average amount of sessions a client will have with a therapist is 1-2 or 3-4, depending on the research. I think the client can get a real sense of what kind of a relationship they might be able to generate by the first session. So it is very important to make sure when establishing the alliance that the mixture of nonspecific and cbt factors are used. Further, making sure that as therapists the basics are met, especially empathy and interpersonal skills like expertness, trustworthiness, and attractiveness.

      Reply

    • Christopher LePage
      Sep 10, 2020 @ 19:14:28

      Hi Madi,
      I enjoyed how you wrote about how structure can increase a therapists expertise and attractiveness. By having this structure it shows to clients that you as a therapist knows what they are talking about, and you are showing confidence in your own skills. It also helps increase attractiveness as clients may feel that structured sessions make them feel more comfortable with the process and the therapist as well.

      Reply

  3. Alison Kahn
    Sep 09, 2020 @ 21:08:28

    1. The therapeutic relationship in CBT emphasizes collaboration and reciprocity. That is, the client is an active participant in his or her treatment and both the therapist and the client build an alliance in which mutual goals are established and worked towards. This collaboration is dependent on developing a sound rapport with the client (displaying empathy, trustworthiness, genuineness, etc.) such that he or she feels comfortable and empowered to participate in treatment. More specifically, collaborative empiricism stresses the importance of action-oriented treatment that focuses on modifying a client’s thoughts and behaviors through the use of evidence-based interventions. Collaborative empiricism involves varying levels of therapist-client activity throughout the duration of treatment. As the client becomes more knowledgeable and equipped with CBT tools, he or she will become more active, while the therapist’s level of activity decreases, creating more of a mentor-protégé relationship in which the client develops autonomy.
    2. Session structure is incredibly important in CBT for several reasons. CBT is a problem-focused therapy with a limited number of sessions and a focus on measurable goals. Because of this, structure within sessions is pivotal in order to obtain the desired treatment outcomes. Further, session structure is important because it demonstrates a therapist’s interpersonal skills (trustworthiness, attractiveness, reliability) which is essential for therapeutic rapport and alliance. Many clients desire structure and providing an agenda during sessions may alleviate client distress regarding treatment outcomes or the presenting problem. Structuring sessions also models the collaborative nature of CBT to the client and helps orient them to CBT as a model of treatment. Finally, session structure provides not only the client with direction during treatment but it also helps therapists to remain on track and working towards the client’s goals effectively and collaboratively.

    Reply

    • Francesca DePergola
      Sep 09, 2020 @ 21:35:52

      Hey Alison,
      Your answer to number 2 was very informative and hit all the marks and more. I think the limitation of sessions is crucial as it gives guidance for where one should be at a particular time. This can definitely help keep both the client and counselor on track as you have stated. I feel like if there was no structure to therapy sessions at all neither the therapist nor the client will know what to focus on, if or when there has been any progress, etc. The agenda sets the course of therapy and in turn all the sessions throughout. This is the “driving force” of the direction the therapy will go in as well as the most effective. When it is attached to specific and measurable treatment goals it can really benefit the client and counselor to get an idea of where they are in the process. This is all very important and crucial when dealing with cognitive behavior therapy as, as you said, is very problem and goal-focused. Great points, thank you!

      Reply

    • Allie Supernor
      Sep 10, 2020 @ 12:38:02

      Hey Alison, I liked how you noted the important characteristics for a sound therapeutic alliance. The therapist must empathy, trustworthiness, genuineness, etc. This is important for the rapport but also that the client feels comfortable and empowered to participate in treatment. In Dr. V’s lecture, he spoke about without the therapeutic relationship, lasting behavior change wasn’t likely.

      Reply

    • Eileen Kinnane
      Sep 10, 2020 @ 22:01:46

      Hi Alison, I really liked how you mentioned the ways in which collaborative empiricism involves different levels of therapist-client activity throughout treatment. It very clearly lays out the process of a client becoming their own therapist. This is a process I’ve struggled with understanding in the past and your explanation has made it much more clear for me.

      Reply

  4. Francesca DePergola
    Sep 09, 2020 @ 21:10:23

    (1) What is your understanding of the therapeutic relationship in CBT (include collaborative empiricism in your discussion)?
    My understanding of the therapeutic relationship in CBT is that although it is not considered the primary process for change in CBT, it “ is still essential for obtaining desired treatment outcomes for improvement in mental health and overall quality of life.” (Volungis 2019) The establishment of the therapeutic alliance is crucial because it is not just the therapist or the client that is only participating, it is a collaboration of both. Together they work on mutual goals. This is important because research has provided significant evidence that there is a positive relationship between client and therapist, there are better treatment outcomes. Specifically, concerning cognitive behavior therapy, it is noted that the relationship early on in the stages predicted symptom improvement. Cognitive behavior therapy is a very collaborative approach. Collaborative empiricism is an “action-oriented” alliance that is driven by research that integrates, tests, and modifies a client’s thoughts and behaviors. Collaborative empiricism as well as the therapeutic alliance are determined by many factors. First, there are non-specific factors which are used in most therapeutic approaches and include many general, but key skills. These skills may come naturally to therapists, but as shown through research these non-specific factors are not enough to help everyone who is suffering from a disorder(s). Within these factors come the Rogerian qualities and interpersonal skills which are the two most common and well known nonspecific factors. The factors are the CBT specific factors in which contribute to the therapeutic alliance and are necessary for collaborative empiricism. These factors are much better for specific disorders like anxiety and depression, just as others may be better for other disorders such as eating disorders.
    (2) Why is it important to have session structure for effective CBT?
    It is very important to have session structure for effective CBT because it essentially socializes the client to cognitive behavior therapy. Having structure also “enhances therapeutic efficiency by facilitating organized therapy that stays focused on the problems of the most relevance and the corresponding goals and interventions.” (Volungis 2019) Most clients will want and need some type of structure. Most of the time clients will be distressed and when in therapy they will be vulnerable, structure instills comfort, and hope that therapy may provide some relief. It also exemplifies some of those core interpersonal skills that contribute immensely to the development of the therapeutic relationship. How much structure a therapist will use is generally up to their discretion as it is based on the client and the current phase of therapy. All of these factors and more are why it is important to use structure. If there was no structure the therapist may need unorganized, unable to get to everything that needs to get covered within a session. Having a basic outline of the session will show the expertness of the therapist and will make it more possible to hit the key parts of the session.

    Reply

    • Alison Kahn
      Sep 09, 2020 @ 21:19:27

      Francesca,

      In my discussion post, I also emphasized the importance of session structure as it relates to successfully obtaining treatment goals in a time-limited session. CBT is a very goal-oriented therapy and I can imagine it would be extremely difficult to meet treatment goals without utilizing a structure to guide the sessions. I also like how you highlighted the importance of session structure to relay expertness. Providing session structure ensures the client that the therapist is on track and collaboratively working towards treatment goals.

      Reply

    • Christopher LePage
      Sep 10, 2020 @ 19:02:36

      Hi Francesca,
      I really liked your use of quotes for the prompt. I also liked how you went into depth about how different factors may influence both the therapeutic relationship, but also collaborative empiricism. These factors do have such a big impact on these concepts play out, and are important to consider.

      Reply

    • Madi
      Sep 11, 2020 @ 12:15:20

      Hi Francesca,
      I would argue that the therapeutic relationship is considered one of the primary processes for CBT. For if there is no therapeutic alliance then there is no real therapy done. I feel as thought you make this point in the middle of your response. I thought your response to the second question was very good as you discussed how important is it to socialize one to CBT.

      Reply

  5. Haley Scola
    Sep 10, 2020 @ 12:53:16

    1. The therapeutic relationship in CBT is a collaborative, meaning both the therapist and client are active participants throughout the therapy. They work together towards one mutual goal, also known as an alliance. Throughout this process together there is an integration between the therapists CBT knowledge of assessment and interventions that are empirically supports along with the use of information provided by the client as well. This relationship is defined as collaborative empiricism which is an action-oriented therapeutic alliance driven by research that integrated, tests, and modifies clients’ thoughts and behaviors. Lastly, research has shown that across theoretical approaches there is a strong relationship between the therapist-client relationship and treatment outcomes. This puts a lot of pressure on that relationship because this can have a negative or a positive impact on the client’s well-being (basically “make-or-break”). Additionally, studies have shown that the therapeutic relationship can predict symptom improvement early in treatment. When establishing a CBT therapeutic alliance there are nonspecific factors and CBT-specific factors that need to be considered. Nonspecific factors are used in most therapeutic approaches and include key skills that come naturally to most therapists. While CBT-specific factors contribute to the therapeutic alliance and are necessary for collaborative empiricism. These specific factors are necessary when treating a psychologically distressed individual and nonspecific factors are not sufficient alone.
    2. Session structure is so important in therapy for several reasons. The first reason is the client is most likely coming to therapy to gain a sense of structure. This consistent response is helping the client socialize to CBT and know what to expect each session. This allows for both the therapist and the client to have a sense of purpose and efficiency. Second, session structure allows for you to model the collaborative nature of CBT. It’s a give-and-take and the structure of each session is modeling that while simultaneously showing you client that you are flexible to their needs and wants with a sense of purpose. Additionally, the structure allows for the therapist to come off as confident in their ability and skills which benefits the therapeutic relationship. Third, it provides direction for both the therapist and the client. Even the most experienced therapists need guidance in maneuvering each session because throughout therapy it is totally normal to get a little side tracked because it could be purposeful and useful information but it’s a reminded of the goals and where you need to get back to in order to meet those goals. Lastly, it enhances therapeutic efficiency by facilitating organized therapy that stayed focused on the problems of most relevance and corresponding goals and interventions.

    Reply

  6. Selene Anaya
    Sep 10, 2020 @ 14:02:31

    1. The therapeutic relationship in CBT is heavily collaborative and crucial for the effectiveness of therapy. Unlike many other forms of therapy, the therapeutic alliance is one thing that must be established from the beginning of therapy in order for it to be effective. This means that both the client and the therapist are working together toward mutual goals both in and outside of therapy. This alliance can be established through both nonspecific and CBT-specific factors. Nonspecific factors include basic interpersonal skills such as showing that you are an expert in what you know, you are trustworthy, and you are likable/personable. Other nonspecific factors include Rogerian qualities such as empathy, genuineness, and unconditional positive regard, all of which are especially important to form a trusting relationship and allow the client to open up fully. In terms of more CBT-specific factors, collaborative empiricism is the key factor that fosters the empirical effectiveness of CBT. Collaborative empiricism is an action-oriented therapeutic alliance that is driven by research that integrates tests and modifies clients’ thoughts and behaviors. The main focus is to identify maladaptive thoughts and behaviors and then test their validity and/or utility. There are also other factors to consider such as client-specific factors including their presenting symptoms, environmental stressors, and sociocultural factors. These are important to examine because obtaining a holistic view of the client and the client’s situation will help you better understand the client and therefore, help them in a way that works for them. The therapist-client activity level is also another important factor to consider because this fluctuates over the course of therapy starting with the therapist doing most of the guiding. By the end, the client will have more control over what they would like to discuss, therefore reinforcing the “team effort” or collaborative approach CBT offers rather than the client just being passive to what the therapist is saying. This collaborative approach should also be used when developing the client’s case formulation. When clients agree and help create their treatment plan, they are more likely to agree with, complete, and follow their treatment goals and interventions.
    2. Clients like and need structure, so it is very important to establish session structure early on in CBT. Most clients who go to therapy are distressed and/or either may lack or need help with structure in their own lives, so having a structure to therapy could be comforting and less anxiety-provoking each time they go in. The clients know what to expect in each session and they are more likely to return as they get more comfortable with the structure. Not only is it helpful for the client to have structure, but it helps with the organization of therapy and will allow for a schedule that is compatible and the most effective for the amount of time an individual is given per session. Cramming in everything in a 50-60 minute session seems impossible, but with good structure and planning, it can be done effectively. It is also nice to establish because some clients like to vent, so having a structure will allow clients to know when it is time for them to do so while also being able to accomplish other things that are planned for that session.

    Reply

    • Trey Powers
      Sep 12, 2020 @ 15:01:22

      Hey Selene!

      I liked your description of how important structure is to the therapy process. You brought up several good points regarding how beneficial structure can be for the client, not only in terms of their emotional wellbeing, but also in terms of helping them to make good progress over time. I wonder, however, whether over-structuring sessions ever becomes a problem. I could potentially see sessions becoming so rigid that there is no room for spontaneity. I think it is important to maintain structure, but also be open to changing the agenda as need be.

      Reply

  7. Christopher LePage
    Sep 10, 2020 @ 15:04:44

    1) The therapeutic relationship in regard to CBT is a crucial part of the therapeutic process. The therapeutic relationship is about establishing rapport between a client and their therapist. This includes working back and forth on creating a treatment plan and working on a goal that was established by both parties. The therapeutic relationship is so important to work on, because it also allows the client to be more comfortable within the sessions. This can be beneficial, because it allows clients to be more open and honest about what is going on in their lives, and how they want to treat it. Collaborative empiricism is also hugely important to the CBT process. Collaborative empiricism is more action-oriented, and uses evidence-based practices to assess the clients thoughts and behaviors. By having these tests measure clients thoughts and behaviors you are making for more effective sessions with your client, because you have a more complete picture of what is going on in a clients’ life.
    2) Session structure is so important for effective CBT, because it not only gives direction to the therapist, but also to the client. This direction and guidance given by having structured sessions, also makes clients feel more comfortable. When an individual comes into a therapy session, they are most likely under some distress and may feel nervous about the overall process. By providing this structure, you are making them feel more comfortable with the process, because they know more about what to expect from the sessions. Having structured sessions also leads to more organized therapy. Often, therapy sessions can get off topic, but by having this structure, you are more likely to stay focused on the issues at hand.

    Reply

    • Haley Scola
      Sep 11, 2020 @ 12:07:22

      Hi Chris,
      I really liked how you explained the collaborative process as “working back and forth on creating a treatment plan and working on a goal that as established by both parties”. I thought it was very insightful in that you discuss the give-and-take process that goes with collaborative empiricism. I also agree that building rapport allows the client to feel more comfortable in being open and honest with you. I think while were building the relationship it goes back to presenting as trustworthy, an expert, and attractive to the client. Lastly, I loved how you said structure in sessions helps the client because they may feel nervous about the overall process and the structure allows them to know what to expect. Overall really great post Chris!

      Reply

    • Selene Anaya
      Sep 12, 2020 @ 13:42:57

      Hi Chris! I like how you explained the importance of the therapeutic relationship and how it facilitates the effectiveness of CBT. I think all of the points you made are very true, especially how having that strong therapeutic relationship can be to allow clients to open up and share fully what is going on in their lives. I thought it was also great how you mentioned how the structure gives direction to the client. Allowing for the opportunity for the client to see where therapy is going and the progress they can be making throughout the course of therapy can be especially effective. I think I was always nervous about the possibility of getting off-topic in therapy, but now that I know that CBT involves a lot of structure and I have seen ways to tell the client when we will talk about a certain topic, I feel a lot better.

      Reply

  8. Eileen Kinnane
    Sep 10, 2020 @ 15:18:04

    (1) What is your understanding of the therapeutic relationship in CBT (include collaborative empiricism in your discussion)? 

    Establishing an effective therapeutic alliance in CBT is essential for the client when it comes to making change. In CBT, both the therapist and the client play an active role in the sessions. It is the responsibility of both the client and the therapist to work on setting and meeting goals. Basically, sessions for CBT are a collaborative process that involve work from both (or all) parties. This is where collaborative empiricism comes in. Collaborative empiricism is a specific facilitation technique used to help in helping a client meet their goals. It is also a practice of showing respect for the client by making them an active member in decisions that are made regarding their care and treatment. It is essentially the action and practice of establishing and maintaining an effective therapeutic alliance. Along with this, it also incorporates research and evidence-based practices to fully examine and adapt a client’s thoughts and behaviors.

    (2) Why is it important to have session structure for effective CBT?

    It is important to have session structure in CBT for many reasons. One of these reasons is that allows for the therapist to practice and demonstrate their interpersonal skills such as attractiveness and trustworthiness, which can be especially crucial for beginning therapists. Along with this, it is found that clients respond well to structure as it may help ease stress that is associated with treatment. Lastly, having a consistent structure in session will also help the client socialize to CBT and helps to enhance the collaboration that is incorporated into therapy.

    Reply

    • Trey Powers
      Sep 12, 2020 @ 14:56:14

      Hi Eileen!

      I think that your description in the first question did a good job of connecting the concepts of the therapeutic alliance and collaborative empiricism. The emphasis on client and counselor working together on goals set together is a very important part of the process of CBT, which I think you highlighted nicely.

      Reply

  9. Trey Powers
    Sep 10, 2020 @ 15:46:03

    1.

    The therapeutic relationship is an essential element of conducting effective therapy. When a new client enters therapy, they are often in an extremely vulnerable place emotionally, which is exacerbated by the fact that they have just met the person who they are expected to reveal elements of themselves that are highly personal. It is therefore necessary to immediately begin to build the therapeutic relationship with the client in order for them to feel comfortable. It has been shown that failure to establish a strong therapeutic relationship frequently leads to either poorer outcomes for the client, or the client terminating treatment early, sometimes even after the first session. There are a number of steps the counselor must take in order to forge and solidify the therapeutic relationship. Possibly the most basic step is to ensure that they are being empathetic when dealing with the client. This shows the client that the counselor is listening to what they are saying and that their feelings are valid. In addition to empathy, the counselor must treat the client with unconditional positive regard. Regardless of what the client may say, or how they may come across to the counselor, the counselor must not react negatively, take offense, or lash out at the client. Rather, an atmosphere of acceptance and non-judgement must be created in order to allow the client to feel comfortable with expressing anything they may feel necessary during the session. A fundamental element of the therapeutic relationship, and of CBT in general, is that of collaborative empiricism. Communication in CBT is not unidirectional, with the counselor conveying knowledge to the client. Instead, the two work together in collaboration throughout the therapy process. In this way, goal-setting and plans of action are generated by both client and counselor in order to address the maladaptive thinking that the client is engaging in. Involving the client in the process not only empowers them by giving them a voice, but also provides them with a sense of ownership over the process, as well as any progress that is made. By doing this, the client is more likely to be invested in the process, work toward the goals that are set, and take pride in the accomplishments that they make over the course of therapy. It also gives them confidence in their own ability to solve problems in the future as they increasingly realize that they have the tools to help themselves.

    2.

    Structure is an integral part of effective CBT which has benefits for both the client and the counselor. For the counselor, establishing structure for both individual sessions and the course of therapy in the future allows them to have a set list of steps in place, which eliminates the need to generate a plan of action spontaneously, and allows for a premeditated flow to the process. For the client, one of the more important benefits to having structure is alleviating anxiety. The therapeutic process is not common knowledge, and therefore the client will likely not know what to expect going into the first session. Explaining how each session will proceed and involving them in the process of designing a plan for the future makes the process more transparent, and allows the client to anticipate what will happen during each consecutive session. Structure can also help to ensure that progress is being made. Setting goals for future sessions puts a certain level of accountability on the client to follow through with their homework. Should these goals not be met, any issues that prevented progress from being made can then be discussed, and hopefully eliminated. Finally, because CBT often occurs over the course of a set period of sessions, being able to conceptualize the progress that must be made between start and finish is often necessary.

    Reply

  10. Brigitte Manseau
    Sep 10, 2020 @ 15:46:51

    1. Although the therapeutic relationship is not the primary focus in CBT, it still plays an important role in the therapeutic process. Unlike other theoretical approaches, CBT requires the client to be an active participant in therapy and relies on collaboration between the client and therapist to achieve mutual goals. The therapeutic alliance is the relationship of the client and therapist which helps them to create, work towards, and accomplish mutual goals together. Studies investigating CBT outcomes have shown that the therapeutic relationship early on predicts symptom improvement. This highlights how important therapeutic alliance is from the start. The therapeutic alliance is established through nonspecific factors and CBT-specific factors. Nonspecific factors are used in most therapeutic approaches and include skills that often come naturally to therapists. Nonspecific factors include Rogerian qualities such as empathy, unconditional positive regard, and genuineness. Additionally, nonspecific factors include interpersonal skills such as expertness, trustworthiness, and attractiveness. The key part of CBT-specific factors is collaborative empiricism. Collaborative empiricism is an action-based therapeutic alliance driven by research that integrates, tests, and modifies clients’ thoughts and behaviors. The primary purpose is to identify maladaptive behaviors and thoughts which are then assessed for their validity and/or utility. Collaborative empiricism has three specific factors: therapist-client activity level, client-specific factors, and conceptualization and treatment. Therapist-client activity level is the amount of effort and participation the client and the therapist have during a session. The level of participation depending on what phase of therapy the therapist and client are in. Client-specific factors include presenting symptoms, environment stressors, and sociocultural factors.

    2. Session structure is vital to conduct effective CBT sessions. Structure provides direction and focus for both the therapist and the client. This allows for the session to be more effective because the therapist and client are focused on the most relevant problems and their corresponding goals and interventions. Without structure it can be easy to stray away and talk about issues that are not particularly pressing or relevant to their goals. Most clients like and need structure in therapy. Session structure helps to reduce some clients’ anxiety because they know what to expect each session. Also, the client feels more comfortable once the therapist explains how and why he/she would like to structure the sessions. Starting from the first session, structure may provide hope that therapy can provide the client relief. Additionally, session structure demonstrates the therapist’s expertness, trustworthiness, and attractiveness which in turn helps improve the therapeutic relationship.

    Reply

    • Eileen Kinnane
      Sep 10, 2020 @ 21:34:53

      Hi Brigitte,
      I really like how you explained the three factors of collaborative empiricism. This was something I didn’t touch upon too much and your explanation of it was simple and easy to understand. I also really enjoyed your explanation on session structure, particularly when you mentioned how without it, it can be difficult to stay on track and meet goals. This is something I think can seem obvious to think about and discus, but might take more energy when it comes to actually implementing it into practice.

      Reply

    • Selene Anaya
      Sep 12, 2020 @ 13:03:11

      Hey Brigitte! I really like how you explained the importance of the therapeutic relationship in CBT. I have always thought that it would be emphasized across the different types of therapy, so it was a surprise when I found out that not every therapeutic approach values it as much as CBT especially with all of the empirical evidence to support its importance. I also thought that learning about the breakdown of the factors of the therapeutic alliance was interesting. As Dr. V said, a lot of the skills aren’t able to be taught, so it’s good to recognize those skills that we probably already possess and emphasize their importance. Until this class, I didn’t know that there was a specific structure that was common in CBT practice. I can see now how effective providing and having a structure for clients can be. I like how you mentioned that the structure supports the perception of the therapist’s expertness, trustworthiness, and attractiveness and tied it back to how it is helpful towards building and supporting the therapeutic relationship.

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Adam M. Volungis, PhD, LMHC

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 66 other followers

%d bloggers like this: