Topic 4: Psychoeducation & Behavioral Activation {by 10/7}

[Psychoeducation] – Watch MDD-4: Psychoeducation – Therapy Expectations and the Cognitive model AND PDA-4: Psychoeducation – Diagnosis.  Answer the following: (1) How can you adjust psychoeducation of therapy expectations and the cognitive model based on a client’s distress and presenting problems?  That is, what can be said differently, and how can it be done differently?  (2) For psychoeducation of specific disorders, what are some ways you can “normalize” each clients’ experience without alienating them or coming off as lacking empathy?

 

[Behavioral Activation] – Watch MDD-5: Behavioral Activation – Psychoeducation & Introducing Weekly Activity Monitoring Log (WAML).  Answer the following: (1) Based upon what you know about this client so far (e.g., information from his assessment and this video vignette), what patterns of behavior do you think warrant follow-up in the next session while reviewing his WAML?  (2) How would monitoring this client’s accomplishment and pleasure be helpful for his treatment?

 

Your original post should be posted by the beginning of class 10/7.  Have your two replies posted no later than 10/9.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

 

*Videos can be found at R&L website or here: https://dradamvolungis.com/classes/psy-708/cbt-theory-into-practice-psy-708/videos-psy-708/

29 Comments (+add yours?)

  1. Jennifer Vear
    Oct 05, 2021 @ 17:28:05

    Psychoeducation:

    1. Depending on the presenting problems and level of distress that a client comes in with, the clinician should be able to adjust how they give psychoeducation of therapy expectations and the cognitive model. The therapist should present themselves as open and understanding. When talking about therapy expectations, asking questions such as, “Does that sound good to you?” Or “What do you think?” is a great way to show the client that they are going to be a huge part of their treatment process. In setting goals and the agenda for each day, the client and therapist can work together to make sure that there is still that flexibility in treatment, but also that the therapist is working to help make them better. Then, in teaching the client about their presenting problems by using psychoeducation and the cognitive model, it is very important for the therapist to come off as non-judgmental. Each client could respond differently to different techniques of therapy and the cognitive model. The therapist needs to be able to read their body language and openly state that the client is more than welcome to chime in and give feedback. The client should feel comfortable in voicing when something does not seem to be working for them. Then finally, depending on the presenting problem of the client, the therapist will encounter the situation according to that client and their needs.

    2. One way in which therapists can normalize and not alienate clients is to use words such as “we” and “us”. For example, when describing how individuals with anxiety feel and behave, the therapist can say “we behave…” and “we tend to…” when describing various aspects of the disorder/behavior. The same goes for depressive disorders. Using these terms allows the therapist to normalize the symptoms and feelings of these individuals. It also shows them that they are not alone. If a therapist were to only use pronouns such as “you”, the client might feel that there is something wrong with them. Overall, this subtle change in pronouns allows the individual to feel as if they are not alone and also helps to show them how common it is for individuals to experience a lot of the same symptoms. Furthermore, in order for the therapist to come off as empathetic, they should also make sure to pay attention to how the client responds and reacts. The therapist needs to control facial expressions when given difficult or uncomfortable information as well as maintaining that sense of togetherness to make sure the client does not feel alienated.

    Behavioral Activation:

    1. While reviewing Mark’s WAML, it would be good to follow up on his energy levels and concentration levels. One main area that Mark said that he wanted to work on was getting up earlier in the morning and having time to make a decent breakfast. In the WAML, he was able to wake up 30 minutes earlier than before but wanted it to become more of a regular thing. He also wanted to work on spending more time with his girlfriend and actually enjoying those moments he had with her. In the scenario where his friends canceled their dinner plans last minute, he reported feeling very down and personalized the situation by making assumptions about why they did not end up coming. These assumptions reflected how he thought they felt about him, so then he was not able to appreciate and recognize that he was getting that alone time with his girlfriend that he wanted before. Furthermore, he also hopes to do better at work. He personalizes situations there as well, blaming his struggles at work on his own perceived incapabilities, and expresses feeling overwhelmed. Each of these topics is of high value to Mark, which then should warrant the therapist bringing attention to them during the next session.

    2. Monitoring a clients’ pleasure and accomplishment of particular tasks can be very important to the therapeutic process. However, you do not have to measure these two items together. You might not enjoy something, but you could have been able to complete it, which is still good. Monitoring pleasure and accomplishment is more important for the things you value, and to see areas where you would want to accomplish or feel more pleasure from in the future. For example, he could dislike doing dishes, but having finished them is still a really great thing. On the other hand, he could highly value taking out his dog, but he marks the accomplishment low because he wishes he was able to stay outside for longer. Overall, measuring these two features in relation to what the client values, can help the therapeutic process to bring the client’s attention to which areas have changed and which can be improved for the future.

    Reply

    • Katie O'Brien
      Oct 07, 2021 @ 11:44:30

      Jenn,
      I think it’s good to note and to make clients aware that some tasks may not be pleasurable but might result in some feeling of accomplishment, or that some pleasurable activities may not be result in the highest achievement ratings. Like you said, chores such as dishes or laundry might not be pleasurable to some people ever, but it’s still necessary to take care of these things and usually feels better once they’re done. Similarly, even if an activity is simply enjoyable or pleasurable but is not that high in accomplishment, that is okay – it’s nice to have things that simply bring pleasure, even if it’s not getting some big task done.
      It’s a good distinction for clients to remember!
      Katie

      Reply

    • Morgan Rafferty
      Oct 07, 2021 @ 12:28:55

      Hi Jen! Thanks for your great post. Your comments regarding use of pronouns, “we” and “us” rather than “you” really made me think about this in a way I simply have not. I like how this approach avoids making the client feel like an isolated case. I am curious, when you refer to “we”, do you intend for it to come across as the mental health community as a whole? For example, “Plenty of research has been done on PTSD, and “we” have found that….”

      My second comment to your post is appreciation of your clarification that pleasure and accomplishment do not need to be measured together. It is helpful to be reminded that just because a client feels accomplished, it does not mean he/she should also feel pleasure from the behavior (and vice versa). What a difficult way to live if the expectation were to always feel pleasure and accomplishment simulanteously. There are so many tedious tasks we must complete that certainly bring no ounce of pleasure (i.e., doing taxes; weeding; etc)

      Reply

    • Kaitlyn Tonkin
      Oct 07, 2021 @ 12:46:14

      Hi Jenn,

      I see that Morgan already made this comment, but I wanted to point out that I too liked your mention of pronoun use. It is really important for therapists to be cognizant of their language and how that might be perceived by a client. Saying “you” too often might make the client feel like they are at fault or influence how they view their diagnosis. Instead, therapists should focus on using collaborative language, like “we”. I work in ABA and often I will talk to my clients like this too. Instead of saying “you can’t do that” I will reframe it to “we don’t stand on chairs, we sit” so that the client doesn’t feel like they’ve done something wrong. CBT and ABA are very different, but I think the emphasis on language is very important in both types of therapies.

      Great point!

      -Kaitlyn

      Reply

  2. Kaitlyn Tonkin
    Oct 06, 2021 @ 17:31:30

    Psychoeducation:
    1. When educating a client about the cognitive model, a therapist should modify their explanation to match the client’s diagnosis. For example, when discussing the cognitive model and teaching the client about it, it would be useful for the therapist to use an example from the client’s life or put the cognitive model in the context of their diagnosis. In the MDD-4 s, the clinician explains the cognitive model in the context of the client’s diagnosis and uses an example from his life as a way to be more relatable with the client. Psychoeducation might be daunting for some clients, especially those who do not have a background in psychology, so it is important for therapists to use psychoeducation in a way that the client can understand. This does not mean that the therapist has to treat the client as if they are dumb, but use explanations that make sense to the client. Furthermore, the therapist should modify their approach based on age and grade level to ensure that the client understands what is being said to them. As talked about throughout the readings and lectures, psychoeducation is an integral part of the therapy process, so making sure it is done in a way that the client can understand is very important.

    2. As a therapist, an important part of therapy is psychoeducation, which also includes psychoeducation about the client’s diagnosis. It is important for a therapist to normalize their client’s experience, but not to the point of minimizing it and making them feel like they are just another person with the disorder. It could be useful for the therapist to use statistics of incidence or prevalence, but also emphasize that they are there to help the client and genuinely care about helping them enhance their quality of life. Visual aids might be useful for clients to understand facets of their diagnosis better, as shown in the PDA-4 video. This is helpful because it educates the client by making it specific to their life and experiences they have had. It is also important for a therapist to continue to validate their clients as they talk about things they have experienced, while also normalizing their experiences. Therapists can bring in examples from their own personal life, if they feel comfortable, or compare to other clients they have had. However, it is still necessary that therapists communicate empathy so that the client doesn’t feel like their experience is being minimized. Communicating empathy through verbal and nonverbal interactions is important for helping clients feel this way.

    Behavioral Activation:
    1. Following up with a client on their homework assignments is an important section of therapy. The next session that Mark attends, it would be useful to follow up with the behaviors he indicated he wanted to work on throughout the week. For example, Mark mentioned wanting to wake up earlier and even go to bed earlier, so it would be of value to check in with him and see if he did those things, and if not, it might be helpful to figure out what got in the way of him accomplishing those tasks. Mark also mentions withdrawing from activities when he feels down, so it would be beneficial to see how he did with that throughout the week, did he withdraw from things less or more, and if he withdrew more, what contributed to that. There were other behaviors that Mark mentioned, which he planned to include on his WAML, which should also be addressed in the next session. I think it would also be a good idea to just check in with Mark and see if there were “basic” tasks, like doing the dishes or taking care of himself that Mark noticed he was engaging in differently throughout the week- whether that be more often, less often, or the same amount. Reviewing these behaviors gives both the therapist and the client the opportunity to assess how the assignment went, and also if it was effective or not. It can also inform further treatment.

    2. Monitoring Mark’s levels of pleasure and accomplishment are important in understanding any progress he has made or not. It also gives the therapist an idea of what the client has been feeling throughout the week. As noted, Mark has experienced diminished pleasure in usual activities and because of that he sometimes just does not engage in those activities. So, measuring pleasure can help the therapist to see any patterns of behaviors that might be maintaining or increasing Mark’s level of distress, like withdrawing. It also is important to assess his level of accomplishment when it comes to completing tasks. Accomplishment is linked to motivation, meaning that if Mark feels accomplished when doing the things he normally neglects, he is more likely to do them again in the future. This can also inform which activities had little accomplishment and maybe should be reassessed. Overall, measuring pleasure and accomplishment is important because it helps the client and therapist understand certain feelings related to behavior (which is an important part of the cognitive model) and it helps inform further treatment because both the client and therapist can understand what is working and what is not working, but also what can be improved upon and what does not have to be improved.

    Reply

    • Jennifer Vear
      Oct 07, 2021 @ 11:00:05

      Hi Kaitlyn,

      I really like how in the first question you mentioned that the therapist needs to meet the client where they are at when teaching them about the cognitive model and in psychoeducation. That includes age level, education level, and other factors. This aspect is very important to make sure that the client does not feel like the therapist is talking down to them to be too “expert-like”, but instead makes that client feel like it is more of a conversation that they can understand, apply to their lives and experiences, and used to only help them understand and feel better. It should not be anything that is going to make them feel less than.

      Great job!
      – Jenn

      Reply

    • Giana Faia
      Oct 08, 2021 @ 17:48:50

      Hi Kaitlyn,

      I like how you pointed out the use of an example from the client’s life when educating the client about the cognitive model. I found that after watching this in the video, the client more easily understood the cognitive model because the clinician used a real life example familiar to the client. It I also important to explain the information in a way the client can easily understand and minimizing the use of jargon when explaining. Thanks for your response!

      Giana

      Reply

    • Lisa Andrianopoulos
      Oct 08, 2021 @ 20:05:21

      Hi Kaitlyn,
      I appreciate your comment that Psychoeducation can be daunting for the client. The goal of psychoeducation is to provide some relief and knowledge regarding their diagnosis. At first however, it can be overwhelming. Yes, it is extremely important to know where your client is coming from. Culture plays a role here too, because in some cultures there is stigma around having a mental illness and/or a disability. For some, it might be worth exploring this before you even enter into the Psychoeducation. As many have said in this blog, it is very important to impart the information in a way the client can best understand and receive it.
      Lisa

      Reply

  3. Valerie Graveline
    Oct 07, 2021 @ 00:07:13

    Psychoeducation
    1) It is important for clinicians to have the ability to adjust their approach of psychoeducation depending on their client’s level of distress and specific presenting problems. First, when addressing psychoeducation pertaining to therapy expectations or the cognitive model, it is crucial that the clinician is confident in their knowledge and is engaging while presenting this information to the client. If the client is not confident in their ability to share given psychoeducation with the client, this may lead to further confusion on the side of the client in understanding the information. If a clinician notices that their client’s distress is significantly affecting their ability to understand the psychoeducation related to therapy expectations, the clinician should focus on the basic, key themes of what they are trying to address. If the client is overwhelmed, it is important not to bombard them with too much jargon or information to remember. When this occurs, the clinician can instead utilize multiple sessions to explain psychoeducation related to therapy outcomes, so as to pace the information with respect to the client’s needs. Also, the clinician can continuously pause and ask the client if the information is making sense, and if not, the clinician can provide clarification where it is needed. Similarly, with the cognitive model, the clinician should consistently ask the client if the psychoeducation they are presenting is making sense to them and if not, the clinician should adjust their approach accordingly. If the client struggles to understand the cognitive model, the clinician should again initially address the key themes associated with the model so as to not overwhelm the client. The clinician should acknowledge the pace at which they should be presenting the information depending on the client’s distress and presenting problems as well. With both psychoeducation pertaining to therapy expectations and the cognitive model, the clinician can ask the client for feedback in order to understand how to further adjust their approach to the client.

    2) Pertaining to the client’s diagnoses, the clinician should ensure that they are validating the client’s individual experiences associated with their presenting problems, and should also normalize the symptoms associated with the diagnoses. However, the clinician should not “over normalize” the symptoms, in the sense that it would belittle the client’s experiences if the information is presented as “everyone feels this way”, as it can make the client’s experiences feel insignificant. The clinician can instead present psychoeducation around the client’s diagnoses as a way of informing treatment interventions, rather than simply a label. To normalize the client’s diagnoses while acknowledging the clients’ specific experiences, the clinician can provide visual examples utilizing the cognitive model in order to provide the client further understanding of such diagnoses. With the clinician utilizing the client’s own experiences, it validates their experiences while potentially offering them optimism for how various treatment interventions based on their diagnoses can help.

    Behavioral Activation
    1) After introducing the WAML to Mark in session, it is crucial that he and the clinician review the activity log in the following session in order to emphasize its importance, and address any maladaptive or adaptive behavioral patterns that may have been noted. As the WAML was introduced to Mark, various maladaptive patterns were briefly addressed including his withdrawal behaviors, feeling rushed, lacking presence with girlfriend, and overall lacking pleasure in many different activities. With all this in mind, it is first important that the clinician follows-up on Mark’s various withdrawal behaviors, which he described as his way of running away from his problems. This seems to be an overarching behavior that will have to be continuously addressed, thus making it especially crucial to acknowledge in the first follow-up session. Next, it would be beneficial to address behaviors such as Mark increasingly being present with his girlfriend, which may manifest as various activities such as walking the dog together or going on dates. Furthermore, based on what was addressed in this session, Mark’s behavioral pattern of feeling “rushed” in the mornings due to waking up late should be discussed. Mark states that he currently wakes up around 8, but wishes to wake up earlier so he can shower and eat breakfast without feeling he has little time to complete such activities. When following up on each of these behavioral patterns, it would prove beneficial to also address the pleasure and accomplishment ratings Mark assigned to each activity, as he seemed hopeful in various activities resulting in feelings of accomplishment, such as doing the dishes.

    2) Monitoring Mark’s feelings of accomplishment and pleasure for the various activities noted on his WAML may allow him to recognize what activities he feels especially accomplished doing. At one instance in the session, Mark sounded hopeful about rating the activities’ levels of accomplishment and pleasure, as it allows him to further recognize that he feels proud of himself after completing various activities. With this said, Mark acknowledged that there are some activities, such as washing the dishes, where he feels high ratings of accomplishment but low ratings of pleasure. It is important for the client’s to understand that the goal of pleasure and accomplishment ratings is not to achieve consistently high levels of both, but to recognize how they feel when completing such activities. If Mark were to consistently rate accomplishment and pleasure levels as low, it would allow the clinician to address these activities and would open conversation for Mark and his clinician to talk through the reasoning for the low ratings. Further, it would allow the clinician to see what behavioral patterns should be adjusted in order to replace such maladaptive patterns with those that are adaptive. Also, by completing these ratings, Mark would hopefully be able to acknowledge that there were perhaps some good parts to his days that he can continue to engage in.

    Reply

    • Katie O'Brien
      Oct 07, 2021 @ 11:27:23

      Valerie,
      I like how you pointed out that psychoeducation can be paced to the clients needs and that therapists can take more than one session if necessary to make sure the client truly understands and feels comfortable with the information. While there might be a desire to getting right to the “treatment” part of therapy, it’s important to remember that the client’s understanding of those techniques is based upon their understanding of the model. If a therapist rushes through the psychoeducation part and the client is not truly comfortable with the model, techniques might not be effective as they do not have a good understanding of the model and how it applies to their problems. It’s better not to rush!
      Great point.
      Katie

      Reply

    • Lisa Andrianopoulos
      Oct 08, 2021 @ 20:19:04

      Hi Valerie, I appreciate your thoughts on how monitoring Marc’s ratings of accomplishment and pleasure may allow him to recognize what activities he feels especially accomplished doing. While pleasure is of course important, we can’t discount the importance of feeling accomplished as well. A sense of accomplishment in particular, is important for building a sense of self-efficacy. Also, while the activity itself may not be particularly pleasurable, having accomplished a task helps you feel productive. As you accumulate these productive experiences overall mood can be elevated.

      Reply

  4. Lisa Andrianopoulos
    Oct 07, 2021 @ 08:57:31

    Psychoeducation
    1) When utilizing psychoeducation in CBT, the therapist must carefully consider the client’s type of distress as well as the severity of that distress. This allows the therapist to choose interventions (i.e., skills to be taught) that are specific to the client. The purpose is to provide relief for the current distress while at the same time helping the client to develop strategies that will minimize distresses that occur in the future (even after therapy has ended). Additionally, any information imparted must be conveyed in a manner that is easily understood by the client. For example, especially initially, the therapist will need to be careful not to use too much jargon while introducing key concepts. Also, the therapist will need to understand the client’s level of intelligence, cognitive and emotional sophistication and psychological self-awareness and adjust accordingly. For psychoeducation to be most effective, the therapist should incorporate examples specific to the client’s presenting problem.
    2) It is important to normalize a client’s situation. However, “over normalizing” can be damaging. While helping the client to know that they are not alone can be validating and provide some sense of relief, the therapist must be careful not to minimize the client’s unique experience. As seen in the video vignettes, this can be done by acknowledging the client’s pain and that what they are experiencing is very real to them. Also seen in the vignette’s, anticipating a catastrophic thought the client might have helps to both normalize it and lessen its impact somewhat. That is, it slowly introducing the idea of challenging the thought while validating having it at the same time.

    Behavioral Activation
    1) Marc has a low energy level. As a result, he tends to avoid completing some daily activities, or if he does do them, he perceives them as laborious and may not complete them. As a result, some of his basic needs are not being met, and he is finding little enjoyment in the activities he is participating in. In reviewing his weekly activity-monitoring log, it will important to look for patterns in these behaviors and explore what might be maintaining them. Marc also tends to withdraw socially. While this helps in briefly reducing some immediate distress, it increases the overall distress in the end and adds to the negative cycle. Marc agrees that this is an ineffective coping strategy, and reducing it is a goal he identified as being important to him. Therefore, looking for and exploring withdrawal behaviors will be important when reviewing the WAML. In exploring both activity completion and withdrawal, it will be important to look for patterns in when the behaviors occur – time, precipitating/surrounding events, etc.. It will also be important to know whether Marc is getting a sense of accomplishment and/or pleasure from the activities he is doing.
    2) Monitoring Marc’s perceived sense of accomplishment and pleasure will be helpful for his treatment because it is known that behavioral inactivity along with low accomplishment and pleasure typically develop into and maintain distressing maladaptive cognitive and behavioral patterns. The goal for treatment is to break these maladaptive behavioral patterns through behavioral activation. The idea is to get the client moving in the opposite direction in order to break the cycle. Monitoring accomplishment and pleasure is important also, because it helps you to know if the behavioral activation has been implemented effectively. Additionally, it allows the therapist and client to monitor and modify targets for change. As the maladaptive behaviors slowly change and gradually become part of Marc’s lifestyle, he will likely experience more accomplishment and pleasure, which in turn will lead to increased feelings of self-efficacy as well as increased motivation to change.

    Reply

    • Jennifer Vear
      Oct 07, 2021 @ 11:05:04

      Hi Lisa!

      I really appreciate how you mentioned “over normalizing” when it comes to a clients’ experiences. You are right: it is very important to make sure that you do not make them feel as if you are minimizing their experiences. Although many people do experience symptoms of anxiety and depression, each person is going to go through their own unique experiences that affect their lives in different ways. If they feel that you are minimizing their experiences, they might not want to trust you or continue treatment. There is definitely a balance and it is important to read your client and really gauge how they feel through what they say as well as what they do not say.

      Great job!

      – Jenn

      Reply

  5. Katie O'Brien
    Oct 07, 2021 @ 11:08:59

    Psychoeducation:
    1.) When using psychoeducation on therapy expectations and the cognitive model, therapists need to be aware of their clients and where they are at. For example, therapists should explain concepts in ways the client can understand based on their language abilities and education levels, as the psychoeducation will not be useful if the client does not feel like they understand. Likewise, if a client is incredibly distressed, a lengthy lecture with a lot of jargon will likely not be helpful. Being able to adjust to a simpler way of explaining would be helpful. It’s important to frame psychoeducation in terms of the client’s distress and presenting problems. Psychoeducation begins to orient the client to therapy, to working together with their therapist, and helps build expectations for how the rest of therapy will go. With this in mind, it makes sense to use their own presenting problems to help them understand what is going on from the very beginning. When using examples more relevant to the client, such as situations from their own life, it becomes more understandable and “sticks” more with the client. It is also helpful in terms of expectations for eventual skills and techniques the therapist and client will be using to treat the problem down the line, as the client is already beginning to understand these concepts in reference to their own problems, and will be able apply the techniques more readily.
    2.) It is helpful to normalize a client’s experience, as many are afraid of being “crazy.” Sharing statistics or prevalence rates of their disorder can show that they are not alone. However, the therapist does not want to make the client feel like they are just a number, so it can also be helpful to show evidence that CBT has worked in the past for people with that disorder. This can be through research literature or through the therapists own experiences with success treating other clients. While not promising a 100% cure, this can instill hope in the clients that they can get better. Finally, each client is individual, and it is important to acknowledge that their experiences and emotions are unique to them and to validate their feelings. This helps the client to not just feel like another case.

    Behavioral Activation:
    1.) Mark seems to have themes of difficulty initiating activities and personalization in his personal and work life. For example, Mark has a difficult time getting started in the mornings and would like to try getting up earlier to help with that. As this is a goal of his own and also one that ties in well with some of his broader issues, it is definitely worth following up and seeing if he was able to get up earlier and if it had any effect on how he felt that morning. If he was not able to do this, it is worth going over what got in his way and ways to get through those issues should they arise again the following week. Difficulty getting started is applicable to other areas as well such as household chores or going out with Melissa, so it is worth looking at some of those activities as well. Mark says he often does not have a problem once a task is started but the issue is beginning a task, so working on initiating activities would likely improve Mark’s feeling of achievement. In his personal and work life, Mark tends to personalize situations which leads to rumination and feeling badly. It is worth identifying times in the WAML when Mark felt this way so that negative automatic thoughts and eventually core beliefs can be addressed, as Mark seems to deal with the unlikable thinking pattern. Once those have been identified, Mark can begin working on evaluating them and any alternatives that might have been more accurate or less distressing.
    2.) Monitoring Mark’s achievement and pleasure would be very helpful because he seems to feel a bit better once he starts and finishes a task. While he has difficulty getting started, he does feel a sense of achievement at getting the dishes done or spending a night out with Melissa. He has also stated certain activities have brought him more pleasure than he initially thought they would, so seeing higher pleasure and achievement ratings on his WAML would be evidence to support that. The more evidence he has that supports he will enjoy or feel accomplished having an evening out or getting chores done, the more likely he is to initiate more of those behaviors. In turn, his pleasure and achievement might continue to go up.

    Reply

    • Frayah Wilkey
      Oct 07, 2021 @ 20:04:58

      Katie,
      You did a really great job of explaining psychoeducation and effectively teaching it to clients. I like how you brought up the importance of using digestible information, especially for clients who are very distressed. In many health care settings, the language used can make the client feel that care is inaccessible to them. This is a huge issue and should be addressed by clinicians in order to retain the client. Beginning therapy can be stressful so avoiding jargon is a great tool for clinicians. Great post overall!

      Frayah

      Reply

  6. Frayah Wilkey
    Oct 07, 2021 @ 11:41:03

    1. Psychoeducation:
    a. All therapy sessions should be somewhat tailored to the specifics of the client, including discussions of psychoeducation. The clinician should consider their client’s presenting problems and distress levels to gauge what interventions are needed and where the end goal of therapy is. This will allow them to introduce a specific diagnoses or label to the client’s problem and together, they can go over the goals of therapy and how they will be accomplished. This level of specificity is necessary because not all problems will be treated the same way and the client should be made aware of the details pertaining to them. Moreover, a client’s distress level should dictate how the clinician handles discussions about psychoeducation. For example, if the client has social anxiety and is feeling very self-conscious, the clinician may take particular care in explaining the disorder and how many people struggle with it. On the other hand, a patient with MDD may have sessions more oriented to psychoeducation about goal setting or behavioral activation because they are struggling deeply with every day tasks.

    b. Normalization of abnormal psychology is important. The mental health field is still stigmatized by many people so it is important that clinicians take the time to weed through any biases the client may have about themselves or their diagnosis. A clinician can do this by introducing some basic numbers about how many people struggle with the specific disorder or how common it really is among Americans. They may also make it specific to the client saying something such as “many high school girls can relate to the anxious feelings that you get at school”. However, the clinician should remain empathetic and make it clear that the problem is valid and can be helped with therapy. They should never minimize the client’s presenting problem to ensure that the client feels heard. Visual aids can be helpful to accomplish this and can make the client feel more comfortable.

    2. Behavioral Activation:
    a. Based on Mark’s WAML, it seems that he is struggling with some aspects of day-to-day functioning, such as sleep patterns and concentration. He is also struggling with connecting to others and seems to be dealing with anhedonia, making daily life more difficult. All of these behaviors would warrant a follow-up session and the clinician should be concerned with a possible continued decline in Mark’s mentality. Sleep patterns can greatly effect an individual and the clinician should work to maintain regularity which could help improve Mark’s affect. The clinician could ask simple questions about his sleep to gauge where he is at and what course of action needs to be done (i.e. possible medication referral, meditation techniques, etc.). His personal relationships are equally important to look into due to the impact they have on him. The clinician should make sure to check in on this so that they can accurately track any decline that needs to be addresses.

    b. Monitoring Mark’s behaviors would be useful for a number of reasons. First, it will show the clinician what treatments are working. This can guide future treatment decisions and goal setting. It can also encourage Mark to feel accomplished and want to continue his work in therapy. He struggles with feeling positively about his life and providing an overall summary of his goals and what he’s done could orient him in a more positive direction. Anhedonia can diminish a person’s sense of positivity so instilling some of that again could be very beneficial to later stages of treatment.

    Reply

    • Morgan Rafferty
      Oct 07, 2021 @ 12:37:32

      Frayah,
      I like your depiction of how a therapist should approach delivering psychoeducation based upon the presenting symptoms and distress level of the client. A therapist who accomodates and is malleable when it comes to this portion of therapy (and all portions) is most effective. The therapist needs to be attuned to meeting the client where they are.
      I also like how you point out that guiding Mark to accomplish more in his day to day living, will lead to an increase in positivity about himself which will be extremely beneficial to his overall well-being.

      Thanks for this great post!

      Reply

    • Valerie Graveline
      Oct 07, 2021 @ 15:47:26

      Hi Frayah,

      I thought you made a very good point about specificity pertaining to psychoeducation about a client’s diagnoses is important because not all presenting problems or diagnoses will be treated the same. I feel that perhaps many clients may go into therapy thinking that many if not all presenting problems are approached the same way, so it is definitely important to address the differences in how various treatment interventions will be utilized depending on the diagnoses. I also thought it was valuable how you brought up that many diagnoses are still stigmatized today, which further emphasizes why clients should be taught about their specific diagnoses. I think this is especially important to address considering many individuals may feel fearful of a particular diagnosis depending on the weight its label carries in society. When educating clients about their diagnoses, the clinician should emphasize that the diagnosis does not define who they are, rather it allows them to make informed treatment decisions.

      Valerie

      Reply

    • Giana Faia
      Oct 08, 2021 @ 17:59:17

      Hi Frayah,

      I like how you mentioned the idea of introducing some data on others with the same diagnosis as a way to “normalize” it to the client. With this, it is important to validate their diagnosis but not so much so that they feel it is insignificant. Along with this, the use of visual aids are helpful for the client making connections and feel more comfortable about their diagnosis. Thanks for sharing!

      Giana

      Reply

    • Lindsay O'Meara
      Oct 09, 2021 @ 11:44:19

      Hi Frayah,

      The mental health field is stigmatized and we want to make sure that our clients feel at home with us, rather than judged. Helping the client to understand that they are not alone is an essential part of therapy. Being careful to not minimize the clients’ experience is so important as well. Collaboration is key in CBT, so we need to make sure that we are caring and empathetic when addressing the clients’ issues so that we can provide the best therapeutic experience that we can.

      Reply

  7. Morgan Rafferty
    Oct 07, 2021 @ 12:19:09

    Psychoeducation
    1.)
    Psychoeducation is a crucial element of CBT. Clients need to be provided with knowledge. Therapeutic effectiveness is strongly influenced by the quality of psychoeducation that is provided. Psychoeducation is helpful in establishing therapeutic rapport. Therapists should refrain from lecturing to their clients. Instead, therapists should continually ask questions and elicit feedback from their clients.
    Adjustments should be made by the therapist depending upon the distress level and presenting problems of the client. Psychoeducation at the beginning of therapy is more formal; general expectations for therapy and information related to diagnosis and problems are typically addressed in the first couple of sessions. A successful path toward lessening a client’s distress is for a client to feel validated and hopeful about improving. A therapist should be adept at gauging their clients level of distress throughout the session. If it appears as though the client is feeling overwhelmed or tuning out during psychoeducation, the therapist should lessen the dose of psychoeducation for the time being. Checking in with the client and asking “how are you doing with me giving you this information right now?” is a good way of figuring out if he/she is on board with the psychoeducation component.
    Opportunities for psychoeducation present throughout the course of therapy. When a client exhibits distress, psychoeducation can be beneficial in terms of building a foundation to work from and also can set a tone of optimism. The content of psychoeducation is adjusted on an individual basis in terms of the level of knowledge a client seems able/willing to absorb. Most clients feel relief upon hearing about their diagnosis, common symptoms, incidence/prevalence rates and possible etiological factors. When a therapist shares this type of information it helps to normalize the client’s own personal experience.

    2.)
    When a client displays distress about their problems it is helpful as a therapist to assure them that you have worked with others with the same diagnoses with positive outcomes. It is helpful for a client in distress to know they are not alone in their suffering; that there are others dealing with the same symptoms. It is, however, essential that as therapists we do not minimize the client’s uniqueness in our efforts to attempt to normalize their distress. This could lead a client to feeling that they are just another person suffering from a condition that many other people are enduring as well. It can make them feel like just another number rather than someone who has their own personalized circumstance. By actively listening to details of each client’s specific life and making a point to let each client know that you have listened, absorbed and retained as many details as possible, a client will know you have genuine empathy for them as an individual. Clients can take comfort in knowing that they are not the only one in the world suffering from whatever ailments bring them to therapy. At the same time, they know they are receiving individualized therapy tailored specifically toward their needs when their therapist pays attention to and cares about fine details that matter to the client.

    Behavioral Activation
    1.)
    During Mark’s next session it would be valuable to follow-up on any negative automatic thoughts he might have tracked over the course of the week. Mark would benefit from an analysis of these thoughts in terms of which ones are valid vs. which ones are inaccurate. Efforts can then be made toward modifying his inaccurate automatic thoughts which in turn would positively influence Mark’s behaviors and physiological feelings. Mark would feel less guilt, shame and hopelessness if able to modify his inaccurate automatic thoughts (i.e., automatically assuming his friend doesn’t want to be friends when he is unable to talk on the phone).
    Mark is interested in working on his tendency to withdraw and disengage with his girlfriend. The therapist should follow-up with Mark to see if he engaged in withdrawing behaviors during the week. When Mark has an increase in emotional distress, he winds up with low energy and struggles with completing tasks at work and at home. The therapist should follow-up and see if Mark faced these same struggles this past week and address how improvements might be made.

    2.)
    It would be beneficial to follow-up on Mark’s accomplishments over the course of the week. He tends to minimize his accomplishments. He was starting to sleep in later (8a.m.) and was rushed in the morning as a result. It would be worth exploring whether this habit continued over the past week. By monitoring Mark’s accomplishments, he will feel that he is being held accountable for his behavior. This can serve as a very powerful tool in terms of conjuring up motivation. Mark was told it is ok to not always feel pleasure from accomplishing tasks. What is noteworthy is figuring out with Mark what activities he thinks he should feel pleasure but yet is not. A goal could be modifying thoughts toward those behaviors in an attempt to try to feel more pleasure from engaging in them.

    Reply

    • Kaitlyn Tonkin
      Oct 07, 2021 @ 12:41:16

      Hi Morgan,

      I think you made a really great point about checking in with the client throughout the psychoeducational process to make sure they are not feeling overwhelmed by the information they are receiving. Depending on the client, having so much information provided in a short amount of time can be really overwhelming and stressful. Like you said, it is the therapist’s job to check-in with their clients to make sure things are making sense, give them space to ask questions, and also allow them to take breaks and come back to certain aspects of psychoeducation later on. If a client is brand new to therapy, psychoeducation might be incredibly overwhelming and the therapist should take their time in explaining to their clients what to expect and always allow space for the client to give feedback and ask questions.

      -Kaitlyn

      Reply

    • Frayah Wilkey
      Oct 07, 2021 @ 20:00:02

      Morgan,
      I think you did a really good job of analyzing the videos and Marks overall problems. It seems like you’re good at picking up on nuances based on your post and class discussions. It also seems like you did a great job in pulling out what pieces are important regarding follow up and what should be discussed. Overall a great post!

      Frayah

      Reply

    • Lindsay O'Meara
      Oct 09, 2021 @ 11:47:20

      Hi Morgan,

      I think it’s really great that you mentioned that client’s should be asked for feedback. It is important that we create a space in which our client feels comfortable communicating with us. I agree that it is important to modify your explanations of psychoeducation depending on the state of the client. The last thing we want is to overwhelm the client and risk losing them because they feel like it might be too much for them.

      Reply

  8. Francesca Bellizzi
    Oct 07, 2021 @ 12:21:57

    [Psychoeducation]

    1. Psychoeducation is an important part of the therapeutic process as it provides clients with the opportunity and ability to work collaboratively throughout their own therapy. However, the therapist should adjust their psychoeducation “material” depending on the client’s distress and presenting problems – since everyone is not the same. During the early phase of psychoeducation, the therapist “sets the stage” for the therapy process by explaining general expectations and providing information to the client about their problems and/or diagnosis. When discussing therapy expectations with the client, there are individualized factors (i.e. distress and presenting problems) that may change the way in which these are presented. For example, if you have two clients (one with MDD and one with PD – agoraphobic) then the goals that are set for therapy are going to significantly differ. Here, a goal for the client with MDD may be to address and modify negative thoughts and behaviors, while a goal for the PDA client may be exposure and coping techniques. Likewise, a therapist should not educate a client who has panic disorder with agoraphobia about the symptoms, prevalence, and interventions for major depressive disorder. These adjustments are made as you come to learn more about the client and understand their presenting problems. Moreover, if a client is already relatively versed in psychological language or has already undergone therapy for the same presenting problem, then they may require less psychoeducation than others. In considering the way education about the cognitive model would be adjusted, it is through the use of real-life examples where a therapist can make adjustments. Specifically, using events that the client has experiences themselves to explain the interactions between thoughts, feelings, and behaviors can make the cognitive model easier to understand due to personalization. Making sure to tailor psychoeducation to the client through evaluating and understanding their experiences, problems, and level of distress is important in creating a strong foundation for the therapy process.

    2. In normalizing the client’s experience it is important to come off as nonjudgemental, lacking empathy, or even alienating them. To do this, a therapist can understand the symptoms and problems that the client is experiencing and then discussing the commonality of the diagnosis (prevalence rates), the symptoms that are experienced, and even the cause for their problems and distress. However, it is important to remember to not push aside the client’s own experiences; rather, a therapist should draw connections between their personal experiences and commonalities that are seen amongst that specific population. Similarly, the therapist can use collaborative vocabulary such as “we” to make the therapeutic experience more normal (and collaborative). Not only this, but validating the way a client feels, thinks, and behaves can make them feel as though there is nothing wrong with them despite their distress. By validating the client and exposing the common nature of the diagnosis, symptoms, and distress their presenting problems may become normalized.

    [Behavioral Activation]

    1. Some patterns of behavior that would be important to follow up on in his next session have to do with his tendency to withdraw. The overall pattern on behavior that I think would be important to readdress withdrawal, yet this pattern has “sub-behaviors” that would help build more context. For instance, his ability to get things done and meeting his basic needs would be a good topic to discuss because the amount he engages in these behaviors would reflect how much he is withdrawing on a daily basis. Furthermore, he might not write down “oh I was withdrawing from x time to y time” so understanding the behaviors he engages in (or doesn’t) can help to infer the instances where he is withdrawing. Moreover, it would be important to follow up on his levels of energy and motivation while reviewing his activity log. Following up on these aspects can help to expand upon his own goals (i.e. getting up earlier).

    2. Monitoring his levels of accomplishment and pleasure may have a significant impact on the efficacy of his treatment. In the video, Mark stated that he was “having problems” with his level of enjoyment and that he was not getting any pleasure out of activities (if he was engaging). The level of pleasure is an important thing to measure as it can give the therapist an idea of the progress being made (as anhedonia is a symptom of MDD), and can also serve as a tool for Mark that shows an increase of pleasure. Along with this is measuring his feelings of accomplishment, as Mark mentions that he is withdrawing from getting things done, like washing the dishes. Being able to monitor the tasks he completes and seeing the corresponding accomplishment level is important because it shows Mark those positive feelings when he engages in daily activities. Likewise, this will be a good way to explain to Mark that we sometimes have to engage in activities that make us feel accomplished although we don’t necessarily enjoy engaging in them.

    Reply

    • Valerie Graveline
      Oct 08, 2021 @ 12:43:36

      Hi Francesca,

      I like how you brought up that the “sub-behaviors” that make up his withdrawal helps to provide more context for the clinician to understand these patterns of behavior. Seeing as withdrawal is one of Mark’s main maladaptive behavioral patterns, it is crucial that the clinician has as much information around these behaviors as possible in order to make informed treatment decisions. I think it’s also really important for these patterns to be addressed in subsequent sessions so that Mark can ultimately learn how to recognize these behaviors as they occur, and adjust them accordingly.

      Valerie

      Reply

  9. Giana Faia
    Oct 07, 2021 @ 15:34:43

    Psychoeducation-

    (1)Psychoeducation can be adjusted when discussing expectations and the cognitive model based on the clients distress and presenting problems. First, you want to be brief and also make sure that you are using terminology that the client will understand. You want to stay away from the use of heavy jargon, because most people who are not in the field of psychology will not know the terms we use. With this, it is helpful to explain some of the jargon being used in a way in which the client will understand. It is also helpful to use examples in your explanations that they would understand, such as ones relating to their life, as a way for them to make connections. It is important to check-in throughout and make sure the client is engaged and following what is being said. Based on the presenting problems and level of distress the client is experiencing, you’ll want to gage whether or not the client can be easily overwhelmed or not. With psychoeducation, you want to be upfront with the client but not in a way that will overwhelm them.

    (2) When “normalizing” the clients’ experiences, it is important to validate them. You want validate these thing because they feel very real to the client. By normalizing the clients experience based on diagnosis, it demonstrates your knowledge and understanding of it while also providing an optimistic outlook on their future therapeutic experience. However, you don’t want to “over normalize” their experience, leading them to believe that their experience is insignificant. Along with this, explaining the cognitive model using visuals and clients’ person experiences are helpful to better explain their diagnosis. It is also important to explain the symptoms pertaining to their specific diagnosis and how they might perceive those symptoms. An example from the video with Lindsay is when Dr. V explains the symptoms she experiences when she has a panic attack and how those symptoms are similar to those of a heart attack. Here, he validates what she is feeling but also provides an alternative explanation to why she feels this way.

    Behavioral Activation-

    (1) Based on Mark’s WAML, some patterns of behavior that warrant a follow-up include those relating to energy and concentration. Mark struggles with waking up early in the morning which is something he wants to focus on improving. He also wants to be more active in walking the dog with his girlfriend. By making note of these in the WAML, you can track these patterns and see if they are increasing, decreasing, or remaining the same. The following week, the therapist can see if Mark has made improvements on waking up, completing daily tasks, or engaging in activities with his girlfriend.

    (2) Monitoring the client’s accomplishments and pleasure is beneficial so that they are aware of these accomplishments and pleasures. However, these should not be measured together because you can complete something but not find it pleasurable, but it is still an accomplishment. For Mark, he washed dishes but was aware there was a low level of pleasure but a high level of accomplishment involved in this task. It is important to monitor pleasure and accomplishments because moving forward in therapy, you want to be aware of high or low levels of accomplishment and pleasure and be aware of the patterns. This can be beneficial for treatment planning because you can incorporate things they find pleasurable as well as tasks they feel most accomplished by.

    Reply

    • Francesca Bellizzi
      Oct 10, 2021 @ 08:31:21

      Hi Giana,

      I liked your explanation on adjusting psychoeducation based on the client. I did not think of discussing the use of “heavy jargon” (as you put it) and being sure to explain what those kinds of psychological terms mean to the clients. Also, I like your point of making sure that the client is not too overwhelmed. While we know that therapy can bring up some uncomfortable feelings, the last thing we would want our clients to feel is overwhelmed because we didn’t explain ourselves well enough.

      Great job!!
      Francesca

      Reply

  10. Lindsay O'Meara
    Oct 09, 2021 @ 11:39:17

    [Psychoeducation]
    1. Psychoeducation helps to establish therapeutic rapport with clients. This creates a collaborative process where the client gains the knowledge to use cognitive-behavioral skills in order to solve their life problems after therapy has ended. You should adjust the psychoeducation of therapy and expectations and the cognitive model based on a client’s distress and presenting problems. An explanation of therapy expectations and the cognitive model can be adjusted to the client’s presenting state. It is important to discuss these expectations in a knowledgeable and non-threatening way so that the client can become comfortable in therapy. You should try not to use too much jargon so that your client does not become overwhelmed. You can break up psychoeducation, expectations, and information on the cognitive model to meet the pace of your client. It is also important to take note of what is distressing the client so that you can provide the best treatment possible.
    2. For psychoeducation of specific disorders, there are ways to “normalize” the clients’ experience without alienating them or coming off as lacking empathy. One way to do this is to discuss symptoms that are common, incidence and prevalence rates, and possible etiological factors. While you do this, you want to make sure to remember and get across that your client is unique. We never want to minimize the clients experience, but rather let them know that their needs are important and that we are there to help. We can talk to the client about how others have had positive results in therapy. Creating a collaborative process, where there is mutual understanding can help the client to feel more comfortable. This can also aid in helping the client to understand how to maintain their distress and is a good time to talk about which interventions may be used.

    [Behavioral Activation]
    1. Having a client fill out a weekly activity monitoring log can help the client and the therapist to recognize which patterns of behavior are present. In order to modify thoughts and behaviors, we need to find out what behaviors are present in the client. In Mark’s case, there are certain areas that we would want to follow up on. Mark withdraws when he feels stressed or overwhelmed, so it would be important to identify what the means for him. Specifically, which events are stressful, and what he does to cope in those situations. We would want to follow up on how much time is spent with his dog and girlfriend. We would want to see if he is applying to other jobs. We would also want to follow up with his morning routine and see how much time he really has time in the mornings.
    2. Monitoring this client’s accomplishment and pleasure will be helpful to Mark’s treatment because we will be able to see which behaviors create distress, and which behaviors result in a feeling of accomplishment. When we can identify which behaviors are bringing pleasure and accomplishment to the client’s life, we can try to help them to find more time to spend on those activities. When client’s feel accomplished, they are likely to gain motivation in completing those tasks in the future.

    Reply

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Adam M. Volungis, PhD, LMHC

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