Topic 4: Psychoeducation & Behavioral Activation {by 2/16}

[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?

*Please remember to complete your own WAML for class next week.

 

Your original post should be posted by the beginning of class 2/16.  Have your two replies posted no later than 2/18.  *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/

61 Comments (+add yours?)

  1. Tiana Faulkner
    Feb 10, 2023 @ 19:12:58

    How much information is given can always be adjusted, not every client may need or want to listen to all of the information that should be given. The way the therapist gives the information can be changed as well. Some clients are able to understand the more complicated terms used, some others may need more laymen terms or more explanations. Also, depending on the client’s presenting problems or distress, there may be more of an emphasis on certain features of CBT. Like in one of the videos (MDD-4) there was a more in-depth explanation of the cognitive model, even a visual of the model for the client to utilize and apply the presenting problem to. Also, explaining the treatment plan. There can be a broad explanation of what will be done or a more in-depth explanation of what is planned.
    The therapist may be able to normalize the behavior of the disorder the client is experiencing by talking about the small positives of the disorder. For example, in the PDA-4 video, there was an explanation of how anxiety can sometimes be a good thing, it is the excess of anxiety that becomes the problem. Sometimes it can be about helping the client understand that their symptoms may never fully go away because there sometimes may need to be a small amount to help protect the client in every day life. Or, helping the client understand the symptoms of their disorder, how they are not alone, explaining how these symptoms come about, and talking about how they are not going to end the way they think they will. Just like how in the video “panic attacks won’t end in death”. Additionally, reinforcing the thoughts and symptoms but explaining how they are not real. “These symptoms will not end in the way you think they will, but I understand why you feel like they will”.
    Some of the patterns of behavior that warrant a follow-up are the withdrawal he experiences, his amount of activity involving either his girlfriend or his friends, anything that happened when at work, what was valued for him, walking his dog, really anything that has a low rating of being enjoyable or pleasurable, or even things that have a higher rating so that in the next session you can talk about what made it enjoyable and why.
    Monitoring accomplishments and pleasure can be helpful because it focuses on the positive rather than the negative. When there is more focus on the bad things the client is more likely to ruminate on those negative behaviors or feelings. It can give the client tangible things to focus on and be happy about. They get to see the progress they have made and the things that they enjoy right out in front of them.

    Reply

    • Melissa Elder
      Feb 14, 2023 @ 18:23:49

      Tiana,
      It is important that a client does understand all information provided by the clinician, whether they want to hear it or not, there will always be a way to portray the needed information to them. I agree with the importance of mentioning the small positives, as you mentioned this allows the client to feel more comfortable with their diagnosis. I agree it is important to focus on monitoring accomplishments and pleasure to capitalize on the positives while avoiding the negative aspects.

      Reply

  2. Magdalen Paul
    Feb 11, 2023 @ 15:25:28

    Psychoeducation can be adjusted in various ways to cater to a client’s distress and presenting problems. First, language and vocabulary utilized can adjust according to the client’s educational level and other cognitive factors. This will better allow the client to comprehend that which you are trying to educate them on. Further, the content of the psychoeducation itself can be placed in context of a relevant stressor/situation that the client has shared with you or that may resonate with them and their distress. The cognitive model can be described using examples that are personally relevant and “make sense” to the client, such as an experience the client shared with you. You can then insert the client’s specific behaviors, thoughts, and environmental responses into the cognitive model for him or her to better grasp. You can also invite them to collaborate and engage by sharing their own thoughts/emotions/behaviors as you work your way through the model. For psychoeducation of specific disorders, a client’s experience can be normalized by sharing the idea that they are not alone, as other people share similar symptoms and experiences (incidence/prevalence rates and etiological factors can be shared). To avoid seeming apathetic, this point can be stressed alongside the notion that they have their own unique experiences. It is important not to minimize the client’s distress or experience, but also assure them that individuals with similar diagnoses have had positive treatment outcomes.

    Some patterns of behavior that warrant follow-up in the next sessions include social interaction (with his girlfriend, friends, etc), withdrawal, and engaging in activities that he enjoys (like walking his dog). It will be important to revisit how much social interaction he engaged in, as well as how much he enjoyed it or felt accomplished from it. Further, it will be important to check in on instances throughout the week when he may have withdrawn from activities or situations (and take note of what automatic thoughts may have triggered this withdrawal). Further, it will be important to note how often he was able to engage in activities that he claims to enjoy, such as walking his dog and watching sports. Any additional behavioral patterns that arise while examining/reviewing his activity log, such as those which invoke feelings of minimal pleasure and/or accomplishment, are important to review with the client. By monitoring this client’s accomplishments and pleasure, it will help the client better understand what activities he is engaging in, or could engage in more, so as to maximize positive emotions. By showing this client which behaviors tend to drive the most “reward,” it can help reinforce those behaviors and increase their quantity. By understanding what is “rewarding,” either in the form of an accomplishment or pleasure, the client can strive to implement more of those behaviors and increase quality of life as a result.

    Reply

    • Tiana Faulkner
      Feb 13, 2023 @ 15:51:51

      Hi Magdalen! I definitely agree with your entire response to this post. You have a lot of great detail. I especially liked your inclusion of using psychoeducation in a way that includes using examples that are personally relevant to the client such as examples or stories given by the client to help make it make sense. I also really liked all of the details you included that should be followed up on in the next session. Many of the details you chose I also agreed with, however, I also liked your inclusion of the extra behaviors and feelings.

      Reply

  3. Whitney Andrew
    Feb 13, 2023 @ 21:54:24

    Psychoeducation is adjusted to the client specifically, focusing on the issues that are causing them discomfort or harm in their lives. The clinician can adjust their approach to best fit the client’s stressors; a clinician would not use the same approach for a client with anxiety as they would a client with depression. In the same thought, not every client presents with the same intensity of symptoms and therefore will not benefit from the same approach that another client with anxiety may have. The psychoeducation can also be adjusted with vocabulary used to help the client better understand the education. To explain, someone who is not well versed in clinical jargon would not benefit from a psychoeducation session full of clinical specific jargon as they would not understand what is being discussed.
    In order to normalize a client’s experience, the first step is to validate their emotions resulted from the stressor. Though they may not be true, the example with MDD the automatic thoughts the client was having were addressed and considered valid by the clinician, but immediately following they were disproven. Another way to normalize experiences are to also point out some positives that result from the experiences, like anxiety surrounding tests to study exemplifies that anxiety can be beneficial and not also a thought process that is hindering.
    One behavior pattern that is warranted for a follow up is the lack of routine in taking care of himself, like washing dishes and completing chores. There is also the pattern of withdrawal and social activity that should be followed up on as this reaction is perpetuating the ‘stuck’ feeling this client is experiencing. I think monitoring this client’s accomplishment and pleasure would be helpful to better understand what is able to motivate him and also what activities or people help bring him joy. It would also be beneficial for the client to see their progress in order to truly track their accomplishment and not as easily downplay what they have completed to fall back into the perpetuating cycle of feeling worthless.

    Reply

    • Melissa Elder
      Feb 14, 2023 @ 18:11:59

      Whitney,
      I like that you pointed out a clinician would not use the same treatment approach for a client with anxiety compared to depression, but also that you added, everyone who presents with anxiety will not necessarily benefit from the same treatment plan or approach. I wish I had added this to my post as that is an extremely important point. I also agree that validation is so important for a client. I appreciate that you added how important it is for a client to see their progress as this can help them see they really are improving, resulting in fewer opportunities for them to question their accomplishments.

      Reply

    • Magdalen Paul
      Feb 15, 2023 @ 16:25:33

      Hi Whitney! I like your point about the use (or avoidance of) clinical jargon. While we are trained to understand the “clinical jargon” in courses, and many clients may appreciate this more academic phrasing in therapy, it is important to be able to convey this information in a variety of manners appropriate for various clients. Ultimately, whatever resonates with a client most–and allows them the best overall comprehension–is key to illustrate. This also helps to build rapport!

      Reply

    • Abby Sproles
      Feb 15, 2023 @ 18:16:33

      Hi Whitney! I agree with your point on adjusting the clinical jargon to the client. While we need to educate clients in a manner that is easily understandable, some clients may benefit from or be interested in hearing specific terms. In the video with Mark, you can see that Dr. V was able to ‘match to’ the client effectively. He mentioned specific terms like “collaborative empiricism” and “cognitive distortions” but expanded on what they mean and how it affects Mark. Therapists can use certain terms with some clients when they feel that the client can understand them.

      Reply

  4. Abby Sproles
    Feb 13, 2023 @ 22:16:11

    Psychoeducation can be personalized to the client’s presenting problems and personal level of distress by discussing how their thoughts, emotions, and behaviors fit into the cognitive model. The client can identify a recent, distressing example and the therapist may explain how negative thoughts triggered distressing emotions and/or dysfunctional behaviors. In addition, the therapist can tailor psychoeducation of therapy expectations to the potential strategies that the two will work together on during the therapeutic process. For example, the therapeutic strategies discussed in the session with Lindsay (e.g., breathing techniques, challenging thoughts, other relaxation techniques) differed from the strategies discussed with Mark due to different presenting problems.
    For clients with specific disorders, it is important that the therapist validates their distressing emotions. Through psychoeducation, the therapist can discuss that the thoughts may or may not be valid, but despite their validity, the client’s emotions are valid and help them cope with distressing thoughts or behaviors. Furthermore, the therapist can promote optimism by explaining that these maladaptive thoughts and behaviors can change through CBT. The client is not defined by their symptoms, but with time and effort, the two can work together to alleviate symptoms and determine effective coping strategies.
    Based on the information we know about the client, it would be important to follow up on his social withdrawal, sleep patterns, and time engaging in pleasurable activities, such as spending time with his girlfriend, walking his dog, or hanging out with friends. The therapist can determine if the client is ‘stuck’ in some of the concerning behaviors or if he is attempting to increase pleasurable, functional behaviors. Daily monitoring of the client’s pleasure and accomplishment can help the therapist understand what behaviors are valued and those that are difficult to complete. As discussed in the video, the client may value walking his dog more than doing the dishes; thus, his pleasure and accomplishments ratings would differ.

    Reply

    • Tiana Faulkner
      Feb 14, 2023 @ 14:22:24

      Hi Abby! I definitely agree with personalizing the psychoeducation and discussing their thoughts, emotions, and behaviors. I like your inclusion of therapy expectations and potential strategies that may be used in session. Making sure the client knows their emotions and thoughts are valid is super important, similarly it is super important to also make sure the client knows they may not be valid emotions or thoughts. I also like how you included the promotion of optimism and explaining the maladaptiveness that can be changed using CBT. Also, how you stated that the client is not defined by their symptoms, but with time and effort, the two can work together to alleviate symptoms and determine effective coping strategies. Pretty much everything you said for part two in my opinion is right. All of those behaviors need to be monitored and assessed more.

      Reply

    • Jack Halliday
      Feb 15, 2023 @ 17:50:08

      Hey Abby, I really liked your conceptualization of the importance of psychoeducation and how it can be adjusted based on your client’s level of functioning and presenting problems. Psychoeducation can be a very efficient tool for validating the client’s emotions and feelings, just like you said. I also liked your emphasis on the increasing of pleasurable activities through the daily monitoring. Also, like you said, it is a great tool to figure out what activities are increasing the client’s daily enjoyment and which activities are decreasing it, which is essential when treating individuals suffering from depression.

      Reply

    • Whitney Andrew
      Feb 15, 2023 @ 22:35:30

      Hi Abby!

      I really liked the idea of ‘personalizing’ the psychoeducation to the client’s problems, but also to the severity of what they are experiencing as well. It is super important to not under or overplay the client’s experiences with any adversity they may be facing. I also thought it was awesome to highlight the work to strategize and overcome rather than just going through the emotions and coping. Problem solving is definitely something that has to be tailored to the individual, as you had stated.

      Reply

    • Olgena Pano
      Feb 16, 2023 @ 18:30:37

      Hello Abby,
      I liked how you explained the importance of psychoeducation regarding specific disorders by providing concrete examples from the videos. There are cases where sometimes we fear things that we are not well informed about them or do not know how to react when they happen. In CBT, this part is well covered by using psychoeducation, where the client starts to realize the origins and the process of his/her difficulties. Maybe, there are cases where this step is the most important one to help someone build a new perspective or point of view of their situation (however, this depends on the case and disorder/problem type).
      Great post!

      Reply

  5. Melissa Elder
    Feb 14, 2023 @ 13:00:11

    In sessions, psychoeducation can be adjusted many ways to best suit the client who presents in front of the counselor. Depending on the client that a counselor is in session with depends on factors such as what type of vocabulary is used or how emotions are used within the language. Sessions and treatment plans should be fitted to each client specifically to help them feel comfortable and allow a better understanding of what is being presented to them. When explaining a cognitive model to a client it may be easiest to use a situation they have shared to help explain, including the behaviors, thoughts, emotions, and environmental factors surrounding the situation to allow for a deeper understanding. Using CBT this process can help the client understand their emotions, thoughts, and behaviors, why they are occurring, and how to make needed changes. When it comes to normalizing specific disorders, something I noticed within the videos was the counselor validating the typical or normal symptoms or issues within specific disorders the clients experiencing. For instance, people who have the same been diagnosed with the same diagnosis can have similar experiences due to similar diagnoses. These are the symptoms or experiences which can be pinpointed and validated, it is important to help the client recognize that they are not alone in this diagnosis. In the video, there was a reference made about how anxiety is not always a bad thing, but how it can be helpful.
    Based upon the knowledge provided within the videos, it seems that his withdrawal tendencies, sleeping patterns, social interactions, and his engagement in enjoyed activities would need to be followed up on within the next session. I believe it is important for the counselor in this situation to attempt to understand what elevates his mood or provides him with motivation to accomplish activities he enjoys. I think it would also be important to track how any tasks or activities he did throughout his week, his mood when the activity was occurring, and lastly any automatic thoughts that came along with it. Once he tracks his week the counselor can see a bigger picture of what brings him joy while also understanding his automatic thoughts during this time, as well as what is not enjoyable for him and his automatic thoughts during this time. This can help to understand what is going on internally during activities and can assist in knowing if changes need to be made, or how he can change any possible negative automatic thoughts he experiences. Overall, having this broad understanding can help assist the client to work towards an all-around more positive quality of life.

    Reply

    • Whitney Andrew
      Feb 15, 2023 @ 22:41:12

      Hi Melissa!

      Your response for the second question was super reflective for me. I really liked how you brought up Mark’s sleeping patterns; I had definitely overlooked that and was more focused on the withdrawal and social interaction patterns instead! The strategy to place what elevates his mood rather than what makes him fully happy is such a great idea, as some things may not evoke immense joy but can help to raise his mood above a low, which is super helpful for the client. Weekly tracking is definitely a good way to gauge how a client is improving and just doing overall, and can even bring more insight than the client’s account for certain issues they are presenting with.

      Reply

  6. Ashley Millett
    Feb 14, 2023 @ 21:19:27

    With psychoeducation, we as therapists are able to personalize sessions for the benefit of the client. Some clients are able to understand the terminology we use and others would not. We would have to adjust our sessions depending on the client. Also, sometimes, clients might need a better understanding of expectations and the cognitive model. New clients would need the understanding to be on their level rather than a “one and done.” It may take some clients a while to fully understand either what is going on in session or therapy overall. This can be done with going over different parts of sessions or using things such as visuals or other methods. As a therapist, you want the client to be able to understand what is currently going on and what is going to happen. It can prepare them for future sessions. A main goal of sessions such as these, is to make the client feel welcomed rather than feeling otherwise. Every client is different. It is necessary to adjust accordingly depending on the client. For specific disorders, it is very important to give the client reassurance about their disorder. They are not defined by their disorder nor should they be. Sometimes, a client might label themself as the disorder rather than their own person. It can cause more negativity towards their mind or their life. The therapist should also validate the client’s emotions either towards their disorder or overall. Sometimes a client might feel alone or weird about what they are doing. Rather than adding on to the negative thought, the therapist should let them know that they are not alone. The therapist should also have empathy for the client. Not so much where the client might feel that the therapist could be mocking them in a way. Any sort of disorder or issue is tough to go through. Sometimes clients need someone they can count on.

    Based on the client so far, I would like to follow up on his social, withdrawal, and overall sleep behaviors. This is important to use as a baseline for possibly the rest of the sessions. With self-monitoring, it allows the counselor to see what is affecting what in the client. They would be able to see what can trigger a certain behavior. They can also see how a certain event or behavior can affect the client’s entire day. The client has also stated that he wants to be more present with his girlfriend. Self-monitoring can show what he is currently doing. Then later on, the client and the counselor can work together to come up with solutions. The same idea is also for the other two factors. As stated before, it is a baseline for possible solutions later on in sessions. Monitoring the client’s accomplishments and pleasures can be extremely helpful for his treatment. Seeing what the client either likes to do can help influence the solution to the things that want to be changed. The counselor can use the things the client likes to do as a way to help get them through things they do not like to do. What I mean is that the things the client likes, can be used for the things the client either does not like or does not want to do. Along with pleasures, accomplishments are also important. The counselor can use this as motivation for the client. When a client sees what they can accomplish, they might have more determination to do more.

    Reply

    • Becca Boucher
      Feb 15, 2023 @ 17:55:11

      Hi Ashley! I love that you mention using visuals and other methods to help some clients better understand the information provided during psychoeducation. It is really important that we help clients to understand not only the expectations of therapy and how sessions will be run, but their diagnosis and the CBT approach that we will be using. However, these things are not easily understood by a lot of people who haven’t had psychology education experiences, so ensuring that we are teaching them adequately without over-explaining or making our clients feel stupid is incredibly important. I also really liked how you mentioned that with tracking activities you can begin to notice specific patterns such as if a certain behavior or activity occurs on harder days. That’s a really great point, because not only can you see a pattern of behavior like going to bed very late every night, but you can also see from these records how certain behaviors and activities might interact or how they affect each day.

      Reply

  7. Esther Konadu
    Feb 14, 2023 @ 22:42:39

    The best thing to do to adjust would be to bring it up early in therapy that things can change based on how a client feels. Letting the client become aware in the first few sessions by saying “here is what we plan to do together, what do you think?” and then listening to that feedback could help. Also, emphasizes that if there is something that is distressing a client, then they should feel free to bring these concerns to the session. Making sure that they know that while we work together to address their main problem, there is always room for the other pop-up issues is so important. Without this understanding, it would make explaining future expectations or discussing the cognitive model more complex. To normalize client experiences, explaining to them that the disorder is not an end all be all so to speak, and what the disorder’s symptoms are based on their experience, could help. In the video, talking about how long her panic attacks lasted (10-20 minutes) versus the body’s response time (20-30 minutes), as well as the other sensations, made them approachable. Also, being able to explain their experiences as part of the cognitive model would show that you are empathetic and understand how their experience plays out outside of the session.

    The behavior patterns that need follow-up in the next session are withdrawal from friends/loved ones, what were the highlights/challenges of his week, situations & feelings during work, going out with his girlfriend, walking their dog, and maybe his interactions with his friends. Monitoring his accomplishment & pleasure would be helpful to show him what his thoughts are throughout the day. Taking note of how tasks or moments in the day went can allow for thoughts that are not immediately negative. Seeing what tasks bring the most pleasure & accomplishment means that they can be incorporated more often as a part of their routine. Making life more pleasurable is the end goal of therapy.

    Reply

    • mikayladebois
      Feb 16, 2023 @ 08:11:40

      Hi Esther. I really like your point about a client’s diagnosis not being the end of the line for them. I think that a lot of the time society has this connotation that all mental illnesses are completely damning and that they will never be able to move past the diagnosis. Reminding a client that they are more than just a disorder can provide some hope or optimism, which is really important as they progress in their treatment.

      Reply

    • Abby Sproles
      Feb 16, 2023 @ 15:24:39

      Hi Esther, I liked the point you made about making Psychoeducation collaborative. Therapists should ask the client to surface any confusion they have in the moment to ensure that it is immediately addressed. It would be unfortunate if a client did not speak up about their misunderstanding of their disorder, presenting problems, or the type of therapeutic inventions they are undergoing, as it may stunt treatment progress. On the other hand, the therapist should be in tune with the client to determine how to effectively communicate this information and set the expectations for a collaborative process.

      Reply

    • Ashley Millett
      Feb 17, 2023 @ 10:06:38

      Hi Esther,

      I like what you said about adjusting sessions for the client in time of distress. As therapists, we need to make sure our client is comfortable in sessions and also outside of sessions. Collaboration between the therapist and the client is needed in order to provide sufficient care of the client. I also agree with you on the importance of normalizing the client’s experiences. Clients can feel out of place if they think that they are the only one doing through their experience. The client’s therapist should normalize and validate their feelings. It can make them feel less alone in the world knowing others go through it as well. It can also let the client know that their feelings are valid rather than invalid.

      Reply

    • rena yaghmour
      Feb 17, 2023 @ 11:23:50

      Hi Esther,

      I think feedback is so important as it gives the client room to share with their therapist what works and doesn’t work for them. I agree with what you said on how to normalize a clients experiences. I also think validating their experiences and assuring them that whatever they are thinking and feelings is very fair and valid may give them a sense of support and could potentially make them feel better about what is going on. this may also help them be more open and willing to work on what is needed.

      Reply

  8. Jack Halliday
    Feb 15, 2023 @ 17:45:29

    There are countless variations on how you can present the psychoeducation of therapy expectations and the cognitive model based on the client’s distress and presenting problems. For some individuals, particularly those who are in crisis, an in depth and time-consuming psychoanalysis would not be immediately appropriate. That’s not to say that it’s not important, simply that in some cases it could likely be more beneficial if given at a later date. There are also important client characteristics that should be considered before engaging in psychoeducation that should change your approach. The most important one being your client’s level of cognitive functioning. This should shape how you go about explaining the disorder, as you want to meet the client where they at. Regardless of their level of functioning, it is important that you present it in a way that does not come across as patronizing, it is important to keep in mind that the point of psychoeducation is not to show off how smart you are, it is to help your clients better understand their struggles and give them accurate expectations for therapy. I think one of the best ways to normalize client’s experiences, as seen with Lindsay, is to emphasize that these disorders exist on a spectrum. With Lindsay, the therapist mentioned the evolutionary basis of anxiety and emphasized that everybody feels some degree of anxiety. I think this helps to not only normalize their experience, but also helps to not alienate them or come off as lacking empathy.
    Based on the information we have about Mark so far, I think that the two biggest behavior patterns that warrant follow-up are his social interactions (or lack thereof), him engaging in activities that he finds pleasurable, and sleeping patterns. I think that the monitoring of his accomplishments and pleasure could be helpful for his treatment due to his negative automatic thoughts. This could help him to not only identify his negative automatic thoughts but also help him to identify certain activities that may increase his overall enjoyment of life.

    Reply

    • Becca Boucher
      Feb 15, 2023 @ 18:00:51

      Hey Jack! I really like that you bring up clients who are in crisis situations and how they would be much less available for an in-depth psychoeducation at that time. I didn’t even consider that when approaching this question, I was thinking about level of distress, but I forgot that some incoming clients are going to be in a place where psychoeducation is not the primary consideration. I also agree that one way to normalize client’s experiences is through emphasizing the spectrum of each emotion, such as anxiety. Anxiety does serve a purpose and therefore is an important thing for humans to feel, but it can be adaptive or maladaptive depending on the severity and frequency in which it is felt. However, when someone has anxiety it can be really irritating and you can begin to dislike and hate the emotion, but being reminded that it does serve a purpose can be a bit encouraging and helps to show that everyone feels anxiety at some point in their life.

      Reply

    • Maria Nowak
      Feb 17, 2023 @ 21:27:56

      Hi Jack!
      I agree with how you said identifying activities that are pleasurable may increase his overall enjoyment of life. There are also many tasks that he needs to get accomplished but has a lack of motivation to do them. I believe pairing the tasks with activities that he finds pleasurable will increase his overall enjoyment of life as well. When individuals are depressed even activities that were once pleasurable become a task. It is important to try to gain more pleasure in doing any type of task/activities when the client is depressed.

      Reply

    • Megan VanDyke
      Feb 18, 2023 @ 10:21:35

      Hi, Jack! The therapist should follow up on Mark’s social and community engagement and sleep patterns. In his case, it is also beneficial to meet Mark where he is at. We know that when his depression symptoms increase, he is less likely to do any activity and stay home. To work on his goals and increase motivation to follow through with activities, it would be best to work with Mark at the fundamental level, meaning finding small but meaningful activities for him to do that involves things he enjoys. For instance, Mark can plan to go for a 15-minute walk with the dog and his girlfriend after a difficult day at work. That way, he is still managing some physical exercise, like he reported wanting to work on, and spending quality time with his loved ones. Over time, Mark could increase his time walking or move it to a new location, such as the dog park, where he can engage with new community members.

      Reply

  9. Becca Boucher
    Feb 15, 2023 @ 17:46:08

    Based on a client’s distress and presenting problems you can tailor your psychoeducation of therapy expectations and the cognitive model by using personal examples that apply to your client. For example, when discussing the cognitive model, if your client struggles with depression and is often unmotivated to do things, you can talk about how by not completing necessary tasks that individual feels distressed and ends up with negative automatic thoughts which further effect their behaviors, and those behaviors impact their environment. By using their presenting problems as examples, it may help a client better understand the ways in which their thoughts, behaviors and environment interact.
    When doing psychoeducation with clients, normalizing each client’s experience can be important to help them understand that they are not weird or a freak and that there are people who experience the same scary, distressing symptoms. With things like anxiety, or fear, one way you can normalize it is by emphasizing that feelings like anxiety exist for an adaptive reason. Like you say to Lindsey, sometimes anxiety is a good thing, because it can be applied adaptively in our lives when situations are actually dangerous. This normalizes the feeling of anxiety and emphasizes that not all anxiety is bad or maladaptive. This can be helpful to normalize having some worries and anxiety in life and remind clients that everyone faces anxiety and fear at some point.
    With this client, the patterns of behavior that warrant follow-up would be behaviors that maintain or increase his distress such as withdrawing and not meeting his basic needs like washing his clothes and dishes. I think along with these, it would be important to follow-up on what during his week brings him pleasure or increases his self-efficacy as well as what automatic thoughts he is having during times of withdrawal. Monitoring this client’s accomplishment and pleasure would be helpful so that he can see that some things in life bring him feelings of accomplishment and pleasure. It’s also important to identify these so that behaviors identified as highly pleasurable or accomplishing can be increased in frequency so that he is able to experience these positive emotions more often.

    Reply

    • Jack Halliday
      Feb 15, 2023 @ 17:54:30

      Hey Becca, I liked your emphasis on using personal examples when utilizing psychoeducation and setting treatment expectations. Using the client’s presenting problems as examples, I imagine, would have a tremendous impact on how well-received and understood your attempt at psychoeducation is. I also agree that the therapist’s tactic with Lindsay, where they emphasized the ecological benefits and evolutionary need for anxiety helps to normalize her feelings. I also liked how you mentioned with Mark it would be helpful to analyze the behavior monitoring to find out what activities are bringing him joy and feelings of accomplishment. By identifying these, you can hopefully increase the clients level of enjoyment and hopefully it also helps them to realize what activities they do daily that have a positive and negative impact on their lives.

      Reply

    • Ashley Millett
      Feb 17, 2023 @ 09:52:18

      Hi Becca,

      I like what you said about using psychoeducation with personal examples. Sometimes, I feel that some therapists will go by “the book.” They are almost like robots for repeating either the book or their schooling. I think that personalizing either experiences or events is needed for the client. It can make it seem more normalized. It can also ease the client’s thoughts knowing that either their therapist goes through it or other people. The biggest factor we can do with psychoeducation is to normalize the client’s experiences.

      Reply

  10. mikayladebois
    Feb 15, 2023 @ 18:02:45

    1. One thing that will be important when using psychoeducation with clients is for each lesson to be tailored to the client. While it is important for the basic information presented to be the same, clients with different diagnoses or backgrounds must learn different things. That may mean explaining the specific disorder in terms of the cognitive model. For a client with anxiety in which their thoughts lead to certain avoidance behaviors or physiological feelings, it would be beneficial for them to understand how their personal cognitions are influencing them. Also, it is crucial to make sure to match the client’s intellectual level. If the client doesn’t understand the words you are saying, there is no way for them to comprehend the information even if what you are saying is correct. Talking with younger clients or developmentally delayed clients will warrant extra care in ensuring you are understood when using psychoeducation. As far as normalizing the experiences of the client, reminding them that there are other people out there who deal with similar things can be helpful but may also feel ingenuine to the client. Really personalizing the cognitive model to the person’s environments, behaviors, and thoughts will show the client that they are valued by the therapist. We should also be relying on Rogerian skills such as a warm tone and open body language so that the subliminal messages are as compassionate as the overt ones.
    2. Knowing what we do about CBT homework, no matter what the client comes back with we should be addressing the WAML. If the client cannot fill the sheet out, we will want to know what got in the way of them writing down their activities. It is likely that the client will fill out the sheet though, but we still need to go over it with them so that they know the homework we assign is worth doing. If we tell the clients to do something and then never go back to it again, they will begin to think that nothing we say will come back up and we don’t need to follow up. Making note of a client’s accomplishments is a good way to build rapport and self-esteem in the client. Supporting their victories is always a nice feeling for the client and knowing that we are keeping track of more than just their struggles will make them more likely to return for the next session.

    Reply

    • Magdalen Paul
      Feb 16, 2023 @ 07:54:19

      Hi Mikayla! I really like your mention of the importance of implementing Rogerian skills into psychoeducation. The subliminal, covert messages can speak volumes and be the key to your client resonating with what you are trying to teach them. It can be the difference between engagement or disengagement, attention or spacing out, enthusiasm or indifference. Also, I agree that supporting the victories or “small wins” is a great way to build up a client and their motivation levels. You may possibly be the only “voice” in their life that acknowledges and praises the good things that he or she is doing–no matter how big or small. This can make a huge difference in building rapport, keeping the client engaged and motivated, and helping the client see him or herself in a more positive light.

      Reply

  11. Stephanie Lugo
    Feb 15, 2023 @ 23:13:14

    Adjusting the level of psychoeducation being used on a client is essential, especially if you see the client is particularly distressed and unable to comprehend what you may be educating them on. One of the biggest adjustments that can be made surrounds the level of vocabulary and medical language you use when educating the client about their cognitive behaviors. Not every client will understand what is being said when you use that medical jargon. Some clients may be open with their clinician and be able to ask for clarification when needed, but other clients who may already be anxious will not. As medical professionals, we do not want to stress the client out even more just because we decided not to simplify the medical jargon ahead of time. Using simpler knowledge will allow the client to actually comprehend what the professional is saying. As a clinician, it is essential to use examples and experiences that are relevant to the client when explaining the cognitive model.

    When explaining to the client about a certain area of the cognitive model, you can use examples to help the client normalize what they are going through on a daily basis. A clinician can find examples similar to ones the client may have mentioned prior as this will allow the client to relate more to what is being said. The clinician can also ask the client to open up about situations they have experienced in certain areas of their life. This not only allows the client to better understand the knowledge but also allows them to participate more in their therapy session. Explaining to the client that they are not alone and offering them support in all areas of their life is essential as it will make them feel heard. As a clinician, it’s essential that we don’t make the client feel misunderstood, and we need to make sure that we avoid coming off as lacking empathy. The best way we can do this is by making sure we do not undermine their emotions or distress. Even if the client’s stressors seem minimal to us, they may be negatively impacting the client’s daily life on a massive scale. Being open with the client and taking their concerns seriously is the best way we can connect with the client and normalize their experiences without alienating them.

    It’s essential to follow up with clients from session to session, especially when certain information and patterns of behaviors arise. A few of the biggest patterns of behaviors seen with this client that warrant a follow-up are their social withdrawal behaviors/social interactions, sleep patterns, and activities that bring joy to their life. Being able to review and follow up with these behavioral patterns is essential as it will allow the clinician to evaluate if the client is stuck and constantly performing behaviors that are concerning for their well-being. Knowing how the client spends their time each day can be essential as it will allow the clinician a deeper glimpse into the client’s life. Using daily journaling or monitoring techniques can show how much of the client’s time is being used for both the client’s negative behaviors as well as any pleasurable activities. This will allow the clinician to see what areas are causing the client the most distress as well as to what degree the client is suffering. Also being able to monitor not only the negative behaviors but also the client’s accomplishments and pleasurable activities can allow the clinician to know what activities the client should be prioritizing in their life. The goal of therapy is to make the client’s life more enjoyable, so knowing what brings them joy is essential.

    Reply

    • Esther Konadu
      Feb 17, 2023 @ 18:34:00

      Hi Stephanie,

      I agree with your point about how therapists communicate with clients and how some can be more inquisitive, and some may be shyer to speak up. I think that is why in medical settings, people become nervous because of previous experiences and how some professionals do not explain things without jargon. It makes it harder to realize that the diagnosis is about you when the terminology is very cold and off-putting. Seeing that clients understand what a therapist is saying can make therapy more approachable.

      Reply

  12. Gitte Lenaerts
    Feb 16, 2023 @ 07:42:20

    When providing psychoeducation around the client’s diagnosis, speaking and addressing the diagnosis in the client’s language will aid in a better understanding of the client. Using jargon when describing and educating one’s diagnosis to a client who is not familiar with that language can lead to misunderstandings and can harm a therapeutic alliance. Psychoeducation is an important tool to use and provide during sessions when explaining diagnosis, treatment plan, session structure, etc. Molding this process to the client’s style will not only provide a better conceptualization for the client but again, aid in building a working relationship. Providing psychoeducational will ultimately lead the client to use this knowledge in their life outside of session thus providing a framework for the client to cope when terminating therapy. Not all clients need the same level of understanding of their diagnosis and may just want to jump into treatment. With that being said some clients may be experiencing more distress and have more presenting problems that need to be met. It all depends on what the client is seeking out in therapy and what best help them reach their goals. As discussed in lectures, matching to the client to meet their needs is vital, which incorporates into providing psychoeducation. This adds to “normalizing” one’s diagnosis, when explaining a diagnosis, it’s important to be informative but also makes them feel heard at the same time. By validating and explaining their symptoms when educating the client on their diagnosis will provide not only a better understanding but provide a sense of normalization for the client. When sharing symptoms associated with the disorder, this allows the client to feel accepted and understood by the therapist which aids in the therapeutic alliance.

    During Dr. V and Marks’s session, he introduced and reviewed the Weekly Activity Monitoring Log (WAML). Some patterns that would warrant a follow in the next session when reviewing his WAML are signs of withdrawal and isolation. Mark shared that he tends to withdraw from social interactions and opportunities, tracking this behavior will allow not only Dr. V but also Mark to see when and where he is withdrawing the most. Mark also shared that he has withdrawn from his day-to-day activities too, not only social situations, so this would warrant a follow-up. Additionally, the WAML will warrant a follow-up for his sleep schedule as he reported that he has been waking up later than he would like. Monitoring Mark’s accomplishments and pleasure will be helpful for his treatment. This allows Mark to think about the behavior he competed in and what his thoughts and feelings are accompanied by the behavior. This also shows whether he found the activity enjoyable or not, which can let Dr. V know what areas he will need improvement in and what skills to focus on.

    Reply

    • Emily Forde
      Feb 16, 2023 @ 10:20:34

      Hi Gitte! I like how you pointed out that the use of jargon can not only impact the client’s understanding, but can also harm the therapeutic alliance. I agree with this and this proves the necessity of the clinician to use terms and language that are understood by the client. Despite the effort of the clinician to use specific language, the client may not be understanding. Because of this, it is essential for the clinician to check in with the client throughout psychoeducation to ensure they are explaining things effectively and the client is understanding. I also like how you mentioned that tracking Mark’s activities will help identify pleasures that will be effective in treatment planning. I think knowing what Mark enjoys is important as it is reinforcing and will keep him engaged in his treatment.

      Reply

    • Stephanie Lugo
      Feb 18, 2023 @ 22:36:37

      Hi Gitte,

      You made a great point about the importance of following up with clients who are showing signs of withdrawal in their life. Whether it be withdrawing from family, friends, a job, or life events it is important to follow up and make sure this has not become a pattern. If withdrawal has become a pattern in the client’s life it can be a clear sign of a mental health issue. For example, if a client previously mentioned that they always looked forward to going out with friends every weekend, but then all of a sudden started staying home alone. This can show that something in their life, either internally or externally has impacted them. The hope is for a clinician to be able to identify and intervene before the withdrawal becomes a long-term pattern. When a clinician uses the Weekly/Daily monitoring logs it allows them to better track the withdrawal and overall symptoms the client is experiencing. This allows them to have a better insight into what causes their periods of withdrawal.

      Reply

  13. Megan VanDyke
    Feb 16, 2023 @ 07:52:04

    Psychoeducation of therapy expectations and the CBT model can be curated to fit the client’s level of distress and presenting problems. CBT heavily revolves around meeting the client where they are at in the beginning. This is important because we, as therapists, want to ensure that the client is fully aware of the therapeutic process, what is expected of them, and what is expected of the therapist. If the client lacks that sense of clarity, certain aspects of the process may come as a surprise or shock and trigger negative emotions or symptoms. Mark did not present significant levels of distress, given that the stressful events had already occurred. In my opinion, he presented in session with a go-with-the-flow attitude and seemed receptive to completing homework assignments and gradually becoming more independent. However, to someone like Lindsey, who struggles with anxiety and agoraphobia, such tasks may be more difficult. In such cases, it may be more beneficial to normalize the symptoms, like Dr. V did at the beginning of Lindsey’s session and emphasize that the journey to independence is not something that will happen overnight – it happens gradually and can be at the client’s own pace, to an extent. The therapist can also step back and open the space for the client to talk about what they want to see in their sessions to give them a sense of control. Moreover, the word “homework” may scare some clients into not keeping up with therapy, as they may worry that if they don’t complete the assignment, there may be consequences. Therapists can change the name to “activity” or something that sounds more appealing to reduce feelings of anxiety or worry.
    For psychoeducation of specific disorders, one can normalize the client’s experience by validating their emotions and being aware of what language is used. Jargon may overcomplicate an explanation and overwhelm the client. By generalizing the context of the psychoeducation, the client can process what the therapist is saying much easier and rationalize the big picture. For instance, in Lindsey’s session, Dr. V started the conversation on a light note by informing her that anxiety is a normal feeling and a natural response to harmful events but becomes an issue when anxiety is felt too often. The same could be said for other disorders, like MDD, where one could say that while sadness and grief are normal emotions, they can become unhealthy if said feelings linger for too long and daily activities are negatively affected. It is essential to end the psychoeducation by reminding the client that it is possible to resolve the issue by developing coping skills and a treatment plan to process and work on the problems.
    Based on what we know and have seen from Mark, his behavioral withdrawal patterns warrant follow-up when reviewing his WAML in later sessions. We know that when Mark experiences an increase in depressive symptoms, he cancels plans and stays home, which he understands does not improve his symptoms. Tied into social interaction is community engagement or finding pleasurable activities to do in his free time. Sleep patterns are another behavior to monitor throughout the treatment process. He has reported difficulty with oversleeping, impacting his ability to prepare for work promptly. Tracking the WAML each session can be helpful when monitoring Mark’s accomplishments and pleasure. Keeping previous ones and comparing them to the most recent ones can help both Mark and the therapist see gradual improvement, which can help motivate Mark to keep working on his treatment.

    Reply

    • Esther Konadu
      Feb 18, 2023 @ 12:40:05

      Hi Megan,

      Your point about change not occurring overnight was crucial, especially since our collective culture is to work extremely hard for anything to change. The culture shuns slower, progressive changes to a person’s life and ridicules people who take this approach. Making sure that clients learn that they can come to therapy to take a breath during their sessions can be a part of the tools they need. There, they can realize that this process is all about their goals and where they would like to be.

      Reply

  14. rena yaghmour
    Feb 16, 2023 @ 09:01:26

    1. Psychoeducation can be adjusted in different ways in order to help the client fully understand what is expected and also help them understand their presenting problems a little more. For starters, making sure the client understands the vocabulary the therapist is using is key. The therapist should ensure that the client is understanding any terms the therapist is making. With that being said, the therapist should also be talking to the client that best fits their level of communication and knowledge. Asking the client what best works for them is also important and asking if there is anything that we as therapists can improve on. This gives the client room to provide any suggestions and feedback to the therapist and make the therapist aware of what is and isn’t working for them. Every client is different which is why it is important to know what best works for each of them.
    Because each client is different some may react differently to their diagnosis or symptoms which is why validating their feelings best normalizes their experiences not making them feel alienated. Clients want to feel validated but also receive the help they are seeking and if the therapist invalidates anything they say they may feel unsupported or disregarded and possibly create a thought that what they are experiencing is wrong. Like I have mentioned before, each client is different so making sure the therapist is treating them in a way that they feel supported and heard may be different from another client so it is crucial to get an understanding of the client and work off that.

    2. I think anything that is relevant to the client that is talked about in session warrants a follow-up. Therefore, some patterns of behaviors that warrant a follow up in his next session would be his social interactions, sleeping patterns, engagement in activities, and his withdrawal behaviors. Monitoring/asking how he felt throughout the certain activities can give the therapist an idea of where his level of pleasure may be or how accomplished he may have possibly felt. It is also important to note which activities he is beginning to withdraw from and try to understand his reasoning and thought process around why, especially the activities he has identified as his favorite or things he enjoys. The more information the therapist is able to gather the more they can work with the client and implement some CBT skills to help get them back to doing activities they once enjoyed.

    Reply

    • mikayladebois
      Feb 16, 2023 @ 09:30:01

      Hi Rena! I really like what you said about asking the client what may work for them and providing a space for feedback. If the client does well with physical handouts or diagrams drawn the therapist should do their best to utilize those things to ensure the message gets across. That will also help build rapport if the time is taken to include the learning style best suited for the client.

      Reply

    • Taylor Poland
      Feb 17, 2023 @ 21:06:15

      Hi Rena,
      I agree with what you thought warranted a follow-up in the next session. It is important to track his sleeping habits, withdrawal tendencies, and social interactions to gain as much information as possible. By having a collaborative discussion with Mark, patterns may be identified
      find any patterns. Perhaps the activity log will reveal that Mark is not a morning person and should adjust when he does certain tasks to ensure they get accomplished more effectively. As you said, the more information a clinician can gather, the more they can help the client.

      Reply

  15. Taylor Poland
    Feb 16, 2023 @ 09:47:19

    I believe that psychoeducation of therapy expectations can be adjusted based on the client’s individual needs and presenting problems. Some individuals may already have a basic understanding of their diagnosis and treatment plan whereas others lack the information in those domains. It is important to meet the client where they are at and not assume they know something. It is always better to ask to hear from the client about a certain aspect to ensure they have a clear understanding before moving forward. In addition, certain presenting problems may encourage the clinician to place emphasis on certain aspects of treatment in comparison to others. To normalize the client’s experience, I think validating those thoughts and feelings is key. By telling the client that their symptoms are normal within that diagnosis, they may feel less alienated. I really liked how the clinician explained to Lindsey that everyone experiences a level of anxiety which can be helpful in some situations. I think stating that may help Lindsey realize that she is not alone. As always, open body language and a warm tone may help the clinician come off as empathetic toward the client.
    I think that it is important to always follow up on homework assignments at the beginning of the next session. I say this because homework is not just some filler activity to keep them busy- it serves an important role in the treatment process. By prioritizing the review of the homework, the client will see the importance of completing it and it will hopefully start good conversations. That being said, certain patterns of behaviors should be addressed while reviewing the Weekly Activity Monitoring Log (WAML). The client in the video may want to discuss his sleeping patterns and social interactions in further detail with the clinician. The client can share their pleasantness rating and accomplishment level for certain activities related to sleeping and social interactions to give the clinician a better idea of how he is feeling. It may be helpful to track the client’s accomplishment and pleasure levels for activities to see what the client values. The tracking may also spark conversation if patterns of displeasure or unaccomplishment persist further.

    Reply

    • Emily Forde
      Feb 16, 2023 @ 10:15:23

      Hi Taylor! I like how you mentioned that some clients may already have an understanding of their diagnosis. Because of this, I feel like it would be important to ask them what they know and are aware of regarding their specific diagnosis. Knowing this could guide the therapist on what information they need to learn or what information may need to be corrected. I also like how you brought up that the tracking can help to spark conversation. I feel this is true and this tracking can serve as a tool to guide the next session and discuss problem areas and areas the client may be thriving in.

      Reply

  16. Emily Forde
    Feb 16, 2023 @ 10:12:13

    For psychoeducation to be the most effective for the client and their presenting problems, it is important to use their personal and relevant examples when explaining. In the video, using the client’s personal dilemma with a friend showed the client how the CBT cycle works and made it much easier to understand. In addition, a clinician should adjust their psychoeducation to fit the person, both in their language and presentation style. If the person would not be able to understand technical psychological terms, the clinician would need to adjust and use terms they would understand. In this case, it would also be important for the clinician to constantly check in to see if the client is following and understanding. The clinician should also adjust their presentation of psychoeducation based on what they know works for the person. In both MDD-4 and PDA-4, the use of a white board to provide a visual explanation, which helped both clients to see the model and better understand. Additionally, it is helpful to keep the client engaged throughout psychoeducation so they can learn more and play an active role in their learning process. Keeping the client engaged will also help the therapist determine if the client is understanding or needs more help to understand.
    The therapist can normalize the client’s experience by explaining each part of the disorder to them fully which can be used to validate what they are going through. In addition, a therapist can explain the positives, such as anxiety resulting in better performance to a certain degree. Doing so can help the client to feel like their disorder is not all bad but has some positive components to it.
    After going through his WAML, I would follow-up with his social withdrawal, interaction with his girlfriend, sleeping pattern, and value placed on certain things.
    Monitoring his accomplishments would be helpful because it would focus on what he is valuing and how he is prioritizing his time. If he wants to work on having more time for self-care or social interactions but has no free time in his day, this tracking will show this and will allow for him to change his time prioritizing patterns in the future. Additionally, this monitoring will help the client see what is going well in their life.

    Reply

    • Gitte Lenaerts
      Feb 17, 2023 @ 16:39:57

      Hi Emily, I like that you brought up using visual aids for psychoeducation. As you mentioned in both MDD-4 and PDA-4, Dr. V uses a whiteboard to provide an explanation of the CBT model within their own presenting problems and distress. Using visual aids not only provides education but is also a collaborative process. This way, the clients can see what is being said and taught to them rather than just listening. And as you mentioned, this will also keep the client engaged as well. Nice post!

      Reply

    • Stephanie Lugo
      Feb 18, 2023 @ 22:48:15

      Hi Emily,

      You made a great point about changing and morphing the premise of psychoeducation for each client. Of course, no client is the same, and no client learns the same way. Knowing your client and how they learn and receive information best can allow you to provide psychoeducation properly. Instead of just sitting there and lecturing the client about their mental illness or presenting problems it is better to educate them in ways that the knowledge will stick. If a client learns better by reading about their possible disorder you can provide pamphlets or educated materials. If they learn better by using visuals you can provide pictures, charts, graphs, or like used in the video a whiteboard. Being able to find ways to make the process more welcoming and inviting will cause the client less distress and unwanted anxiety about the future.

      Reply

  17. Lucy Rising
    Feb 16, 2023 @ 11:20:25

    One of the best ways to adjust psychoeducation for different clients/presenting problems is to (as we saw in the videos) explain the concepts using the generalized terms (thoughts, behaviors, emotions, etc.) but have the clients fill these in with their specific issues. We saw with Mark that Professor V. explained the cognitive triad but had M fill in the spaces with his thoughts and emotions in relation to the behavior he was distressed over. And in the case with L, she had focused less on emotions and more on physiological sensation, so Prof. V. had the circles reflect that and again had her work through the process of filling out the diagram with her specific experiences. This can really help build the therapeutic alliance and develop the collaborative element of the relationship, because instead of just lecturing at her like it was one of our classes, he is working with her and gaining more information about her presenting problems by having it be a collaborative process.
    As for normalizing our clients’ experiences, as we saw in the videos (especially the ones with L) the best way to do so is to remind them that these are normal human experiences and that they aren’t the only people who experience difficulty in regulating/assessing/appraising them. Prof. V. explained that anxiety is actually supposed to be a good thing when felt in the “correct” way. And later when he was going over exposure and saying that she’ll realize it is not as bad as she thinks, L responds hesitantly and they have a laugh about it but then he reassures her that most clients have a similar reaction as her but learn as therapy progresses that it is in fact true.

    Knowing M’s behaviors and rough treatment goals, I would want to follow up on his withdrawal behaviors and if/when he spent time with his girlfriend/friends. These seem to be a major contributor in his distress and if we can see the patterns in his daily routine and question him further about what facilitated those instances of withdrawal in his schedule that can help us begin formulating a treatment plan with behavioral activation and cognitive restructuring. Highlighting his accomplishments can help give him that positive reinforcement that he might not be providing for himself. When depressed people can start seeing good/neutral things as negative, so it is important for us to bring focus back to him and the things he is doing well.

    Reply

    • Olgena Pano
      Feb 16, 2023 @ 18:21:54

      Hello Lucy,

      I enjoyed reading your post especially the second part where you highlighted both the strengths and the withdrawn situations of the client. It is important for the clinician to be aware about all potential risk factors, and beneficial elements that would help the client overcome his difficult situation. In addition, is important not to minimize any type of threatening situations that are affecting the client’s emotional wellbeing, and not to neglect positive aspects that could link to the client motivation and self appreciation.

      Reply

    • Alysha Benoit
      Feb 18, 2023 @ 22:04:37

      Hi Lucy, I really like the way you mention that although basic CBT principles are at the core of therapy, each client fits their distress into the principles differently. Conceptually, this is very important for effective CBT because it allows clients to gain a better understanding of themselves (and the therapist to understand the client better as well). I also agree with you when you mention the importance of demonstrating to clients that some means of stress are actually adapative and “correct”. I think this is a great way to help clients feel “normalized” in and outside of session in addition to letting them know they aren’t alone in how they may feel. I think another way that helps to normalize how a client may feel about their presenting issues is the collaborative process between the client and therapist as a whole. CBT works by placing a balance of responsibility between the therapist and client and changes through the process of early, middle, and late stages of therapy. Overall, I appreciate your insight.. great job!

      Reply

  18. Grace Ling
    Feb 16, 2023 @ 15:51:06

    Psychoeducation of therapy expectations and the CBT model may be adjusted to fit the client’s level of distress and presenting problems. As demonstrated in the video, Mark’s situation with his friend is incorporated into the model. Integrating his problems into the model helps facilitate a better understanding of each factor and their relationships. Psychoeducation can also be adjusted to clients’ educational levels. For many people conceptualizing the model may be difficult, so providing a visual and using clear language can help facilitate understanding. Clients are also able to ask questions and comment on their own capabilities which may allow the therapist to further educate the client. For psychoeducation of specific disorders, validating the clients’ feelings and emotions can normalize the client’s experience. Specifically with Lindsey, explaining her feelings of anxiety as a means to protect oneself from danger can normalize her experience.
    Behaviors that warrant a follow-up are social withdrawal, sleep patterns, and enjoyable activities. The WAML would pinpoint when these behaviors appear in his everyday life and the thoughts/emotions that accompany them. Discussing any activities that invoked feelings of enjoyment and accomplishment or no enjoyment and accomplishment may be discussed and analyzed. Additionally, monitoring these feelings can provide insight and encourage change.

    Reply

    • Gitte Lenaerts
      Feb 17, 2023 @ 16:25:00

      Hi Grace, I like the example you shared of how psychoeducation of therapy expectations and the CBT model can be adjusted to fit the client’s level of distress and presenting problems. You shared how it was demonstrated in Mark’s video with his situation with his friends and how Dr. V incorporated that into the model. I think this is a great way to match to the client’s level and build a rapport with them as well. Psychoeducation is a great tool to use to not only educate the client but build that helping relationship. Great post!

      Reply

    • Taylor Poland
      Feb 17, 2023 @ 20:45:19

      Hey Grace, I agree with what warrants a follow-up in the next session. Mark’s sleep patterns, social withdrawal, and enjoyable activities should be discussed in the next session to gain a better understanding of what is going on. You made a good point that it is important to not only bring up activities that Mark rates low in pleasure and accomplishment but also bring up activities he scores high on. I was very focused on what he needed to improve on but it is good to note what he is doing well on as well in order to reinforce that behavior.

      Reply

    • Megan VanDyke
      Feb 18, 2023 @ 10:27:37

      Hi, Grace! I agree that psychoeducation should be designed to fit the client’s level, as meeting the client where they are is an essential part of cognitive-behavioral therapy. This process is meant to help the client better understand what they are experiencing and recognize that treatment is possible. If the client is not in the right headspace, or if the information is communicated in a way the client does not fully understand, then psychoeducation is not as effective. I like that you also noted adding visual aids to complement psychoeducation, making it more accessible and easier to comprehend.

      Reply

  19. Jonas Horan
    Feb 16, 2023 @ 18:07:22

    1: I noticed in the videos that Dr V used slightly different CBT triangles for each of his patients. For Mark he used a triangle with emotions, thoughts, and behaviors, but with Lindsey he used physiological sensations, thoughts and behaviors. It makes a lot of sense to shift the focus for the presenting problem, Since Mark was depressed the emotions are more important to focus on, but with Lindsey’s panic disorder, physiological sensations were more significant.

    2: Since CBT validates emotions but not thoughts, it can be helpful to illustrate how reasonable a client’s emotions are when viewed in the context of their automatic thoughts. This is made easier for disorders that often have specific types of automatic thoughts associated with them. Letting a client know that lots of people with depression, for example, have certain kinds of negative automatic thoughts, can make a client feel understood.

    1: Based on the assessment video, it looks like Mark has a lot of classic depressive behaviors that warrant observation. I’m honestly not sure which ones to focus on since he’s struggling in a lot of areas. His job has been difficult, his relationship is suffering, and he’s lost touch with friends. Hopefully we could see at least small victories in some of these areas that we could leverage for improvement.

    2: Monitoring accomplishments and pleasure gives us something to work towards and lets us emphasize what we want Mark to do more of. Making note of and increasing positive experiences gives us material to question his automatic negative thoughts.

    Reply

    • Maria Nowak
      Feb 17, 2023 @ 20:53:54

      Hi Jonas!
      I really like your example on how to normalize a client’s symptoms. Negative automatic thoughts are normal for someone who has depression but a client may not feel like what they are experiencing is normal. It is important to ensure they know others have these same thoughts. Also, other areas that could potentially be addressed are Mark’s sleeping patterns, physical, and social activities.

      Reply

  20. Olgena Pano
    Feb 16, 2023 @ 18:08:25

    1. Watching the video lectures and therapy sessions, it clearly shows the importance of psychoeducation as a significant element in the CBT chain. As discussed in class lectures in order to provide valid CBT therapy, all its structure and procedures must be followed by the clinician so that the client is able to receive all the benefits of the therapeutic experience. In contrast to the professionals, clients are not always informed about the origins of their problematics, the process that leads into these disturbances, and the structured treatment plan they must follow to improve their psychological condition and life quality. When being aware and informed of these steps, it might help the client to understand and follow the given directions better, and therefore complete the steps needed on their part to decrease the psychological disturbances.

    Considering the clients backgrounds, and the specific of their diagnosis it is important to explain and adjust the psychoeducation process based on their level of understanding the therapeutic process, to help them receive the information given as clearly as possible. Therefore, it is important for the clinician to select the information given to the client, by providing information that directly links to their concerns, and avoiding the unnecessary information that would not benefit their specific condition and might feel overwhelming to the client. Carefully choosing the language used by avoiding labeling, and not forgetting that clients are more than their diagnosis is an important factor to keep in mind. Using models and examples to demonstrate particular procedures might help the client problem solving skills, and guidance.

    Overall, it is important to make the client focus on positive aspects and their personal strengths that would help them overcome their struggles, and increase their beliefs of improving their situations. Therefore, by focusing on these strengths, showing that you are attending and listening when they are talking, empathizing and validating their emotional states are important factors to view their situation from their perspective , help them “normalize ”it , and show that there is hope and room for progress.

    2.First when watching the video session of this client, enforces the idea of how essential each step of CBT structure is to lead to another one. Analyzing the client self-monitoring help both the clinician and the client analyze the levels of motivation that the client experiences when completing or not these activities. In addition, this activity helps tracking the strength areas. As discussed previously in class focusing on these aspects helps the client emotional state and direct the clinician focus into a specific treatment plan needed for the case.

    Reply

    • Grace Ling
      Feb 19, 2023 @ 19:36:25

      Hi Olga, I like that you mentioned that clients sometimes are not aware of where their presenting problems originate. Psychoeducation and structure function to ultimately benefit the client. I think it is important to assess where the client is before enforcing strict procedures. Some clients may need more time addressing immediate stressors so presenting information to them may not be what they need at certain moments. From there, clinicians are able to help clients examine their thoughts and behaviors.

      Reply

  21. Alysha Benoit
    Feb 16, 2023 @ 20:34:43

    There are notable ways in which a therapist is able to adjust psychoeducation of therapy expectations and the CBT model to fit a client’s needs best. Every client presents differently in terms of how they demonstrate distress and functioning. To that point, a cognitive-behavioral therapist should be able to adjust the functionality of their psychoeducation and style of CBT to match their client’s presenting problems, however, a great aspect of CBT is that it also attends to client strengths and adaptability throughout sessions. One way a therapist can adjust their psychoeducation is through the manner in which they describe the CBT model. Specifically, a therapist should present their psychoeducation using language and vocabulary that they believe is comfortable to the client. Additionally, the therapist and client relationship plays a strong role in how psychoeducation is presented in therapy. As previously mentioned, every client presents themselves and their distress differently, which has an immediate effect on the therapeutic relationship. A therapist that is able to build a strong rapport with their client will have a straight-forward ability to adjust their session structure, presentation of CBT modalities, and psychoeducation because they have a more accurate idea of what style of language their client is able to understand. Furthermore, therapists should remind their clients that psychoeducation and therapy through the CBT model is a collaborative effort between both the client and therapist. With regard to psychoeducation for specific disorders, a therapist should gauge the best way to go about making their client feel seen and understood yet not alienated. In CBT, it is best for the therapist to educate their client’s about their specific disorder through a CBT lens. For example, if a client presents with an anxiety disorder, the therapist could help to describe how this disorder is affecting them through CBT visuals and terminology. Providing a client with a better understanding of the thoughts, feelings, and behaviors that display an anxiety disorder, but use the personal experiences they have already shared with you in doing so.
    There are a variety of behaviors that Mark speaks about that could warrant a follow-up in the next session. For example Mark speaks about his difficulties in engaging in social activities and monitoring how he feels during these activities. Mark demonstrates a decent level of self-awareness throughout the session in which he is aware of the activities that could bring him more pleasure but seems to not notice it as much until he speaks about it with another person. This demonstrates that social engagement could be very beneficial to him. Additionally, it seems as though the initiating behaviors he speaks about could warrant follow-up in the next session(s) Mark’s self-awareness and “motivation” is present, but it seems that actually getting the change started is where he struggles. Overall, monitoring Mark’s accomplishments and pleasure (for all clients in general) is extremely beneficial in treatment because it helps to demonstrate the effectiveness of psychoeducation and treatment. Additionally, as clients are able to understand more about themselves, they are able to channel their maladaptive qualities into pleasurable activities.

    Reply

    • Grace Ling
      Feb 19, 2023 @ 19:50:06

      Hi Aly, I did not think to consider how the therapeutic relationship can affect psychoeducation. It should have been more obvious but having a strong therapeutic alliance may encourage clients to attend to the information being taught to them. This may also influence how the information is presented to the client. The collaborative nature of CBT includes working with the client and providing them with tools to learn more about themselves.

      Reply

  22. Maria Nowak
    Feb 17, 2023 @ 20:45:20

    Psychoeducation can be adjusted in various ways depending on how much distress the client is in. Primarily, it is important to explain the client’s diagnosis in a more simplistic way. Using too much jargon and dwelling on the topic can overwhelm the client. Though, it is important to ensure psychoeducation has been implemented and including information about their diagnosis and how CBT can help them cope.
    In terms of talking to a client about a specific diagnosis it is very important to normalize but not minimize their symptoms. For example, it is important to make sure the client knows their symptoms are normal for their diagnosis. Though, you want to be compassionate and warmer so it does not seem like you are lacking empathy.
    Some of the patterns of behavior that warrant a follow up is the withdrawal he was experiencing from his girlfriend and friends. Additionally, it would be important to follow up on his physical activity, sleeping patterns, and other social activities. Each of these aspects of the client’s life have had an impact on his depression and anxiety.
    Monitoring this client’s accomplishments and pleasure would be helpful for his treatment because we want to be able to see how much pleasure he is receiving with his accomplishments or other activities he wants to do. There will obviously be things he has to do that wont give him as much pleasure as others. But if we can see what gives him pleasure and what doesn’t, we can pair the tasks. This way he can do something less pleasurable and reward himself with something more pleasurable.

    Reply

    • Alysha Benoit
      Feb 18, 2023 @ 20:42:18

      Hi Maria, I really like how you bring attention to normalizing yet not minimizing client symptoms. It’s important that therapists are able to understand their client’s symptoms in an accurate way, especially when providing them with psychoeducation regarding CBT modalities. I also like how you mention the use of pairing less pleasurable tasks and activities with pleasurable ones. I think that is a great way to increase the likelihood that a client will follow through with their goals in therapy.

      Reply

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Adam M. Volungis, PhD, LMHC

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