Topic 4: Psychoeducation & Behavioral Activation {by 9/24}

[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-6: Behavioral Activation – Reviewing Weekly Activity Monitoring Log.  Answer the following: (1) What additional questions would you ask this client about his Weekly Activity Monitoring Log to assist you in moving forward with his Daily Activity Schedule (See Table 6.3)?  In other words, what additional information do you want to know?  (2) Based on what you know about this client so far (e.g., information from his assessment and his WAML), what specific activities or tasks would you like to see on his first Daily Activity Schedule?

Your original post should be posted by the beginning of class 9/24.  Have your two replies posted no later than 9/26.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

32 Comments (+add yours?)

  1. Allie Supernor
    Sep 20, 2020 @ 11:46:48

    Part One MDD-4 and PDA-4-
    A major part of CBT is the psychoeducation piece. Psychoeducation helps establish therapeutic rapport and continues throughout each phase of therapy. CBT is very transparent approach, and psychoeducation is used to educate the person receiving therapy about their diagnosis and presenting problems. Additionally, psychoeducation helps the clients build optimism, motivation, and understand how CBT can be potential to reduce their distress and improve quality of life. Not only is CBT transparent, it also has to be a malleable approach. Not every approach will work with every client. This is true for psychoeducation as well.
    Therapy expectations can be adjusted based on a client’s distress and presenting problems. Therapy expectations is setting a broad agenda for therapy as a whole. All clients come to therapy with preconceived notions. One may have had therapy from a therapist who used a different approach. As the therapist you would have to adjust their expectations or even “retain” their role as a client. In other words, you may have to “undo what another therapist has done.” This is one way you would have to adjust therapy expectations based on a client’s experience. Other things that are done in psychoeducation are talking about roles, setting the agenda, assigning homework and challenging thoughts and behaviors. These can be adjusted based on the individual, as CBT is a person-centered approach. For example, you can explain one’s diagnosis and the cognitive behavioral model using visual aids, like a whiteboard or journaling. Additionally, you can explain their diagnosis and presenting problems in a way that provides hope. In Dr. V’s second video he talks about anxiety being a motivator, rather than something that is crippling. That provides hope and does not come across as condescending or lacking empathy. Furthermore, he explains the symptoms of anxiety/panic attacks (hot flashes, dizziness) in a way that normalizes her experience but does not minimalize it. He uses psychoeducation and biological explanations to explain WHY she experiences those symptoms, without saying ‘oh, everyone feels that way.’ Explaining the bodily sensations provide reasoning to her diagnosis, without minimalizing her experience as someone suffering from panic attacks.
    Part Two MDD-6:
    It was evident that Mark and Dr. V have built up a strong therapeutic alliance because Dr. V was able to explore a lot of feelings with Mark regarding his Weekly Activity Monitoring Log. Not all clients may be as forthcoming as Mark. Questions I would like to ask clients about their Weekly Log would be (1) was this easy or challenging for you? How come? (2) Was it enjoyable for your or pleasant? Why do you say that? (3) Did or what did you learn from doing this activity? (4) How do you feeling about this log when reflecting back this past week? (5) Lastly, what is your current motivation or hope?
    Mark disclosed a lot of telling information to design his first Daily Activity Schedule! He identified running late and feeling lagged every single morning. Mark shared that he doesn’t even have time to sit in the morning and that he showers and runs out the door. Because of this, Mark identified that he doesn’t feel motivated at work until after he’s been there for some time. Additionally, Mark identified not feeling socially connected with his friends as he would like. He really enjoyed the football game this past week and thought it would make sense to include his friends next time.
    For tasks I would add making breakfast to help with his ‘racing the clock’ feeling in the morning; maintaining household tasks as he felt initiates these was still troublesome; and adding yard work and gardening to his regimen. For pleasurable activities I would hope to see taking the dog for walks and to dog parks, social activities with his friends, hiking/nature activities with Melissa and continuing weekly date nights with Melissa.

    Reply

    • Haley Scola
      Sep 26, 2020 @ 10:55:19

      Hi Allie,
      I thought your explanation of psychoeducation and its purposes was very insightful. Specifically, when you stated that it helps the clients build optimism, motivation, and understand how CBT can be potential to reduce their distress and improve quality of life. That sentence alone was very informative. Second, I really liked how you explained adjusting therapy and psychoeducation to be individualistic by focusing on therapy expectations such as the use of visual aids, or verbal explanations. Additionally, I thought the questions you had for Mark such as “Did or what did you learn from doing this activity? “and “How do you feeling about this log when reflecting back this past week?” were great and held a lot of information in them. I didn’t ask those same ones but after reading your post I thought I definitely should have. Lastly, your tasks for Mark were also really helpful and I could see this homework to be beneficial.

      Reply

  2. Madi
    Sep 21, 2020 @ 16:24:59

    1. Psychoeducation
    a. The client’s distress determines the way psychoeducation is used in therapy. For if a person is in a crisis moment then providing the client with psychoeducation will not benefit the client. I also think it is crucial to convey information to the client without lecturing at them. Providing psychoeducation about therapy expectations and the model should occur in the first or second session so that the client can know what to expect in therapy. If the client knows what to expect in therapy, then he or she will know what to do outside of a session and what to expect from each session.
    b. Providing psychoeducation about a client’s disorder to important but can easily be done poorly. Telling a client that he or she has a specific disorder can be defeating for the client. To normalize the client’s experience a counselor can validate and normalize the emotions that he or she is experiencing. By validating the client’s emotions makes them feel like he or she is not “crazy.” By normalizing the client’s feelings and what they are experiencing the client then feels that what they are going through is normal. By normalizing the diagnosis, the client can then move past how terrifying the label is.
    2. Behavioral Activation
    a. The additional information that I would want from the client is what does his morning routine looks like down to the specific things. I would also want to know what his nighttime routine looks like to see if he has a hard time falling asleep and if that is, he has a hard time waking up in the morning. Additionally, I would want to ask about the quality of his sleep.
    b. The specific activities that I would like to see on the daily activity schedule walking the dog (daily exercise), waking up earlier, scheduling time for himself into the activity schedule, thought journal, hanging out the guys, texting or calling friends, going on hikes with others, and attending a cooking class.

    Reply

    • Allie Supernor
      Sep 21, 2020 @ 16:30:24

      Hi Madi, I appreciate that your post recognizes the risk of of using pyschoeducation can end poorly. I feel a bit nervous when thinking about using psychoeducation, myself. I know that timing, what you say, approach and tone of voice/demeanour play a significant role and I respect that your post alluded to this.
      I also liked that your post inquired about Mark’s nighttime routine. I didn’t even think that could contribute to his poor morning routine! Good job!

      Reply

    • Alison Kahn
      Sep 21, 2020 @ 21:13:02

      Madi,

      Similar to your post, I found myself very focused on the client’s morning routine and difficulty finding time to complete routines before work. I think identifying specifically what his morning routine looks would be really helping and something that he could easily incorporate into his log. I also said that I wanted to incorporate waking up earlier and more social interactions into the client’s next activity log. Your post was super insightful!

      Reply

    • Francesca DePergola
      Sep 24, 2020 @ 15:50:45

      Hi Madi,
      For the psychoeducation piece, I really like how you mention scenarios that psychoeducation could be beneficial but also harmful. I think you are right when talking about the disorder they might be struggling with might be the first time they have been told so. It can be a very delicate situation that you point out and that is worth mentioning. I also liked reading your answers to behavioral activation as the questions you ask and the specific activities you mentioned were things I agreed with. I especially like the idea of the thought journal, I think that could be very beneficial to the client in his state!

      Reply

    • Christopher LePage
      Sep 24, 2020 @ 19:40:23

      Hi Madi, I liked how you mentioned how you would really want to take a look at Mark’s nighttime routine, as this could have a serious impact on his mornings. By having a bad nighttime routine where you are not getting enough sleep, this could be causing him to feel more rushed in the mornings. I also enjoyed how you mentioned that by providing psychoeducation, this could validate the client’s feelings. This is a good point, as with new information they may be able to see that they are not so alone in their diagnoses.

      Reply

    • Haley Scola
      Sep 26, 2020 @ 11:06:04

      Hi Madi,
      Your point about making sure not to lecture at the client when providing psychoeducation really caught my eye because I thought it was one of those really important aspects that we don’t necessarily talk about because its “assumed”. I also liked how you said how its important to validate the clients emotions so they do not feel “crazy” but at the same time I do think it is important for them to understand if these thoughts or emotions are invalid and carry a negative utility for their well-being. Being aware of these “irrational thoughts” is the first step to over coming them. To add, I thought it was important that you want to know about his bedtime routine because that can hold a lot of insight. Lastly, I also recommended the similar tasks for Mark to complete. I think he would really benefit from setting more structure in his life and help keep the balance of work and pleasure.

      Reply

  3. Allie Supernor
    Sep 21, 2020 @ 16:27:28

    *I apologize if this is a duplicate- I’ve been having more internet problems than usual.

    Part One-
    A major part of CBT is the psychoeducation piece. Psychoeducation helps establish therapeutic rapport and continues throughout each phase of therapy. CBT is very transparent approach, and psychoeducation is used to educate the person receiving therapy about their diagnosis and presenting problems. Additionally, psychoeducation helps the clients build optimism, motivation, and understand how CBT can be a legitime potential to reduce their distress and improve quality of life. Not only is CBT transparent, it also has to be a malleable approach. Not every approach will work with every client. This is true for psychoeducation as well.
    Therapy expectations can be adjusted based on a client’s distress and presenting problems. Therapy expectations is setting a broad agenda for therapy as a whole. All clients come to therapy with preconceived notions. One may have had therapy from a therapist who used a different approach. As the therapist you would have to adjust their expectations or even “retain” their role as a client. In other words, you may have to “undo what another therapist has done.” This is one way you would have to adjust therapy expectations based on a client’s experience. Other things that are done in psychoeducation are talking about roles, setting the agenda, assigning homework and challenging thoughts and behaviors. These can be adjusted based on the individual, as CBT is a person-centered approach. For example, you can explain one’s diagnosis and the cognitive behavioral model using visual aids, like a whiteboard or journaling. Additionally, you can explain their diagnosis and presenting problems in a way that provides hope. In Dr. V’s second video he talks about anxiety being a motivator, rather than something that is crippling. That provides hope and does not come across as condescending or lacking empathy. Furthermore, he explains the symptoms of anxiety/panic attacks (hot flashes, dizziness) in a way that normalizes her experience but does not minimalize it. He uses psychoeducation and biological explanations to explain WHY she experiences those symptoms, without saying ‘oh, everyone feels that way.’ Explaining the bodily sensations provide reasoning to her diagnosis, without minimalizing her experience as someone suffering from panic attacks.

    Part Two-
    It was evident that Mark and Dr. V have built up a strong therapeutic alliance because Dr. V was able to explore a lot of feelings with Mark regarding his Weekly Activity Monitoring Log. Not all clients may be as forthcoming as Mark. Questions I would like to ask clients about their Weekly Log would be (1) was this easy or challenging for you? How come? (2) Was it enjoyable for your or pleasant? Why do you say that? (3) Did or what did you learn from doing this activity? (4) How do you feeling about this log when reflecting back this past week? (5) Lastly, what is your current motivation or hope?
    Mark disclosed a lot of telling information to design his first Daily Activity Schedule! He identified running late and feeling lagged every single morning. Mark shared that he doesn’t even have time to sit in the morning and that he showers and runs out the door. Because of this, Mark identified that he doesn’t feel motivated at work until after he’s been there for some time. Additionally, Mark identified not feeling socially connected with his friends as he would like. He really enjoyed the football game this past week and thought it would make sense to include his friends next time.

    Reply

    • Selene Anaya
      Sep 25, 2020 @ 17:37:39

      Hey Allie!
      I really like how you explained why psychoeducation is important. I think a lot of people do not realize how big of a role it plays in CBT (I was one of them!). I can see now all of the benefits of educating clients about the work they are doing and explaining how and why it is working. I have always believed that the best way to be effective is to be transparent and that’s exactly what we are doing when we take the time to educate clients. I also really like how you considered having clients that have been to therapy before. I never really thought about how different CBT can look for clients who are familiar with other approaches. This is definitely a way that therapy can be adjusted based on the clients experience that I failed to mention. I think it’s cool how we can alter sessions according to what will work best for the client and the many different techniques and the wide variety of options that are available in CBT makes that adjustment easier. Regarding the second question, I like how you wanted to ask Mark about his current motivation or hope for his situation. I think it is always important to assess this regardless of how well his log seems to have gone because it will give therapists a good idea of what they may see in the future.

      Reply

  4. Alison Kahn
    Sep 21, 2020 @ 21:08:05

    1.
    a. Psychoeducation of therapy expectations and the cognitive model can be adjusted in many ways. By understanding the client’s presenting problems and level of distress, therapists can determine the most appropriate method of providing psychoeducation to a client in a way that will be understandable and effective. For example, the therapist may determine that the use of visual aids (drawing diagrams, defining various CBT terms in writing) may be beneficial for a client. Further, the therapist might utilize terminology that is more understandable to the client (i.e., using more commonly understood language to define a CBT concept) until the client has a better grasp on the treatment modality. The therapist can also modify the content of the psychoeducation based on the client’s presenting concerns. For example, if a client is presenting as depressed, the therapist may choose to first provide psychoeducation around behavioral activation before delving into cognitive processes such as negative automatic thoughts. If the client’s presenting problem is centered around anxiety, the therapist may choose to educate him or her about negative automatic thoughts and physiological arousal rather than behavioral activation.
    b. Therapists can normalize a client’s experience with a specific disorder by providing validation and displaying empathy. In order to do this, therapists should be self-aware and understand that although an individual’s emotional response may seem extreme, it is very real and very distressing to the individual. Therapists can validate clients by teaching them that their emotional response to negative automatic thoughts are accurate and reasonable, but the negative automatic thoughts are most often exaggerated and unreasonable. Finally, by providing psychoeducation specific to a client’s presenting concern, the therapist helps take the stigma and alienation away from the diagnosis. Teaching the client about his or her diagnosis, explaining the psychological and physiological symptoms, and providing relevant data about prevalence, treatment, and positive outcomes can bolster hope and optimism for the client.
    2.
    a. After reviewing the weekly activity monitoring log, I would want to ask the client some further questions in order to determine next steps for the daily activity schedule:
    i. “What was it like for you to fill out this activity log?”
    ii. “Was there anything about your log entries that you found particularly interesting?”
    iii. “What was it about the activities that you rated as “pleasurable” that you enjoyed?”
    iv. “What would you like to see on next week’s log (i.e., specific activities, your responses, etc.)?”

    I believe that these questions would aid the therapist in determining the client’s thought about the activity as well as what he would like to see in his activity logs going forward. I also think that this would help the client to think more deeply about his thoughts and emotions as he engages in the activity log.
    b. Based on what I know about the client, I would want to see the following activities in future logs:
    i. Wake up earlier, have a good breakfast
    ii. Monitor/record thoughts and emotions in the morning right after waking up
    iii. Take the dog for walks/to the park regularly
    iv. Engage in more social interactions (i.e., going out with wife, spending time with friends)
    v. Identify and record at least one positive on particularly difficult days.

    I would like to see the client engage in these activities because I believe it would reinforce those behaviors that he self-identified as being pleasurable or accomplishing while also helping him to continue exploring areas of difficulty (I.e., waking up in the morning). I also think these activities would help the client to recognize positives and strengths even on days that he is feeling increased distress.

    Reply

    • Madi
      Sep 25, 2020 @ 15:39:40

      Hi Allison,
      I agree with you that how the client presents determines how psychoeducation is provided to the client. Also agree with the use of validation and empathy as a way to normalize the experience of having a mental illness. I really liked the questions and suggestions you posed in your post.

      Reply

    • Eileen Kinnane
      Sep 27, 2020 @ 17:33:47

      Hi Alison,
      I really like how you discussed the importance of validation and empathy in Psychoeducation, especially in helping the client understand that their challenges are reasonable and real. I also really appreciated how your follow up questions were designed in order to have a more effective log in the future.

      Reply

  5. Alison Kahn
    Sep 21, 2020 @ 21:18:22

    Allie,

    I love how you provided psychoeducation on psychoeducation in your blog post! I definitely agree with you that not every client should be given psychoeducation the same way. I also really love your thought about “un-teaching” what a previous therapist may have taught as it relates to therapy expectations. That is something that I hadn’t before considered, but is probably super important when working with a client who may have previously seen a therapist using a different treatment model.

    Reply

  6. Alison Kahn
    Sep 21, 2020 @ 21:20:20

    1.
    a. Psychoeducation of therapy expectations and the cognitive model can be adjusted in many ways. By understanding the client’s presenting problems and level of distress, therapists can determine the most appropriate method of providing psychoeducation to a client in a way that will be understandable and effective. For example, the therapist may determine that the use of visual aids (drawing diagrams, defining various CBT terms in writing) may be beneficial for a client. Further, the therapist might utilize terminology that is more understandable to the client (i.e., using more commonly understood language to define a CBT concept) until the client has a better grasp on the treatment modality. The therapist can also modify the content of the psychoeducation based on the client’s presenting concerns. For example, if a client is presenting as depressed, the therapist may choose to first provide psychoeducation around behavioral activation before delving into cognitive processes such as negative automatic thoughts. If the client’s presenting problem is centered around anxiety, the therapist may choose to educate him or her about negative automatic thoughts and physiological arousal rather than behavioral activation.
    b. Therapists can normalize a client’s experience with a specific disorder by providing validation and displaying empathy. In order to do this, therapists should be self-aware and understand that although an individual’s emotional response may seem extreme, it is very real and very distressing to the individual. Therapists can validate clients by teaching them that their emotional response to negative automatic thoughts are accurate and reasonable, but the negative automatic thoughts are most often exaggerated and unreasonable. Finally, by providing psychoeducation specific to a client’s presenting concern, the therapist helps take the stigma and alienation away from the diagnosis. Teaching the client about his or her diagnosis, explaining the psychological and physiological symptoms, and providing relevant data about prevalence, treatment, and positive outcomes can bolster hope and optimism for the client.

    2.
    a. After reviewing the weekly activity monitoring log, I would want to ask the client some further questions in order to determine next steps for the daily activity schedule:
    i. “What was it like for you to fill out this activity log?”
    ii. “Was there anything about your log entries that you found particularly interesting?”
    iii. “What was it about the activities that you rated as “pleasurable” that you enjoyed?”
    iv. “What would you like to see on next week’s log (i.e., specific activities, your responses, etc.)?”

    I believe that these questions would aid the therapist in determining what the client thought about the activity as well as what he would like to see in his activity logs going forward. I also think that this would help the client to think more deeply about his thoughts and emotions as he engages in the activity log.

    b. Based on what I know about the client, I would want to see the following activities in future logs:
    i. Wake up earlier, have a good breakfast
    ii. Monitor/record thoughts and emotions in the morning right after waking up
    iii. Take the dog for walks/to the park regularly
    iv. Engage in more social interactions (i.e., going out with wife, spending time with friends)
    v. Identify and record at least one positive on particularly difficult days.

    I would like to see the client engage in these activities because I believe it would reinforce those behaviors that he self-identified as being pleasurable or accomplishing while also helping him to continue exploring areas of difficulty (I.e., waking up in the morning). I also think these activities would help the client to recognize positives and strengths even on days that he is feeling increased distress.

    Reply

    • Allie Supernor
      Sep 24, 2020 @ 10:14:37

      Alison,
      I suggested similar activities for Mark’s schedule. However, I really like your 5th suggestion! You asked Mark to identify and record at least one positive activity on a hard day. I think this is a great suggestion for Mark as he seemed to hang-on to “Tuesday” in the video. He kept talking about the day being so horrible and I’m sure one good thing did happen!!! What a great suggestion.

      Reply

    • Brigitte Manseau
      Sep 26, 2020 @ 23:00:09

      Hi Alison,
      I liked the specific examples you provided in regard to how clinicians can tailor psychoeducation to a client’s presenting problems. It gave me a better understanding on what aspects of psychoeducation a clinician may focus on for anxiety. I, too, wanted to see Mark wake up earlier, eat breakfast before work, and walk the dog regularly. I like how you mentioned that you would like him to record his thoughts and emotions right after waking up. That may provide insight into what automatic thoughts he has in the morning.

      Reply

  7. Francesca DePergola
    Sep 24, 2020 @ 12:04:54

    Psychoeducation
    (1) A person can adjust psychoeducation of therapy expectation and the cognitive model based on a client’s distress and presenting problems. First, it would be a good idea for the counselor to explain psychoeducation in the early phase of therapy and preferably in a natural way. It is also important to use the client’s own events as examples because this can make it easier to understand. Sometimes being too vague and distanced from the client’s experiences can have them lose interest or they might get confused. Regarding the cognitive model, the same applies. For both psychoeducation of therapy expectations and the cognitive model, it allows the client to be more informed and interested. If they have more information, they will be better at participating later because they understand, and helping themselves out in the future by applying these skills.
    (2) Psychoeducation of specific disorders is important as it can “normalize” each clients’ experience without alienating them or coming off as lacking empathy. It is important for the counselor to validate the client’s emotions and experiences, but be aware not to minimize the client’s experience. Explaining why someone with a particular disorder function in one way versus other individuals will allow some relief to clients that, considering their disorder, this is normal. It is important to be empathic to individuals suffering in all ways, especially in ways one might not relate to. In some cases, depending on each client’s situation, this is the most open and honest they have ever been with someone. This might even be the first time they are mentioning certain behaviors, emotions, cognitions, and so on. Providing empathy reinforces their trust in the counselor, especially when giving psychoeducation about specific disorders.

    Behavioral Activation
    (1) What additional questions would you ask this client about his Weekly Activity Monitoring Log to assist you in moving forward with his Daily Activity Schedule (See Table 6.3)? In other words, what additional information do you want to know?
    It was really nice watching how a counselor would communicate with the client about their weekly activity monitoring log. I think I would like to ask when he had a relatively good day how his sleep habits were, I would be interested in asking about anything he might be looking forward to in the next couple of weeks, and if there were any events he saw as challenging but later determined they were not. I think these questions would offer some insight into his more positive experiences. Since Mark is struggling with depression, he most likely focuses on the negative too often and internalizes it. These questions and his answers might give the counselor the opportunity to shine some light on positive experiences that he can internalize rather than externalize. This could very possibly increase his self-esteem, self-efficacy, and motivation to continue to work towards his goals.
    (2) Based on what you know about this client so far (e.g., information from his assessment and his WAML), what specific activities or tasks would you like to see on his first Daily Activity Schedule?
    Based on what I know about the client so far, I think I would like to see some more social and organized activities. Social whether that be going out on dates with his girlfriend, taking more walks with his dog with a possible friend, etc. I would like him to be more organized with his sleep and wake times, maybe making a bed-time and a list of things to do before he goes to bed to better relax, and so on. I think Mark struggles with social interactions. I think getting him more involved with others would be a potential goal. I also think it would improve his mood a lot if he had a better quality/quantity of sleep.

    Reply

    • Madi
      Sep 25, 2020 @ 15:46:32

      Hi Francesca,
      I liked how you commented on finding a natural way to provide psychoeducation, that it should be organic. I also thought it was insightful about how it allows the client to be more informed and participate more in therapy. I agree with your posed questions and suggestions.

      Reply

  8. Haley Scola
    Sep 24, 2020 @ 12:20:23

    1a. Psychoeducation is a tool that is used so the client can learn and understand what exactly is happening throughout the therapeutic process and in turn allowing them to feel equipped to support themselves and “become their own therapist” in the future. The therapist should adapt to each client in terms of language, humor, learning style, etc. Psychoeducation can be used in language to minimize “jargon” but depending on the client’s education level, you may not jump right into saying “cognitive distortions” but rather use more casual terminology. Additionally, if the client seems to present as hyper anxious in situations they are feeling “judged” the therapist may not go right into saying “homework” but rather explain them as tasks that will record what they did and did not do since the last time they met. To add, if the client says they are a visual learner the therapist is going to be more inclined to use visual aids such as drawing diagrams like Dr. V and defining several CBT terminologies in writing.
    1b. Like Dr. V did when explaining anxiety, he began to normalize it in explaining how in a limited manner anxiety is actually good and is the body’s way of warning and protecting us from danger. Also motivating us to work harder. He then goes on to explain it in severity and frequency which is when it becomes maladaptive. When explaining the logistics, the therapist should continue to validate the emotions that the clients and displaying empathy. For example, when the therapist is explaining this they could say “I know you feel as if you’re going to die because of the physical symptoms you’re having which is completely valid because you feel as if you’re losing control”.

    2a. Additional questions I would like to ask Mark are: Do you find scheduling future activities or tasks difficult since you struggle with initiating tasks? Other than football, what was your most pleasurable activity and why? What was you least pleasure activity that you do regularly? Why?
    I think these questions would help the therapist learn a little bit more into what he could start doing more and what he could start doing less so he can maximize pleasure and maybe find ways he can gain more pleasure in other tasks based on his reasoning.
    2b. Because Mark said he was late a few times I would like to watch him give himself enough time in the morning to shower and eat breakfast before work. Second, I would like him to walk his dog with his wife to increase his physical activity and quality time with his wife (decrease withdrawal). Next, he said he felt a bit distance from his friends so I would like for him to reach out to his friends a few times a week and make plans to see one of them once a week. And finally, because he seems to have indecisive tendencies that then negatively impact his date nights, I would like for him to make the decision of where to go on date night on his own.

    Reply

    • Francesca DePergola
      Sep 24, 2020 @ 16:06:09

      Hey Haley,
      I really like your explanation of psychoeducation because it gives such a wide view of what it is. I also like the examples you use because as you mentioned, anxious people may have higher anxiety levels when learning all of this. I also like your example of taking the physiological symptoms and showing the client that they are protective. Within the behavioral activation questions, I liked your questions a lot and thought that your activities that you would like to see him accomplish were interesting! I especially was interested in the idea of date night alone wondering how that would be/what that would entail!

      Reply

  9. Brigitte Manseau
    Sep 24, 2020 @ 15:59:53

    1.a Psychoeducation plays an important role in CBT. There are various ways clinicians can adjust psychoeducation of therapy expectations and the cognitive model based on the client’s distress and presenting problems. For starters, when explaining the cognitive model the clinician may personalize the explanation by using specific examples related to the client’s presenting problems. Therefore, the client may understand the Reciprocal Cognitive-Behavioral Model better because it is more relevant to his or her own distress. A clinician may provide visuals of the various aspects of the cognitive model to help some clients grasp the concept better. Also, the clinician could write down certain key terms or therapy expectations on a white board so the individual is more familiar with the terms. Depending on the client, the clinician may slightly focus more on a particular therapy expectation. If the client had previous therapy experience with a therapist that does not align with the CBT experience, the clinician may focus on emphasize collaboration and autonomy. For instance, the clinician may highlight that the client does work, feedback goes both ways, and that the client will take more of the lead as sessions progress with the clinician’s support. If you can tell that a client is “testing out” therapy meaning he or she is not fully committed to therapy, the clinician may emphasize how CBT has great potential to reduce the client’s distress and improve their daily functioning.

    b. It is important to “normalize” each clients’ experience without alienating the client. A clinician can “normalize” the disorder by explaining common symptoms and factors of the particular disorder with empathy. Explaining to the client that you have had past clients with similar issues who were treated with positive outcomes may bring relief to the client and increase feelings of hope. It is crucial not to minimize or dismiss the client’s emotions and experiences. Doing so could make the client feel worse, increase their levels of hopelessness, and possibly jeopardize the therapeutic relationship.

    2a. I would ask the client the following questions about his Weekly Activity Monitoring Log (WAML):
    What was it like for you filling out the WAML?
    Did you have any thoughts or emotions in response to any particular activities or tasks on your activity log?
    Are there any pleasurable activities that you used to partake in that were not included in the activity log?
    What can be done to increase pleasurable activities this upcoming week?

    b. Based on what I know about the client so far, I would want to see the following activities and tasks on his first Daily Activity Schedule:
    Wake up at 7am to ensure he has enough time to make breakfast, eat, and shower
    Make and enjoy breakfast before going to work
    Maintain doing household chores (vacuuming, wash/dry laundry, fold laundry, wash dishes, etc.)
    Take the dog on a walk a few times a week (If Melissa is home, ask her if she would like to join)
    Continue having date night with Melissa once a week
    Make plans to watch the football game with friends this week
    Invite a friend to play video games whether it is online or in person

    My main focus would be on his morning routine, increasing his social interactions, maintaining household tasks, and continuing to increase his pleasurable activities weekly.

    Reply

    • Christopher LePage
      Sep 24, 2020 @ 19:44:59

      Hi Brigitte,
      I enjoyed how a lot of your additional questions were more emotional check-ins. Essentially keeping up with the client’s emotions and making sure that they are enjoying the process. This is so important to do as a counselor, as tasks are only going to be effective if the client is keeping up with the tasks. By having these check-ins you are also gaining client rapport, as you are demonstrating empathy and attentiveness to your client.

      Reply

    • Selene Anaya
      Sep 25, 2020 @ 17:43:58

      Hi Brigitte! I like how you considered the different kinds of visuals that can be provided to clients to facilitate their understanding of different concepts. I think this is especially important to consider when working with children and families because (and even adults) because every individual is different regarding the way they comprehend certain things. Speaking of children and families, I am curious about how psychoeducation changes with child and family therapy. Anyways, I also thought it was great that you considered adjusting psychoeducation around the clients perception of therapy itself. I think assessing that could really help some clients who are “iffy” about therapy. I thought it was nice that you focused on more of Mark’s emotions and how he feels about the log because it is clear that Mark is able to talk about his feelings and this could bring up some important insight. I mentioned in my post that finding some things that he notices he enjoys and feels good about might be good for adjusting his daily activity schedule. I also really liked your detailed activity schedule. I think you pinpointed his main issues in it perfectly!

      Reply

  10. Selene Anaya
    Sep 24, 2020 @ 16:04:15

    Part One –
    1. Psychoeducation is a crucial part of CBT. This piece is what differentiates CBT from many other therapeutic approaches. It allows individuals to learn about what they are working on rather than just going through the motions and can provide the opportunity for them to apply the same skills and knowledge to future issues. Psychoeducation of therapy and expectations and the cognitive model can be adjusted based on a client’s distress and presenting problems. This adjustment can allow for easier understanding by linking the concepts to their real-life problems and facilitate application. It is important to remember that psychoeducation should be used only when it is of benefit to the client. If a client is severely distressed, trying to teach them something can potentially be counterproductive. Aside from providing psychoeducation in application to the client’s real-life situations, it can also be adjusted by matching the client’s level. This means that fancy jargon is only used with those who may understand it, even then, however, jargon should not be used and concepts should be explained thoroughly and in a way that is easy to understand.
    2. For psychoeducation of specific disorders, it can be helpful to first validate and normalize their disorder in order to avoid coming off as lacking empathy or alienating them. This can be done through a conversation or if the therapist feels it is necessary, providing graphs or data to the client can be helpful as well. Not only validating their disorders should be done, but validating their emotions about having the disorder and talking them through what that might mean for them can be helpful to avoid or get rid of any negative thoughts that may come from hearing their diagnosis/label.

    Part 2-
    1. It is clear that the therapeutic relationship is strong in the videos because Mark is able to really open up and be honest about his Weekly Activity Monitoring Log. To assist in moving forward with the daily activity schedule, I would ask more about more specifically which parts were good to see and which parts were not. I would also ask more about rating and possibly seeing what that means to him to try and uncover why he stopped. I would also like to ask Mark to clarify what exactly he thinks motivated him to do more regarding his laundry and dishes. Also asking if he notices a pattern not only time of day but maybe after certain activities if he sees that his motivation to do tasks is particularly high or low. Also getting an idea of what he thinks can be done to improve his motivation possibly based on the answer to the last question.
    2. I think I would really like to see a specific set up of Mark’s morning on his first Daily Activity Schedule. He shared a lot of information regarding how hard his mornings are to get started. He also shared that he likes not being rushed, so possibly channeling that feeling and using that as motivation to continue could be helpful. Recording thoughts and emotions after certain activities would be nice to see on the log as well. Of course, more social interactions or working on planning interactions or places to eat/things to do with his wife could be helpful for him. I think also having Mark identify a few areas where he felt particularly motivated or accomplished could be helpful for him too. All of these items will help Mark realize the areas in his life that may need more help or which thoughts/activities impact his mood or motivation after they are done. Once that is all identified, it will be easier for Mark to do more of the positive things that he feels good about.

    Reply

    • Brigitte Manseau
      Sep 26, 2020 @ 23:00:54

      Hi Selene,
      I agree, clinicians should adjust his or her explanations based on the client’s intellect. A clinician may have opportunities to use jargon with some clients but the majority of clients will likely be unfamiliar with psychological terms. I like how you highlighted the importance of validating clients’ emotions in regard to their disorder(s). It is important to understand how the client feels so the clinician can address any specific negative emotions. I thought it was a great idea to ask questions focused on Mark’s motivation. Understanding what motivates Mark may help increase or add certain activities to his Daily Activity Schedule.

      Reply

  11. Christopher LePage
    Sep 24, 2020 @ 19:36:18

    1.a) Psychoeducation is an extremely important tool to use, as it allows for clients to get more information on the therapeutic process, and why they are experiencing what they are experiencing. Psychoeducation can be adjusted when clients are experiencing some sort of distress. When you understand the clients present concerns, psychoeducation can be adjusted to help alleviate the distress by giving the client more information. Once you know the presenting concerns, this makes the psychoeducation more effective, since they are receiving information that is based on their experiences. It is also important to use psychoeducation based off of the clients strengths. For example, some clients learn better in different ways. This could be visually, auditory, spatially people learn in all types of way, and in order to be most effective for the client, it is important you tailor the psychoeducation to them.
    b) Psychoeducation can help normalize specific disorders, is because it helps normalize what is happening to the individual. Getting a mental disorder diagnosis can be a scary thing, but it can also be helpful. For some individuals, it may feel validating to know that this experience is not just occurring to them. By getting psychoeducation on a disorder, how to treat it, what it looks like, all helps normalize how common the disorder may be, making the individual feel less alienated. This process could also help take away some of the stigmatization of the disorder, as the individual becomes more and more aware that this disorder could be potentially impacting millions of people.
    2.a) In terms of additional questions, one that I would ask, is what did you enjoy/dislike about the process? What, if anything, would you want to change for next week? Was there anything too difficult/too easy for you to do? I think these would be good additional questions, as it makes sure the client is actively engaged in the tasks, and will put in the work to keep up with the plan.
    b) Some specific activities I would like to see, is a set morning routine. Sometimes having a nice, calming routine can be relaxing for individuals, especially for those who feel they are rushed in the morning. I would also like to see him take the dog for more walks. Once people get into this routine, they can become more motivated to continue to go for walks, and potentially discover new walking areas. Finally, I would like to see him have scheduled social interactions. Especially for someone who puts emphasis that they want more socialization, it is crucial to get those opportunities.

    Reply

    • Eileen Kinnane
      Sep 27, 2020 @ 17:36:56

      Hi Christopher,
      I really appreciated your explanation of how psychoeducation can be adjusted to the client based on their level of distress. Something you mentioned that I didn’t was that Psychoeducation can relieve distress because a client has more information on what is going on. I thought that was a really important note to make. I also really liked how to expanded on the importance of having a morning routine. It was really interesting to read about how having that routine can set the client up for a more productive day.

      Reply

    • Trey Powers
      Sep 28, 2020 @ 16:29:27

      Hi Chris!

      I agree with your point about how relieving it can be to get a diagnosis, even though it may be intimidating. I think this is especially true for people who have no idea what they are experiencing or why. To start feeling completely different from how you once did and not have any explanation can be a scary experience. Also, not knowing whether anyone else has experienced what you are dealing with can make you feel like an outsider, or that others will not understand you. Hearing that not only is your experience shared by others, but that it also has a name and a method of overcoming it can therefore lift some of the weight that the person is experiencing.

      Reply

  12. Eileen Kinnane
    Sep 27, 2020 @ 14:49:07

    (1a)Psychoeducation can vary based on the level of distress the client is in. For example, if a client is in an extreme amount of distress, taking time to provide Psychoeducation may not be beneficial to the client at that time. Understanding the client’s presenting problems is essential when it comes to Psychoeducation. This helps in tailoring the Psychoeducation to the client so it has a more personal approach. It is also important to tailor Psychoeducation to the client’s learning style and/or level. For example, using language that is easy to understand, but it also effective in educating.

    (1b) In regard to specific disorders, providing psychoeducation is extremely important. However, it can easily be done ineffectively. Having a diagnosis can often ease some of a client’s distress. It is also important for the therapist to not minimize the client’s experience in discussing and normalizing the diagnosis. It is a fine balancing of easing the client’s distress while still validating their presenting problems.

    (2a)Some information I would like to review with the client are different routines he has, how well he sleeps, and how long he lays in be before getting up in the morning. I would also like to learn more about his thoughts and opinions on the Daily Activity Schedule. It would be good to know if there was anything that was shocking/surprising to him and if there was anything he was impressed with. Lastly, I would like to see what Mark thinks he can do to improve his motivation when he is feeling less inclined to do things.

    (2b)Some activities I would like to see on Marks Daily Activity Log include hanging out with his friends, taking his dog out for walks, and waking up/getting up earlier. I would also like to see him participating in more activities with his wife, whether it be cooking a meal together, or going out together on a date.

    Reply

    • Trey Powers
      Sep 28, 2020 @ 16:24:48

      Hi Eileen!

      I had some similar activities that I would like to see Mark engaging in. Increasing his social interactions seems like something he would like to make a priority, so I agree with you on spending more time with friends. I like your point about spending more time with his girlfriend as well. I think that it is important for him to continue to actively maintain the relationship through his depression. This likely not only provides him with a source of hope, support, and pleasure, but also avoiding a breakup will prevent his depression from worsening.

      Reply

  13. Trey Powers
    Sep 28, 2020 @ 16:21:45

    Psychoeducation
    1.
    Psychoeducation is an important element of the CBT process for any client, regardless of their diagnosis. That being said, the specific nature of the client’s problems must be taken into consideration when providing psychoeducation. An individual who is in significant distress or is experiencing a great deal of impairment may not have much hope, which can therefore affect their beliefs about how effective therapy will be, and their ability to change. It is important for such clients that the psychoeducation focus on providing hope and encouragement for the client, citing other clients who were able to recover, or statistics that demonstrate the effectiveness of CBT for their specific problem. For a client who is experiencing less severe distress, they may be more willing and able to engage in the process, and have more positive outcome expectations. In this case, the focus can be turned to psychoeducation about how the process will work, and specific goals that the client has.
    2.
    When providing psychoeducation about a specific diagnosis, it is important to both inform the client about their disorder while also taking care to not alienate them. If a client is not sufficiently informed about the nature of their diagnosis, they are more likely to experience anxiety surrounding who they are feeling the way they are, leading them to wonder what is wrong with them and why they are different from others. Explaining that their symptoms are common to their disorder, while also providing statistics demonstrating the prevalence of the disorder can be a source of relief, as the client finally has an explanation for the way they are feeling, and understands that they are not alone. This process must be done carefully, however, as it is possible that the client may feel that they are “just another person with a disorder.” It is important, therefore, to concentrate both on the generalized symptomology that is associated with a specific disorder, while also focusing on how the thoughts, behaviors, and emotions of the individual client are being affected. This makes the explanation more personalized, and leads the client to feel as though they are not simply a statistic, but are being treated as a person with a disorder.

    Behavioral Activation
    1.
    When dealing with Mark’s WAML, I would ask a few additional questions. First, I would like to know more about what holds him back from initiating activities, as it seems as though once he begins a task, he finishes it. I would also like to ask why it seemed that he did not feel much of a sense of accomplishment for salvaging the conference even though he did so successfully and in the moment.
    2.
    There are several potential activities that I would like to see on Mark’s Activity Log. Increasing his social interactions seems to be something that he wants to attempt, so I would like to see him engaging in activities with others, even if they are activities that he would ordinarily do alone. I think that getting out more with his dog would also be a good idea, as it not only gets him active, but it also is a source of pleasure for him. Finally, I would like to see a change in his morning routine. Perhaps waking up earlier would allow him to feel less rushed, and potentially afford him enough time to have a sit-down meal, rather than rushing out the door without eating, or with something small that he carries out.

    Reply

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Adam M. Volungis, PhD, LMHC

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