Cognitive Behavioural Counselling in Action
Publication Year: 2016
This best-selling, practical, evidence-based guide to the cognitive behavioural approach takes you step-by-step through the process of counselling, from initial contact with the client to termination and follow up. The book follows a skills-based format based around the Bordin and Dryden model of bonds, goals, tasks and views, with expanded case material to further illustrate links between theory and practice. This third edition includes new content on: • the working alliance — what it is and why it is so important • challenges and pitfalls in the counselling process • when to challenge and when not to challenge clients beliefs • emotional problems such as shame, guilt and jealousy as well as anxiety, depression and anger. Drawing on their own extensive experience and contemporary research, the authors provide a ...
- Front Matter
- Back Matter
- Subject Index
Part 1: A BASIC GUIDE TO COGNITIVE BEHAVIOURAL COUNSELLING
- Chapter 2: Structure and Outline of the Basic Guide
- Chapter 3: Preparation Stage I – Breaking the Ice: Screening, First Meeting, Establishing a Bond
- Chapter 4: Preparation Stage II – Will This Help? Clarifying Problems and Goals, Introducing the Cognitive Approach, Making anInformed Commitment
- Chapter 5: Beginning Stage I – What’s the Problem Specifically? Cognitive Assessment of a Specific Example
- Chapter 6: Beginning Stage II – What Are We Aiming For? Conceptualising the Problem, New Thinking, Feeling and Action Goals
- Chapter 7: Middle Stage I – Getting Realistic: Challenging and Changing Inferences
- Chapter 8: Middle Stage II – Changing Hot Thoughts: Challenging and Changing Evaluations
- Chapter 9: Middle Stage III – Imagery Rescripting: Changing Distressing Memories
- Chapter 10: Middle Stage IV – Working Through: Agenda Setting and Homework
- Chapter 11: Middle Stage V – Dealing with Pitfalls in Cognitive Behavioural Counselling
- Chapter 12: Ending Stage – Coaching the Client to Become His Own Counsellor
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© Peter Trower, Jason Jones and Windy Dryden 2016
First edition published 1988. Reprinted 1990, 1991, 1992, 1993, 1995, 1996, 1998, 1999, 2000, 2002, 2003, 2004 (twice), 2005, 2006, 2007 (twice), 2008 (twice), 2009, 2010
Second edition published 2011. Reprinted 2011
This third edition published 2016
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Library of Congress Control Number: 2015938109
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ISBN 978-1-4739-1369-1 (pbk)
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SAGE Counselling in Action[Page ii]
Series Editor: WINDY DRYDEN
SAGE Counselling in Action is a bestselling series of short, practical introductions designed for students and trainees. Covering theory and practice, the books are core texts for many courses, both in counselling and other professions such as nursing, social work and teaching. Books in the series include:
Standards and Ethics for Counselling in Action, Fourth Edition
Dave Mearns and Brian Thorne with John McLeod
Person-Centred Counselling in Action, Fourth Edition
Petrūska Clarkson updated by Simon Cavicchia
Gestalt Counselling in Action, Fourth Edition
Transactional Analysis Counselling in Action, Fourth Edition
Psychosynthesis Counselling in Action, Fourth Edition
Sue Culley and Tim Bond
Integrative Counselling Skills in Action, Third Edition
Psychodynamic Counselling in Action, Fourth Edition
Windy Dryden and Andrew Reeves
Key Issues for Counselling in Action, Second Edition
Rational Emotive Behavioural Counselling in Action, Third Edition
Patricia D’Ardenne and Aruna Mahtini
Transcultural Counselling in Action, Second Edition
About the Authors
Client Guides and Worksheets for CBC[Page 227]
These handouts, guides and worksheets are provided to help you to help your client carry out his tasks, to keep a record and to track his steps through the stages of CBC. PDF versions are available to download from https://study.sagepub.com/trower3
The three appendices contain an information handout describing CBC in general, a Preparation Guide and Daily Thought Record (Appendix 1), an Assessment and Goal Planning Guide and ABC Diary (Appendix 2) and an Options for Change Guide and Homework Skills Monitoring Form for the Counsellor (Appendix 3).
Suggestions as to how and when the counsellor can introduce and handout the information guides and worksheets to the client are provided in the Task Briefings, Action Summaries and Case Examples in this book.[Page 228][Page 229]Appendix 1 Information Handout, Preparation Guide and Daily Thought RecordWhat is CBC?
Cognitive Behavioural Counselling (CBC) is often referred to as one of the talking therapies. This is to distinguish it from medication-based treatment, but ‘talking’ is only part of the process, important though this is – it also very much involves carrying out ‘homework’ assignments between sessions, designed to overcome problems and achieve valued goals.
Often described as Cognitive Behaviour Therapy, the CBC approach has a proven evidence base to treat a wide range of mental health problems in adults and children. CBC looks at how certain ways of thinking about problems do not help, can actually make the problems worse, and even create problems where none really existed. These unhelpful ways of thinking can then cause us to be unnecessarily very distressed and to act in self-defeating ways.
The counsellor and client work closely together to change these unhelpful and distressing ways of thinking, feeling and acting, in order to overcome and achieve desired goals.What Can CBC/CBT Help with?
The large body of research, which shows CBC/CBT works effectively and efficiently, has been carefully reviewed by the National Institute for Health and Care Excellence (NICE). NICE provides independent, evidence-based guidance for the NHS on the most effective ways to treat disease and ill-health, including mental health. NICE recommends CBT in the treatment of the following conditions:
- anxiety disorders (including panic attacks and post-traumatic stress disorder)
- obsessive–compulsive disorder
- schizophrenia and psychosis
- bipolar disorder
There is also good evidence that CBT is helpful in treating many other conditions, including:
How Does CBC Work in Practice?
- chronic fatigue
- behavioural difficulties in children
- anxiety disorders in children
- chronic pain[Page 230]
- physical symptoms without a medical diagnosis
- sleep difficulties
- anger management
CBC/CBT can be offered in individual sessions with a counsellor or group sessions with other clients led by a counsellor as part of a group. The number of CBC sessions you need depends on the difficulty you need help with. Often this will be between five and 20 weekly sessions lasting on average 50 minutes but can be shorter or longer according to need. CBC is mainly concerned with difficulties in the present rather than the past, except where past experiences have a direct connection to the present problem.
On first meeting your counsellor, you will discuss the problem you want help with, discuss the CBC approach and what is involved and then between you make a decision whether this approach is appropriate. If you decide to go ahead, you will direct your counsellor where you want to go, what problems you want to overcome and what goals you want to achieve.
In her turn the counsellor will guide you as to how to get there, offering concrete steps, worked out in session, and given to you in the form of handouts and worksheets for you to work on between sessions. It is quite hard work for you and the counsellor, both during the sessions but also between sessions, when various assignments will be suggested for you to carry out. Please remember: CBC has an excellent evidence-based track record of really working, but only if the treatment plan is followed. Your counsellor needs your commitment!
Good Luck!Preparation Guide
This Preparation Guide and Worksheet is designed to help you to start to unravel a problem you might be experiencing and for which you are seeking help. These steps will help you and your counsellor to understand the problem better, help you decide if CBC is an approach which could help, and start to prepare you for it. Try to describe this problem in general terms – the kind of thing that typically happens. Use the steps to help you fill in the Preparation Worksheet.
After you have completed the Preparation Worksheet, your counsellor will invite you to carry out a between session exercise which will also help to show whether CBC is appropriate for you. For this exercise you can use the Daily Thought Record (DTR) to record your feelings and thoughts. Please follow the steps provided.Preparation Steps
Step 1Step 2Step 3[Page 232]Step 4Step 5
- Step 1. On the Preparation Worksheet, write down an account of the main problem you have come to CBC for help with. Describe it briefly, in general terms, in your own words and in your own way.
- Step 2. Write down the disturbed feeling (like very angry or very anxious) you typically have when you are faced with this type of problem, and the probably unhelpful way you typically behave or have an impulse to behave (like lashing out in anger or running away in anxiety) when so faced.
- Step 3. Write down the kind of adverse (negative) event that typically happens or you think might happen (like failing at something) when you experience these feelings.
- Step 4. Write down how you would like to feel (like a bit annoyed and concerned) and behave when faced with this type of adverse event.
- Step 5. Write down any immediate very negative ‘hot’ thoughts that might pop into your head (like ‘I’ve screwed this up’ or ‘this is awful’) when faced with this problem and which probably makes you feel and behave worse. Then write down an alternative, more realistic way of thinking (like ‘could have done better but it’s not so bad’) that would lead to how you would like to feel and behave in reaction to this type of problem.[Page 231]
Your completed Preparation Worksheet should have all the boxes filled in as shown below. Notice the connection between the beliefs and the consequent emotions and behaviours – the B–C (belief–consequent emotion) connection.Completed Preparation Worksheet (Steps 1 to 5 Review and Summary)Preparation Worksheet
[Page 234]Daily Thought Record (DTR)[Page 235]Appendix 2 Assessment and Goal Planning Guide and ABC Diary
- Step 6. Between counselling sessions, try to notice each time you experience that typical disturbed feeling you wrote down on the Preparation Worksheet. This feeling may be triggered by a real event, a physical sensation, or simply during a period of worry or rumination. You can also set a time to bring the disturbed feeling to mind on purpose, in order to practise this thought-monitoring exercise.
- Step 7. While you are noticing the disturbed feeling, try to notice any negative, disturbing thoughts you might be having at the same time.
- Step 8. On the Daily Thought Record (DTR), write down the feeling in box 1, and the thoughts in box 2. Also rate the intensity of the feeling on a scale 0 to 10, where 0 = neutral and 10 = the worst ever experienced. Also note the date and time in box 3.
- Step 9. You can if you wish also make a brief note of the adverse event (box 3), choose an alternative feeling and behaviour you would prefer (box 4) and an alternative way of thinking that would lead to your preference (box 5).
Thank you for completing the Preparation Worksheet. You can now go on to use this Assessment and Goal Planning Guide and Worksheet to carry out more detailed assessment and goal planning. The worksheet is divided into two sections. In the first section, write down an account of the main problem again, this time giving a specific example. The counsellor will then help you carry out an ABC assessment of the problem, where A stands for your description of the adverse event, B for your beliefs about the event and C for your consequent reaction. In the second section you can work out a plan for your goals for dealing with the problem. Finally, you can later record the extent to which you achieve your goals.
So to recap, in the Preparation Worksheet we asked you to describe the type of problem you wanted help with in general terms. This time try to give a specific example of the problem in Step 1, and then hold this example in your mind while you complete the other steps with your counsellor’s help. As with the Preparation Guide, use these steps to help you fill in the Assessment and Goal Planning Worksheet (p. 242). You may also find helpful the worked example below – Brian’s Specific Example (Box A2.12). Use a separate worksheet for each specific problem.Assessment Steps
[Page 236]Goal Planning Steps
- Step 1 (Box A2.1). On the Assessment and Goal Planning Worksheet (p. 242), write down a specific example of the problem (as in Brian’s Specific Example).
- Step 2 (Box A2.2). In the box headed ‘C: Consequent Emotional/Behavioural Problem’, write down the disturbed way you felt and the unhelpful way you acted or had a tendency to act in the problem situation. Rate the strength or intensity of your feeling on a 0–10 scale, where 0 means you didn’t feel it strongly at all and 10 means the most intense you can imagine.
- Step 3 (Box A2.3). In the box headed ‘A: Specific Adverse Event’, describe the adverse event itself, namely what actually happened – like a camera might show – or what you imagined might happen specifically.
- Step 4 (Box A2.4). In the box headed ‘B1: Probably Biased Inferences about A’, write down at least one very negative and probably biased inference that you might have been drawing about the adverse event. (Your inference is what you think it meant.) Rate the extent to which you believe this inference to be true (conviction level) on a 0–10 scale, where 0 means you don’t think it’s true and 10 means you are completely convinced it’s true, and 5 is a half way mark where you are evenly balanced.
- Step 5 (Box A2.5). In the box headed ‘B2: Extreme Evaluations about B1’, write down at least one of the listed extreme evaluations you might have made about the adverse event, if your inference was true. (Your evaluation is how bad you thought it was.) Rate your conviction level in this evaluation on a 0–10 scale, where 0 means you don’t think it bad at all and 10 means you thought it was awful, and 5 means you thought it relatively bad.
Goals Achievement Step
- Step 6 (Box A2.6). In the box headed ‘Emotional/Behavioural Goal’, write down how you would prefer to feel and behave, that is, not disturbed but still a negative feeling but a ‘healthy’ negative one, and a more effective way of behaving.
- Step 7 (Box A2.7). In the box headed ‘B1: Alternative Unbiased Inferences’, write down one or more unbiased alternatives to the biased inferences that might contribute to your emotional/behavioural goal. Rate your conviction level as above.
- Step 8 (Box A2.8). In the box headed ‘B2: Realistic Evaluations’, write two or more alternative evaluations under the headings listed that might help you achieve your emotional/behavioural goal. Rate your conviction level in these evaluations.
- Step 9 (Box A2.9). Finally, in the box headed ‘A: Adverse Event Rescripted’, write down how you would prefer the event to have happened, or might have actually happened if you had remembered it in an unduly negative way. Rate your conviction level in this alternative description.
- Step 10 (Box A2.10). When you get to the Middle Stage of Counselling, probably in a few sessions’ time, return to this worksheet and record in percentage terms the degree to which you feel you have achieved each of the goals as you work through them.
These steps are repeated below, showing where in the worksheet you need to put the answers. A fictitious case example is also provided to illustrate how to fill it in.Step 1Step 2[Page 237]Step 3Step 4Step 5[Page 238]Step 6Step 7Step 8[Page 239]Step 9Step 10
This is my record in percentage terms of the degree to which I achieved each goal.Summary of the Steps to Complete the Assessment and Goal Planning Worksheet[Page 241]Brian’s Specific ExampleAssessment and Goal Planning Worksheet
Date………………………………..ABC Diary Steps
After your session on ABC Assessment, your counsellor will suggest you start to use this ABC Diary, instead of the DTR, to monitor your thoughts in between sessions. As you and your counsellor work through the CBC tasks, you will be invited to add these tasks to your homework, so not only monitoring your thoughts, feelings and behaviour, but changing them, as you progress towards achieving your goals.
ABC Diary[Page 244]Appendix 3 Options for Change Guide and Homework Skills Monitoring Form for the Counsellor
- Step 1. Each day between counselling sessions, again try to notice each time you experience the disturbed feeling you wrote down on the Assessment Worksheet. This feeling may be triggered by a real event, a physical sensation, or simply during a period of worry or rumination. You can also set a time to bring the disturbed feeling to mind on purpose, in order to practise this thought-monitoring exercise.
- Step 2. While you are noticing the disturbed feeling, try to notice any negative inferences and evaluations you might be having at the same time.
- Step 3. On the ABC Diary, write down the feeling in the C box, and any inferences and evaluations you became aware of in the B box. Also rate the intensity of the feeling on a scale 0 to 10, where 0 = neutral and 10 = the worst ever experienced. Also rate the level of conviction you have in each belief on a similar scale, where 0 = you don’t believe it at all and 10 = you are completely convinced.
- Step 4. Make a brief note of the adverse event you had in mind (or was happening) in the A box.
- Step 5. Carry out this step only after your session with your counsellor on how to construct ABC goals. When you are carrying out your thought monitoring (steps 1 to 4), also choose and note down a healthy but still negative emotion and helpful behaviour that you would prefer, and an alternative inference and evaluation that would help you feel and act that way.[Page 243]
- Step 6. Carry out this step only after your session on challenging and changing inferences. When you carry out your thought monitoring and notice a negative biased inference comes to mind, and you choose an alternative unbiased inference, weigh the evidence for each, and also look for an opportunity to put them to the test. Your counsellor will help you choose a test to try. Mark down any percentage change in level of conviction.
- Step 7. Carry out this step only after your session on challenging and changing your extreme evaluations. When you carry out your thought monitoring and notice an extreme evaluation comes to mind, and you choose an alternative realistic evaluation, try one or more of the following: dispute and compare the two beliefs for validity, practise REI using the two beliefs, carry out a shame-attacking exercise. Your counsellor will guide you in these tasks. Mark down any percentage change in level of conviction.
- Step 8. Carry out this step only after your session on changing distressing memories. When you carry out your thought monitoring and notice a distressing image comes to mind, try to bring to mind the rescripted image that you practised in session with your counsellor. Write down the rescripted image, and also any change in conviction.
Thank you for completing the Assessment and Goal Planning Guide, in which you carried out a detailed assessment of the As, Bs and Cs of your prioritised problem, and the A, B and C goals for change.
Now that you have identified your beliefs (B) and the consequent way you feel and react (C) to the adverse event (A), and the goals for change, you can now move on to putting the change options into practice. This will help you develop new and better ways of dealing with your problem.
We describe first the Inference Change Option, which has two parts, Weigh the Evidence (Steps 1 to 5), and Test Your Inferences in a Behavioural Experiment (Steps 6 and 7). Next, we describe the Evaluations Change Option, and finally the Imagery Change Option. We provide worksheets where needed, together with guidance steps. You and your counsellor may not consider it necessary to complete all of the options and steps, or to undertake them in the order presented here.Inference Change Option StepsWeigh the Evidence
Testing the Evidence
- Step 1. In this and the next steps you will be using the Inference Change Worksheet (p. 249). Fill in A, B1 and B1 Alternative, C Problem and C Goal. Use your answers from the Assessment and Goal Planning Worksheet. Box A3.1 (p. 245) tells you how to complete step 1. Also look at Boxes A3.5 and A3.6 to see how two clients, John and Brian, completed this and the next steps.
- Step 2. Try to think of all the evidence you can that would support your Probably Biased Inference (B1) and write this evidence on the Inference Change Worksheet, in the column alongside the B1 box. Boxes A3.2, A3.5 and A3.6 (pp. 246–8) show you how to complete this step.
- Step 3. Try to think of all the evidence you can that would support the Unbiased Inference (B1 Alternative), and write this evidence on the Inference Change Worksheet, in the box next to the B1 Alternative box. Boxes A3.3, A3.5 and A3.6 show you how to complete this step
- Step 4. Now look at the two lists of evidence you have just written and, with the counsellor’s help, question the quality of both lots of evidence. Are both lots of evidence equally reliable? Would both lots of evidence stand up in a court of law? If there is any evidence that doesn’t stand up to scrutiny, cross it out. What do you have left?
- Step 5. In step 4 you weighed up the two lots of evidence carefully and considered which of the two sets of inferences has the strongest support. Now re-rate your level of conviction in each inference and re-rate the intensity of your feelings in the C boxes. Has there been a change?[Page 245]
Step 1[Page 246]Step 2Steps 3–5[Page 247]Steps 6–7[Page 248]Case Example 1: JohnCase Example 2: Brian[Page 249]Inference Change WorksheetEvaluation Change Option StepsChallenging Evaluative Beliefs
- Step 6. If your conviction hasn’t changed substantially as a result of weighing the evidence, you may choose to go on to test the evidence in a real-life behavioural experiment. With your counsellor’s help, you design and carry out an experiment in which you will experience disconfirmation of your inference (B1) and confirmation of the alternative. After carrying out the experiment write down the result on the Inference Change Worksheet. Box A3.4 shows where, and have another look at what John and Brian wrote on their worksheets (Boxes A3.5 and A3.6).
- Step 7. What did you learn from doing the experiment? Why don’t you now again rate your level of conviction in each inference and re-rate the intensity of your feelings. Has there been a change this time?
- Step 8. If you think you have got closer to your inference change goal, and partly because of that your emotional/behavioural goal, record this on your Assessment and Goal Planning Worksheet.
Although your very negative evaluations may cause you to be distressed, they probably seem valid to you, and you may think you don’t have much choice but to go on believing them. In this task we show you how you can robustly challenge them and change them – a method we also call disputing – and make a fundamental difference to how you feel.
Evaluation Change through Rational Emotive Imagery (REI)
- Step 1. In this and the next steps you will be using the Evaluation Change Worksheet (p. 253). Fill in A, B1 and B1 Alternative, B2 and B2 Alternative, C Problem and C Goal. Again, you can copy across your answers from the Assessment and Goal Planning Worksheet. Box A3.7 also tells you how to complete step 1.[Page 250]
- Step 2. With the counsellor’s help, challenge both your demanding and your preferring evaluations together.
- First, ask yourself: which of these two beliefs is more realistically true? Place a tick against the one that you consider more true and a cross against the other one, plus any brief comments.
- Second, ask yourself: which of these two beliefs is more useful or helpful to me? Again, place a tick against the one that is and a cross against the one that isn’t.
- Third, ask yourself: which of these two beliefs makes most logical sense to me? Again, place a tick next to the one that does and a cross next to the one that doesn’t.
- Box A3.8 tells you how to record your challenges for step 2 on the Evaluation Change Worksheet.
- Step 3. With the counsellor’s help, challenge your awfulising and your non-awfulising evaluations together, using the same three challenging questions above. Place ticks and crosses against your choices on the Evaluation Change Worksheet, as shown in Box A3.8.
- Step 4. Again with the counsellor’s help, challenge your low discomfort tolerance (LDT) and your high discomfort tolerance (HDT) evaluations together, using the three challenging questions. Place ticks and crosses as before against your choices, as shown in Box A3.8.
- Step 5. Finally, with the counsellor’s help, dispute your ‘self’ or ‘other’ or ‘life’ depreciation and your ‘self’ or ‘other’ or ‘life’ acceptance evaluations, again using the three questions. As before, place a tick and a cross against your choice (as shown in Box A3.8).
- Step 6. Weigh up the effect of all your challenges on the validity of your extreme evaluations compared with the alternative flexible evaluations.
- First, rate your overall conviction in each set of evaluations on a 0–10 scale, where 0 = totally unconvinced and 10 = totally convinced, and compare this with the rating you gave originally. Has there been a change?
- Second, when you think you have achieved to some degree your evaluation change goal, and because of that your emotional/behavioural goal, record this on your Assessment and Goal Planning Worksheet as a percentage, where 100% is totally achieved, 50% half-way achieved, and so on.
By now you may be able to doubt your unhelpful evaluations in your head by disputing them, but you don’t feel any different, so what good is it just to doubt them? This time we show you how, by switching to the alternative evaluations, you can change how you feel using a method called Rational Emotive Imagery (REI).
[Page 253]Evaluation Change WorksheetEvaluation Change through Behavioural Exposure following REI
- Step 7. Bring to mind as vividly as you can the adverse event A and your unhealthy negative emotion C, which is the problem emotion, such as anxiety, and behaviour, e.g. avoidance. Your extreme evaluative beliefs B2 should automatically come into your mind without even trying.
- Step 8. Change your negative emotion from unhealthy to healthy, e.g. anxiety to healthy concern. Try to do this not by changing the situation A in your mind, but by changing your extreme evaluative B2 to the flexible alternatives. Tell your counsellor any difficulties you had in doing this, and your counsellor will coach you as to how to make this exercise realistic and effective.
- Step 9. Practise this exercise three times a day at home between counselling sessions and keep a record of how you get on with each part:
- whether you can bring the situation (A) vividly to mind,
- whether you can really feel the unhealthy emotion (C),
- whether the extreme evaluative beliefs B2 automatically come into your mind,
- whether you manage to change the emotion, e.g. from anxiety to concern,
- whether you changed it by changing from the extreme beliefs (B2) to the flexible alternatives, e.g. from ‘I would feel completely useless if I failed at this’ to ‘I would completely accept myself even if I failed’.
You have hopefully now made progress in changing your beliefs and your feelings using REI. Now we look at how to bring these changes into your ordinary life, using a method called behavioural exposure. You should only do this after you have rehearsed REI enough times that you can fairly easily and quickly switch from an unhealthy to a healthy negative emotion by switching from extreme to flexible beliefs.
Steps for Cognitive Change Option through Imagery Rescripting
- Step 10. Plan as a homework task to face the problem situation you brought for counselling help and which you used to practise REI.
- Step 11. Go through an REI rehearsal in your mind like you did in steps 7 to 9, of entering the adverse event A and being mindfully aware of your extreme beliefs B2 as they pop into your head, and your unhealthy negative emotional reaction C. Then seek out and go into an actual situation of this type and do the same thing – be mindfully aware of your extreme beliefs and consequent feelings and action tendencies.
- Step 12. Just as you did in steps 7 to 9, change your feeling C from the unhealthy to the healthy, e.g. anxiety to concern. Remember to do this by changing your evaluative beliefs, from the extreme to the flexible B2 alternative.
- Step 13. Even if you can’t change the emotion very easily, keep rehearsing at least one of the flexible beliefs, e.g. ‘I completely accept myself despite … feeling anxious, etc.’, and also act according to this self-acceptance, so staying in the situation, standing tall, looking at people rather than hiding away.[Page 254]
- Step 14. When you think you have achieved to some degree your evaluation change goal and your consequent emotional/behavioural goal, record this on your Assessment and Goal Planning Worksheet as a percentage, where 100% is totally achieved, 50% half achieved, and so on.
Despite all the work you have done on changing the beliefs that cause you to be distressed in your problem situation, you still get so distressed when it comes to facing the situation that you still don’t face it. This may be because the adverse event and toxic beliefs are actually locked up inside your memory of the event. There is a way of unlocking it and changing it called imagery rescripting, and through this method you may be able to achieve your goal of rescripting your memory of the adverse event in the preferred way you recorded on the Assessment and Goal Planning Worksheet. The following are the steps for carrying out one version of imagery rescripting:
[Page 255]Homework Skills Monitoring Form for the Counsellor
- Step 1. With the counsellor’s close guidance and support, try as best you can to go back and ‘re-live’ the specific adverse event A in concrete detail, from beginning to end, and give an account as if you are actually there now.
- Step 2. When you come to the worst, most distressing bits, or ‘hotspots’, try to slow down and report what you are seeing and hearing (A), what you are feeling and doing (C), and all your automatic thoughts – the biased inferences B1 and extreme evaluations B2.
- Step 3. Once out of re-living, work on these hotspots with your counsellor just as you have now learned to do in CBC – identify and write down the ABCs, challenge and change the Bs, from biased to unbiased inferences B1, and from extreme to flexible evaluations B2, write down the new Bs, and write down new aspects of the adverse event A itself, in the light of any inaccuracies and new information that emerged in the re-living and was absent from the memory image.
- Step 4. Rehearse the new information and beliefs so that you are thoroughly familiar with them, then again go back into re-living and, with your counsellor’s guidance, pause at the hotspots and introduce the new information and beliefs.
- Step 5. Make sure your narrative is taped or digitally recorded and then play the tape a number of times as homework, in order to consolidate the changes, each time rating the intensity of affect 0–10 on a subjective units of distress (SUDS) scale.
- Step 6. When you have completed steps 4 and 5 you should have a new ‘rescripted’ memory, which ideally will include the actual event A itself now modified by new information which makes it less negative and toxic, inferential and evaluative beliefs B now modified by being less biased and more realistic and flexible, and, as a consequence of these changes, a healthier negative emotional and more functional action tendency C. When you think you have achieved your goal of ‘rescripting’ your memory in this way, it is worth making a note on your Assessment and Goal Planning Worksheet, which you can use as a reminder if necessary. This will also enable you to compare your rescripted memory with the original problem and your goal.
Listen to the recording of your therapy session and circle ‘Yes’, ‘No’ or ‘N/A’ (Not Appropriate) for each item. For every item circled ‘No’, write down in the space provided what you would have done differently given hindsight and what you would have needed to change in order to have circled the item ‘Yes’.
Did I use a term for homework assignments that was acceptable to the client?
Yes No N/A
Did I properly negotiate the homework assignment with the client (as opposed to telling him/her what to do or accepting uncritically his/her suggestion)?
Yes No N/A
Was the homework assignment expressed clearly?
Yes No N/A
Did I ensure that the client understood the homework assignment?
Yes No N/A
Was the homework assignment relevant to my client’s therapy goals?
Yes No N/A
Did I help the client understand the relevance of the homework assignment to his/her therapy goals?
Yes No N/A
Did the homework assignment follow logically from the work I did with the client in the session?
Yes No N/A
Was the type of homework assignment I negotiated with the client relevant to the stage reached by the two of us on his/her target problem?
Yes No N/A
Did I employ the ‘challenging, but not overwhelming’ principle in negotiating the homework assignment?[Page 256]
Yes No N/A
Did I introduce and explain the ‘no lose’ concept of homework assignments?
Yes No N/A
Did I ensure that the client had the necessary skills to carry out the homework assignment?
Yes No N/A
Did I ensure that the client believed that he/she could do the homework assignment?
Yes No N/A
Did I allow sufficient time in the session to negotiate the homework assignment properly?
Yes No N/A
Did I elicit a firm commitment from the client that he/she would carry out the homework assignment?
Yes No N/A
Did I help the client to specify when, where and how often he/she would carry out the homework assignment?
Yes No N/A
Did I encourage my client to make a written note of the homework assignment and its relevant details?
Yes No N/A
Did the client and I both retain a copy of this written note?
Yes No N/A
Did I elicit from the client potential obstacles to homework completion?[Page 257]
Yes No N/A
Did I help the client to deal in advance with any potential obstacles that he/she disclosed?
Yes No N/A
Did I help the client to rehearse the homework assignment in the session?
Yes No N/A
Did I use the principle of rewards and penalties with the client?
Yes No N/A
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