Action Stage: Translating Action Stage: Translating Insight to Change.Insight to Change.

Goals of Stage IVGoals of Stage IV Changes in one’s thoughts, feelings, or Changes in one’s thoughts, feelings, or

behaviors.behaviors.

1.1. Creation of Action Plans.Creation of Action Plans.

2.2. Skill Development.Skill Development.

3.3. Enhanced Problem Solving.Enhanced Problem Solving.

4.4. Practicing New Behaviors.Practicing New Behaviors.

5.5. Development & Implementation of new Development & Implementation of new Decisions.Decisions.

6.6. Feedback & Evaluation. Feedback & Evaluation.

Cognitive-Behavior TherapyCognitive-Behavior Therapy

Major Ideas/AssumptionsMajor Ideas/Assumptions

Scientific view of behavior and therapy. Strong Scientific view of behavior and therapy. Strong advocates of research and the importance of advocates of research and the importance of evaluating the outcome of helping.evaluating the outcome of helping.

Based on learning theory (classical conditioning, Based on learning theory (classical conditioning, operant conditioning, social learning). operant conditioning, social learning).

All behavior, whether positive or negative, is All behavior, whether positive or negative, is learned. Cognition (thoughts, beliefs, attitudes, learned. Cognition (thoughts, beliefs, attitudes, etc.) are also learned behaviors. etc.) are also learned behaviors.

Behavior is maintained by Behavior is maintained by currentcurrent antecedents antecedents and consequences, not historical events.and consequences, not historical events.

Helper operates as a consultant or teacher.Helper operates as a consultant or teacher.

A-B-C Model of Behavior A-B-C Model of Behavior ChangeChange

AntecedentsAntecedents

BehaviorsBehaviors

ConsequencesConsequences

Assumptions of Cognitive Assumptions of Cognitive TherapyTherapy

Our thoughts or self-statements about our Our thoughts or self-statements about our experiences (not external events experiences (not external events themselves) are responsible for emotional themselves) are responsible for emotional & behavioral reactions (problems). & behavioral reactions (problems). Consequently, changes in our thoughts will Consequently, changes in our thoughts will lead to changes in our emotions & lead to changes in our emotions & behaviors.behaviors.

Although cognitions (self-statements) may Although cognitions (self-statements) may have resulted from historical events, have resulted from historical events, people re-indoctrinate themselves with people re-indoctrinate themselves with these beliefs in the here-and-now.these beliefs in the here-and-now.

Behavioral TechniquesBehavioral Techniques Stimulus Control: changing the environment Stimulus Control: changing the environment

or the antecedents of a behavior.or the antecedents of a behavior. Self-Reinforcement: changing the Self-Reinforcement: changing the

consequences of behavior. Premack consequences of behavior. Premack Principle: reinforcing an undesirable Principle: reinforcing an undesirable behavior with a highly desirable behavior.behavior with a highly desirable behavior.

Skills Training: teaching clients new skills Skills Training: teaching clients new skills and how to control their own behavior (e.g., and how to control their own behavior (e.g., social skills, assertiveness, relaxation social skills, assertiveness, relaxation training). training).

Role-Plays/Behavioral Rehearsal. Role-Plays/Behavioral Rehearsal. Exposure to Feared Stimuli.Exposure to Feared Stimuli. Self-Monitoring/Reactivity.Self-Monitoring/Reactivity.

CBT TechniquesCBT Techniques

Education about CBT.Education about CBT. Countering or Cognitive Restructuring: Countering or Cognitive Restructuring:

replacing negative self-statements with replacing negative self-statements with more positive ones. more positive ones.

Where’s the evidence?Where’s the evidence? Best Friend Technique. Best Friend Technique. Alternative Explanations.Alternative Explanations. Behavioral Disputation: engaging in a feared Behavioral Disputation: engaging in a feared

or avoided behavior.or avoided behavior. Coping Thoughts.Coping Thoughts. Thought Stopping: interrupting negative Thought Stopping: interrupting negative

thoughts through use of a powerful thoughts through use of a powerful distracter, followed by a positive counter-distracter, followed by a positive counter-thought.thought.

Limitations of CBTLimitations of CBT

A number of clients are simply looking A number of clients are simply looking for catharsis and support during tough for catharsis and support during tough times, not specific behavioral changes.times, not specific behavioral changes.

Most clients do not arrive at counseling Most clients do not arrive at counseling ready or willing to make specific ready or willing to make specific behavioral changes. Clients need to be behavioral changes. Clients need to be ready to change before these directive ready to change before these directive techniques will be helpful. techniques will be helpful.

Most appropriate for very specific Most appropriate for very specific behavior disorders (e.g., phobias, behavior disorders (e.g., phobias, sexual disorders).sexual disorders).

Other Action TechniquesOther Action Techniques

Paradoxical Injunctions. Paradoxical Injunctions. Bibliotherapy.Bibliotherapy. Psychoeducation. Psychoeducation. Problem-Solving Training.Problem-Solving Training.

Basic Problem-Solving ModelBasic Problem-Solving Model

1.1. Define the problem.Define the problem.2.2. Brainstorm potential solutions.Brainstorm potential solutions.3.3. Evaluate potential solutions.Evaluate potential solutions.4.4. Select solution(s) that has the Select solution(s) that has the

best probability of producing a best probability of producing a favorable outcome.favorable outcome.

5.5. Implement and evaluate the Implement and evaluate the solution(s).solution(s).

6.6. Repeat, if necessary.Repeat, if necessary.

Solution-Focused Solution-Focused TherapyTherapy

Assumptions:Assumptions: Excessive exploration or insight about the Excessive exploration or insight about the

problem is not necessary before change can problem is not necessary before change can occur. There is not necessarily a direct occur. There is not necessarily a direct connection between a problem and its solution.connection between a problem and its solution.

Clients are resilient and possess the resources Clients are resilient and possess the resources for solving their own problems; they are just for solving their own problems; they are just not using these resources effectively.not using these resources effectively.

Clients, not helpers, are responsible for Clients, not helpers, are responsible for bringing about change.bringing about change.

Life is full of problems, and clients cannot solve Life is full of problems, and clients cannot solve all their problems through a helping all their problems through a helping relationship. relationship.

Philosophy of Intervention:Philosophy of Intervention:

Shift from a focus on “problem Shift from a focus on “problem talk” to a focus on “solution talk” talk” to a focus on “solution talk” and clients’ strengths and and clients’ strengths and resources.resources.

Assume every session might be Assume every session might be the last. Sessions should be the last. Sessions should be scheduled intermittently on a PRN scheduled intermittently on a PRN basis. basis.

TechniquesTechniques Exceptions Suggest Solutions. Exceptions Suggest Solutions. Identify Identify

exceptions to the problem, for therein exceptions to the problem, for therein lies the solution. (“What are you lies the solution. (“What are you already doing that is helpful in already doing that is helpful in reducing the severity of the reducing the severity of the problem?”or “Tell me about the times problem?”or “Tell me about the times when the problem does not occur.”)when the problem does not occur.”)

ComplimentsCompliments: affirm clients’ successes, : affirm clients’ successes, strengths, or exception times. strengths, or exception times.

Questioning TechniquesQuestioning Techniques

Previous Solution Attempts:Previous Solution Attempts: “What have “What have you already tried to resolve this you already tried to resolve this problem?”problem?”

Relationship QuestionsRelationship Questions: “Once the : “Once the problem is solved, what will be different problem is solved, what will be different between you and ___(significant other)?”between you and ___(significant other)?”

Coping QuestionsCoping Questions: “How are you able to : “How are you able to cope to as well as you are with such a cope to as well as you are with such a difficult situation or prevent it from difficult situation or prevent it from getting worse?”getting worse?”

Past Successes: “Past Successes: “Tell me about a Tell me about a time when you successfully dealt time when you successfully dealt with a similar situation.”with a similar situation.”

““What is better since the last time What is better since the last time we met?”we met?”

Stage V: Stage V: Termination/EvaluatioTermination/Evaluatio

nn

Goals of Stage VGoals of Stage V

Review & Evaluate progress.Review & Evaluate progress. Discuss any termination issues (e.g., Discuss any termination issues (e.g.,

difficulty saying good-bye). difficulty saying good-bye). Develop plan for maintaining Develop plan for maintaining

changes (e.g., relapse prevention). changes (e.g., relapse prevention). Plan for additional services, if Plan for additional services, if

needed.needed. Develop external social support.Develop external social support.

When should counseling be When should counseling be terminated?terminated?

Client reaches his or her goals. Client reaches his or her goals. Need to refer client to another Need to refer client to another

professional because one cannot assist professional because one cannot assist the client the client

Lack of progress.Lack of progress. Agency or insurance limits have been Agency or insurance limits have been

reached.reached. Need to promote client independence.Need to promote client independence.

GuidelinesGuidelines

Termination should be discussed Termination should be discussed throughout the relationship; assume throughout the relationship; assume every session could be the last.every session could be the last.

Consider use of fade-out final Consider use of fade-out final sessions.sessions.

Clients involved in long-term helping Clients involved in long-term helping relationships should be prepared for relationships should be prepared for termination.termination.

Plan a follow-up phone call or session Plan a follow-up phone call or session after termination.after termination.