The main theory of Cognitive Behavioural Therapy or C. B. T. is the fact what an individual thinks, influences their mood, the way they feel physically and for that reason how they behave (Williams and Garland, 2002) In addition, it takes into account a clients past activities, current conditions and genetic affects (Offer, Townend, Mills and Cockx, 2008). Therefore the primary aim of the C. B. T. assessment is to build up a knowledge of the clients difficulties and collaboratively create a formulation and treatment solution (Hawton, Salkovskis, Kirk and Clark. , 1989). This is possible through the gathering of information from the client about their problem and the difficulties that they are facing. That is done by having a structured evaluation process that involves questioning your client around their thoughts, physical feelings, behaviours and feelings and the impact these are experiencing on different aspects of the life. It is also essential to establish any triggers for the particular episode or problem and recognise what maintains the symptoms mentioned. It also is vital to handle any risk issues at the examination stage of remedy, such as suicidal ideation or self applied harm also to respond properly to the amount of risk determined.
The analysis also provides therapist an chance to educate your client around their specific problem, the appropriate treatment strategies and get started to assist in the
process of change (Hawton et al. , 1989).
There are extensive different facets of the C. B. T. evaluation. For this particular assignment I will be analysing and focussing on the proposal of the client in remedy, by reflecting on and critically analysing a recent assessment that I have completed used.
Client X was a men in his 50s who was known for CBT by his DOCTOR (G. P. ). He had been suffering with depression following a breakdown of his relationship five years back. He has since been living by itself with reduced contact from his children or grand-children. He's currently unemployed having lost his own business as a result of his marital split up. He provided tearful and lethargic throughout the evaluation. He complained of experiencing low feeling, loss of enjoyment, reduced activity levels, loneliness, sleep problems and hopelessness. He further accepted to fleeting thoughts and ideas of suicide, but explained his children and his faith as strong protective factors in preventing the plans turning to real motives. Finally, he had not been aware of any family history of mental health problems.
The beginning of the encounter is really important, is well kept in mind by clients which is a simple part in producing engagement. (Newell, 1994). Therefore, the greeting and setting up of plans is the first aspect of engaging the client and orientating these to the discussion (Newell and Gourney, 2004). I noticed here that I showed friendliness and genuineness towards your client to help them feel at ease from the starting point of the period. When launching myself I shook Client X's side and smiled. When adding the assessment so when setting the plan, I attempted to avoid using jargon whenever you can, which is often a barrier in communication. Regarding to Williams (2002) non-professional conditions should be used that the client will understand. Often, your client could get started to feel inferior to the therapist that may therefore have a poor effect on the engagement process of the relationship. Although I attemptedto refrain from the use of jargon whenever you can, I had been aware at the beginning of the period that we used the abbreviation "C. B. T" instead of saying the full subject "Cognitive Behavioural Therapy. " The client does question this as he did not understand. Therefore, I had developed the chance to apologise and clarify what I possessed meant in more appropriate, understandable language. Despite the effects of the utilization of jargon on proposal, I thought the client's feedback was useful and exhibited that these were engaging to the program at a level from the starting point.
Another essential requirement of engaging the client is the design of questioning used throughout the analysis. There are two main types of questions, open and closed. Open up questions permit the client to spell it out their problem in their own words, and therefore any habits or causes can be proven (Gamble and Brennan, 2000). Sealed questions are being used to elicit facts and can usually be replied with a "yes" or "no" (Sutton and Stewart, 2002). The technique of questioning is an essential area of the assessment if carried out improperly, can have a detrimental effect on engagement and then the restorative alliance between customer and therapist.
For instance, way too many closed questions can lead to the client feeling interrogated (Burnard, 1997) plus they also, matching to Hames and Joseph (1986), restrict the individual from expressing their true thoughts and feelings.
As with closed, open questions likewise have their limitations. These are broad in scope and email address details are unpredictable in path therefore some information can be omitted (Vehicle Servellen, 1997). Furthermore, Northouse and Northouse (1985) claim that assessments that use some open questions by itself, can result in lengthy, time consuming appointments. This is shown in the assessment carried out with Client X. I came across it difficult to gather information within an organised manner without your client going off on a tangent on many situations. Therefore, after some consideration it is necessary to attempt a good balance of both available and closed down questions to illicit the appropriate information about the client's problem also to engage totally with the individual. I also believed that over a few instances, due to my very own anxieties with carrying out the evaluation, I asked multiple questions simultaneously. This might have impeded the flow of the assessment and also according to Williams (2002) these questions confuse the client. This is because they must bear in mind what they have been asked and then formulate and answer for each one in quick succession. Thus matching to Ley (1977) a significant source of clients disengaging within consultations is the clinician's poor interviewing skills. I also remember that over a few occasions I was aware of asking leading questions which Faulkner (1998) state governments should be averted as they imply a preferred answer and are incorrect in the proposal process.
Skilled questioning is merely as good as the active tuning in that accompanies it (Forster, 2001) which really is a very important factor in client-therapist engagement. Arnold and Boggs (2003) imagine tuning in not only requires the function of reading with the senses but also a dynamic interpretation of what is noticed through verbal and non-verbal communication. It is important that clients feel paid attention to to allow them to engage with the therapist. When reflecting on the evaluation with Client X I sensed my non-verbal gestures, such as eyesight contact, open body language, gestures (such as nodding) and note taking helped to enhance the engagement process. However, when it arrived to verbal marketing communications, such as reflecting back again and summarising to the client what have been said, I felt that was a location of my interviewing skills that should be developed further. Looking again I almost never utilised this tool which could have aided in engaging the client at a far more deeper level which regarding to Beck (1995) if a customer doesn't fully engage at the start of therapy, it is possible that they would not go back for the follow up session.
Active tuning in and reflecting are essential for a clinician showing empathy towards a customer. Rogers (1957) recommended a warm empathic romantic relationship is a necessity when engaging consumer. A definition of empathy by Beck, Hurry Shaw and Emery (1979) is:
" Accurate empathy identifies how well the therapist can step in to the patient's
world and see and experience life the way the patient does. " (page 47).
Within C. B. T. therapists should empathically pay attention to the client's problem and offer a non-judgemental environment where clients feel comfortable on openly speaking about their thoughts, feelings and behaviours (Josefowitz and Myran, 2005).
Client X disclosed some unpleasant and shameful thoughts and behaviours in the assessment, which Thwaites and Levy (2007) believe a client wouldn't say that to or discuss unless they believed a certain degree of empathy from the therapist. The warmth, genuineness and non-judgmental attitude I showed throughout the time is reflected in the open and honest replies from Consumer X. He accepted never to disclosing the thoughts and behaviours that he was experiencing which gave me a level of opinions that he felt that to a level I was able to understand his emotions. At certain things during the session your client became tearful and distressed. Here I remained calm, allowed for silence and sometimes used statements such as " I am aware that is difficult for you, please take your time" which confirmed an empathic understanding to the client. However, as mentioned earlier to fully empathise with a person I should have reflected again what the client had said to validate to him which i understood what have been disclosed. On reflection at times I believe I showed sympathy rather than empathy which if overused can leave clients sense pitied. This sense of pity can reinforce the feeling of hopelessness and low self esteem, especially in clients suffering with major depression such as Client X, therefore in future I need to be more aware of the utilization of sympathy versus empathy.
To conclude, I sensed that overall I did engage with Client X to a reasonable level, however I do feel that there were some areas of the engagement process that might be improved. I believe my main talents were creating ambiance, genuineness and empathy with your client which helped form a good basic for a restorative marriage. I also think that despite the use of jargon in a few instances during the intro, I place the agenda well and included the individual in decision making which is very important to the foundations of an collaborative alliance.
However, after some consideration, there are some areas that contain room for improvement. Firstly, the utilization of questions throughout the diagnosis could be advanced so the interview flows well and the appropriate information is compiled. Briddon, Richards and Lovell (2003) describe that to activate a client fully also to gain an accurate picture of the customers showing problem, the program should begin with broad open up questions, specific open questions and then shut down questions. This technique is recognized as "funnelling", which I aim to apply in future initial interviews.
Secondly, my use of reflecting back to your client could be advanced in future assessments. Although I felt I was concentrating on listening to your client from a personal perspective, reflecting what the client had said back again to them would provide them with the guarantee and confirmation which i was hearing and producing what they were disclosing, thus enhancing client-clinician engagement. That is a tool i intend to use more of in therapy. However, as with the use of questioning the use of representation must be carefully well balanced. If over used it can appear unnatural and notable (Faulkner, 1998) and can result in your client becoming agitated as they may feel mimicked (Collins, 1977).
This also links in with bettering engagement through the empathic marriage. As stated I believed i exhibited a good degree of empathy with Customer X throughout the diagnosis process. However, this could have been improved further through the use of empathic representation (Josefowitz and Myran, 2005). Exact reflection really helps to maintain the 'empathic bridge' corresponding to Gilbert and Leahy (2007) therefore is necessary for true engagement with a client.
Using a reflective model allows me to evaluate my very own performance and pin point areas that need to be done to help boost the level of engagement with clients. I aim to improve the aspects of assessment protected in this assignment through feedback and advice from my clinical supervisor, practise by using role play, reflective practice using documenting equipment and through my very own experiences in medical practice.
Finally, despite there being several areas for bettering my engagement with future clients in the initial evaluation, Macneil, Hasty, Evans, Redlich and Berk (2009) think that although seeming very significant in the first level of contact, engagement can be an ongoing process throughout treatment. Therefore, constant effort and attention is required to maintain the healing relationship.
