- Structure of the Cognitive Therapy Session
The first and most essential component of the therapy session includes setting the agenda. Beck (2011) emphasizes that the most significant component of the cognitive therapy session is soothing the patient and relieving his/her feeling of anxiety, and forming the contact with the client (p. 60). After setting the agenda, it is necessary to conduct the mood check. According to Beck (2011), this part is important, as it assists in understanding the emotional state of the client, and conducting the session in an effective manner. After the mood check, the updates are obtained and the patient’s diagnosis is set. The final part of the introductory element of session is doing the psychoeducation. It should be mentioned that these issues are vital, as the patient has an inner desire to discuss with the psychologist his/her diagnosis and to make sure that it does not affect the quality of relations. In other words, the patient wants to be sure that he/she is not perceived as an abnormal or strange person.
The second block of the cognitive therapy session consists of the following three parts: identification of the existing cognitive problems and setting goals; educating the patient about the cognitive model and discussing the problem. Identification of the client’s specific problems is extremely important. It is necessary to reach the gist and search for the efficient ways of solving the problems. Moreover, Beck (2011) emphasizes the significance of educating the individual on cognitive model. This part includes explanation and illustration of this model to the person.
The final part of the session consists of provision of the elicit summary, reviewing the homework assignment and eliciting the feedback. Beck (2011) states that final summary “ties the treads” (p. 74) of the whole session into one whole, and provides the meaningful oversight of the results, which were achieved.
- Several strategies could be applied in order to identify and modify the intermediate beliefs. To start with, it has to be assumed that everything depends on the belief itself. In particular situations, they may be easily altered, whereas in difficult cases, the concerted effort should be made in order to alter them. Judith Beck (2011) lists a number of strategies, which include Socratic questioning, behavioral experiments, cognitive continuum, intellectual-emotional role plays, application of others as a reference point, acting “as if” and self-disclosure.
Socratic questioning is one of the most efficient techniques, its major benefit is assisting to evaluate the evidence for and against the existing belief. It provides existing advantages and disadvantages; it seriously affects the process of belief maintaining. The therapist assists the patient to alter his/her viewpoint through the detailed analysis of the beliefs.
Another useful strategy is application of behavioral experiments in order to modify the intermediate beliefs. Behavioral experiments assist to check the validity of beliefs. This strategy involves enactments. These experiments help to consider client’s negative expectations that reflect the intermediate beliefs and schemas. The behavioral experiments help to make changes at the level of schemas. They alter the existing beliefs through the gradual analysis and evaluation.
The third technique discussed by Judith Beck (2011) is application of cognitive continuum. Cognitive continuum could be explained as continuum of experience, which presupposes viewing the emotions from the completely new perspective that investigates the ideas from the global, rigid and all-or-nothing viewpoint. This technique alleviates the thinking and assists the patient to recognize the middle ground. In other words, the therapist and client indulge in the emotional role play and in the course of it they alternate playing the roles of the client’s emotional and rational mind.
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There exist a number of other techniques, which provide practical efficiency. However, these seem to be the most effective for the modifying of intermediate beliefs.
- While discussing the issue of core beliefs, Judith Beck (2011) states that the difficulty degree depends on the patient. The techniques for the identification of core beliefs do not differ from those applied for the intermediate beliefs. Judith Beck (2011) mentions that downward arrow technique has to be used in the course of identification process. In order to apply it on practice, at first, the identification of negative-self-beliefs is necessary. One should conduct the summary of negative self-beliefs and understand whether these beliefs reflect general beliefs a person has about himself/herself.
While discussing the process of modification, it should be stated that the same techniques, as those, mentioned for the intermediate beliefs could be applied in this situation.
One of them is self-disclosure. In order to modify the core beliefs, one should reveal the awareness and observations of experiences during the session. The therapist should find out how the patient felt during the session and try to reveal the negative thoughts. After it, the negative beliefs have to be analyzed and evaluated in order to reveal what components were true. In such a way, it will be possible to find out the biased or distorted thinking.
The next technique that could turn out to be efficient is acting “as if.” This technique helps to achieve positive changes in the patient’s health state and alter the core beliefs. The main idea of this technique is assisting the patient to change the core beliefs through the application of “as if” situations, which provide the insight towards the possibility of overcoming the situations. This technique makes the patient believe in other possible reality and adjust his/her ideas towards it.