Integrating CBT into Your Practice

Adding CBT (cognitive behavior therapy) into your sessions requires a balance of implementing a manualized treatment with catering that treatment to the client and making it work for them. The core principle of CBT is to alter unhelpful ways of thinking and behaving and learn new coping skills in an effort to reduce emotional distress and improve daily functioning. CBT can be integrated with many populations including adolescents, adults, couples, and groups. Whatever your population, keep close the intent of providing a service based on a client’s goals, strengths, challenges, and needs. You will also want to keep close the nuts and bolts of CBT including identifying thoughts, feelings, and behaviors, dissecting dysfunctional thoughts, and reframing to make the dysfunctional thoughts more accurate. Its important to stress that it is not about changing a negative thought to a positive one. Its about making the thought more accurate to reflect the feeling or situation. For example, reframing the thought “I’m going to fail” to “I’m nervous about this test and wish I would have studied more” can make a huge difference in in your emotional state during that exam. The latter thought is more accurate in depicting the situation and your feelings. It even motivates you to do something about it next time to produce a new behavior, studying more. The former thought only serves to create anxiety, lower self-esteem, and is not accurate because you cannot know for sure if you will fail until you’ve attempted and got most of the questions wrong.

Integrating CBT into your sessions also requires setting your clients up for success. If you have been practicing a different modality, it will be helpful to let the client know you will be shifting in your approach and what that entails. Be sure to let your clients know that CBT is a highly manualized and structured treatment. Spend a full session on explaining what CBT is (psychoeducation), about how many sessions it will take, the research regarding efficacy, and even how it has worked for some of your other clients. Be sure to find a balance of sticking to the manual (after all sticking to the manual is where the research comes from) and giving your client space to heal and talk about their needs. Be aware that the first few sessions may be more of the therapist delivering information.

Practice/homework are a huge part of implementing effective CBT. Using the word ‘practice’ instead of ‘homework’ can be useful for kids who have homework from school or others who may have trouble thinking about the practice in a positive light. This is in an attempt to increase motivation for completion of the homework. Practicing the techniques daily is what will create meaningful change. Letting clients know that you only see them for 1 hour per week (or whatever the schedule may be) and that practicing for only that time is not going to be enough to create the meaningful change clients need. Clients should also know that this type of therapy requires active participation which requires motivation. There will be helpful handouts and worksheets and you may use a white board to explain concepts from time to time. Encourage clients to come to session prepared with pen and paper. Keeping all notes and handouts in one place that you can bring to every session can be helpful. There may be some sessions dedicated to motivation enhancement, especially if depression symptoms are present.

CBT can also be integrated with other types of therapies easily including acceptance and commitment therapy, mindfulness-based therapy, dialectical behavior therapy, family therapy styles, and more.

CBT has been proven effective for depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness (American Psychological Association, 2017).

If you feel that you or a loved one is struggling mentally, don’t hesitate to seek a professional who treats that issue with CBT. Cognitive Behavior Institute has several therapists that offer CBT sessions. Don’t hesitate to reach out, we would love to help!

Reference
American Psychological Association. (2017). What is Cognitive Behavioral Therapy? Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

Brittany Steiner