Intro to CBT

[Ruthie]

I've been asked to teach a half day intro to CBT to my team. They're an MDT. They haven't had a psychologist for a long time and my predecessors were all psychodynamic in orientation. I think it's safe to say that they know fairly little about CBT.

What do you think are the essential basics about CBT in the context of a community mental health team for people with severe and enduring mental health difficulties to get across? I particularly want to get across the idea that I don't do CBT in a vacuum and that it is important for other people involved with a client to support the work and for me to be supporting theirs.

I'm trying to narrow down and think creatively about it. Ideas please!

Thanks,

Ruthie

[lakeland]

Stream of thought type reply, so excuse me if I state the obvious!

- Something about the C and the B of CBT - how do people work with these?

- Key 'jargon' - (presuming that there will be clients that have had CBT before?) clients might use CBT type language, so some explanation of NATS, diaries etc

- What sort of things will people in the service experienced in previous CBT

- Myths/facts about CBT e.g. what it is recommended for, not just 'here and now' as some people think

- When I'm on training I always like real case examples, they tend to stick in my mind and help me link theory to practice

Hope this helps

[maven]

I'd want to do the basics well, so exploring how thoughts relate to feelings and behaviour. Also the 'drilling down' it takes to identify the key thoughts, and how to challenge them (that might work as an activity, if you gave people a safe example to work on). Also, how the newer ideas fit with the traditional CBT people might be more cynical about. If you wanted to be bold, you could start with people's thoughts and feelings about CBT, and then challenge them during the session!
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Maven.

Wise men talk because they have something to say, fools because they have to say something - Plato
The fool thinks himself to be wise, but the wise man knows himself to be a fool - Shakespeare

[Dr.Dot]

Just read this back, hope its not like a grannies and egg sucking scenario. Was just writing my thought process of what I might do!

I'd defo do the basics and look of thoughts feelings and behaviours. (I would probably do a lot on reinforcement of such, in Skinnerian terms, with everyday examples).

But I would really want to get into the aspect of working together so I think I would do a case illustration with a full diagramatic formulation and then go though several maintainence cycles and illustrate how professionals can unwittingly feed into them, in say depression, GAD, social anxiety, OCD and suggest some ways of moving the client forward instead of institutinonalising them by reinforcing/maintaining behaviour/thoughts and emotions (though I wouldn't quite put it like that!), something like going for a quick walk and then having the ubiquitous cup of tea, the conversation with such tea and biscuit following a walk or whatever, could be validating and encouraging, rather than indulgent (am I being too harsh?)

I think I would also want to give them a small toolkit, nothing drastic, and maybe a reminder: the importance of behavioural activation, activity schedules, sleep hygiene, pros and cons analysis, encourgaing self care, maybe a relaxation technique.*

I may want to do some psychoeducation re cognitive overload, and autobiographical memory, mainly for them to understand their clients more, as it is very annoying when they don't remember to do stuff and that may impact negatively on the theraputic relationship!

I am not sure I would go for diaries and downward arrows, challenging beliefs and the like unless they are going to bring them to you for consultation/supervision. And anyway they would need more training! You just need to get them on board, I reckon, with simple things that don't need much input from you in the first instance. If they want to know more about what happens in therapy, that can happen at a later time. I imagine that they will want to know a bit about it, and what they can do. (but maybe that needs clarifying?)

*I may be inclined, to do some little mindfulness things here as well (suprised?). A breathing excersie perhaps. Then as a coping stratergy: taking a breath, and a little positive self talk, "I am breathing and my feet are on the floor, I can do this". Or a worry jar: write worries down, fold paper, then review in a week, or whenever the next visit/appointment is, worries that remain: validate, and worries that are no longer, a simple noticing that these worries, like negative thoughts/emotions don't last forever, they may come back but they are not nec. always there.
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Dorothy: Now which way do we go?

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[Ruthie]

Thanks everyone. Keep the ideas flowing.

Dorothy, I love your ideas, but I think I'd need weeks to do them justice! It's hard to know how to pitch it as I feel I really need to go back to basics but not patronise. I also think I need to sell cbt, help people identify suitable clients and emphasise that its important for care coordinators to be involved in the process and in follow up for clients with severe and enduring mental health issues.


Anyway will put pen to paper or PowerPoint tomorrow and see what I can come up with!

Anyone know any good experiential exercises?

[w013]

what about starting with discussing a person that you are working with now in the team and using them to draw out the key ideas - some people may even know the person concerned which could help the discussion. I think you are absolutely right about what you want to get over and it's probably best to go easy and not try to cover everything or 'prove' the case for cbt....

also as the preconception is always seems to be that CBT therapists never touch relationship or the past i'd probably work on that angle a bit too ....but again with a real person from the team...

i'm sure it'll be a great success - good luck with it

[RzrbldeSuitcase]

[Ruthie]

I think it varies hugely! I have worked with STR workers who I've recruited into doing basic CBT interventions and also helping me out with behavioural experiments and helping clients with their CBT homework before. I've also worked with qualified staff who think CBT is nothing more than telling the client their thoughts are wrong and telling them what they should be thinking and doing and then calling them "difficult" if they don't adhere!

Where a team hasn't had a psychologist for a long time, I think there's often some misunderstanding about the role and perhaps some resentment that we don't do certain duties, like care coordinate.

I think it's about generating interest, curiosity and enthusiasm about psychological approaches - both in terms of referring clients for individual therapy, but also in using some basic psychological ideas in everyone's work. I think there's a bit of a sales pitch to be done, but being somewhat CBT immersed at the moment, I go into CBT mode in teaching and do it all with lots of guided discovery and hope they come to conclusions I like !