The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)
-
Upload
lester-gordon -
Category
Documents
-
view
244 -
download
0
Transcript of The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)
![Page 1: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/1.jpg)
The Therapeutic Alliance
Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)
![Page 2: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/2.jpg)
Aims
• Discuss the significance and nature of the ‘working alliance’ for the CBT practitioner.
• Show an awareness of how the CBT relationship differs from other therapeutic approaches.
• Reflect on the implicit (unspoken, implied) and explicit (clearly evident) aspects of the therapeutic relationship
![Page 3: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/3.jpg)
The Therapeutic Alliance
• Research has indicated that the relationship between client and counsellor is paramount in the effectiveness of therapy and overrides any one approach or theory (BACP, 2013, Corey 2012, Nelson-Jones 2012).
• Beck was very definitely of the ‘necessary but
not always sufficient’ camp. Beck described ‘a therapeutic alliance of collaboration’ (Beck et al 1979).
![Page 4: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/4.jpg)
The Relationship
• Bordin (1979:253) argues that the relationship is an alliance between counsellor and client and is broader than a therapeutic relationship as it has three strands which he names as bonds, goals and tasks.
• He identifies these as “an agreement on goals, an assignment of task, and the development of bonds (p253).
![Page 5: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/5.jpg)
Stages of the relationship
• Gilbert and Leahy (2007) identify three stages in the development and maintenance of the therapeutic relationship which are the :
• Establishment• Development • Maintenance stages in therapeutic relationship, all of which have mini outcomes or objectives.
![Page 6: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/6.jpg)
Establishment (The therapist)
• Rapport
• Core conditions
• Negotiation of goals the Collaborative
framework
• support and guidance and affirmations
![Page 7: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/7.jpg)
Client Engagement Objectives
• Expectancies
• Intentions
• Motivations
• Hope
![Page 8: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/8.jpg)
Development
Counsellor (demonstrates)• Honesty and transparency establish
a trusting relationship • Encourage a commitment from the
client
![Page 9: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/9.jpg)
Maintain
• To help maintain the relationship clients need to feel satisfied with the quality of the relationship and that they feel that the alliance is productive and positive (Reis and Brown ,1999)
![Page 10: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/10.jpg)
• As soon as the two roles of therapist and client
exist, interpersonal factors come into play e.g. dealing with basic issues such as expectations, goals, rationale, telling the story, assessment etc.
• Therapists need to be aware of these factors and in articular the role they play in client resistances
It a two way process
![Page 11: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/11.jpg)
Ruptures
• Establish a stage of ‘we-ness’ frame the impasse as a shared experience ( Leahy 2007)
• The collaboration is an ongoing negation • Ruptures can be seen as ‘windows 'into a clients
interpersonal belief system and have the potential for real growth if worked through
• Counsellors need to be aware of their own responses and be willing to take responsibility for the part they play in the rupture.
(Gilbert and Leahy, 2007)
![Page 12: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/12.jpg)
Threats to the relationship therapists factors
If the therapist is:
• Intrusive
• Defensive
• Demonstrates negativity
• Inappropriate self-disclosure
![Page 13: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/13.jpg)
Threats to the relationship client factors
• Resistance• hostility • Challenge• withdrawal • Misunderstanding
It is essential that the therapist possesses the skills to be able to deal with these impasses in
the process
![Page 14: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/14.jpg)
Therapist need to be aware of
Client’s reactions towards them especially negative feelings of:• Frustration• Annoyance• Disappointment • Positive feelings of admiration• Adoration
![Page 15: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/15.jpg)
Skills for dealing with interpersonal issues in CBT
RELATIONSHIP BREAKDOWNS DURING SESSIONS (Safran & Segal, 1990)
1. The client is skeptical.2. The client is sarcastic.3. The client makes indirect allusions to relationship
problems via a third relationship – e.g., ‘I can’t stand women who tell me what to do.’
4. Client and therapist disagree on goals or tasks.5. Client is over-compliant.6. The client does not respond to an intervention.7. The client activates ‘therapy safety behaviours’: e.g.,
avoids going near painful areas.
![Page 16: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/16.jpg)
How therapists can unhook from negative interpersonal patterns
• First, be aware enough of own reaction to ‘catch’ oneself reacting.
• Second, be aware enough to step back from the reaction to avoid ‘over-reaction’ or ‘retaliation’ (some client behaviours can be quite provocative).
• Third, decide when to comment – may be best to discuss in supervision first.
• Fourth, consider and own one’s part in the interaction (sometimes the main problem can be a therapist schema reaction – e.g., the therapist’s need to be helpful or right, etc.).
![Page 17: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/17.jpg)
IMMEDIACY: a key interpersonal skill
• Immediacy is the skill to use reflections on the nature of what is going on between you and the client in ways that are helpful to the client.
• Often useful to ‘slow things down’ and invite the client to reflect with you – ‘Can we just stop and think what happened there? It seemed to me that … How did it seem to you?’
• Need to think how emotionally open I can be with this client. It can be a priceless opportunity for them to learn how they come over to others. Most social situations are not safe enough for this – therapy can be.
![Page 18: The Therapeutic Alliance Cognitive Behavioural Therapy (Source : Gilbert and Leahy, 2007)](https://reader033.fdocuments.us/reader033/viewer/2022061612/56649ea75503460f94baaec9/html5/thumbnails/18.jpg)
References
Gilbert, P., Leahy, L. (eds)(2007) The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies, London: Routledge.