Ray W. Christner, Psy.D., NCSP CEO, Cognitive Health Solutions, LLC - - PDF document

• Ray W. Christner, Psy.D., NCSP

CEO, Cognitive Health Solutions, LLC Licensed Clinical Psychologist Certified School Psychologist

• Review the basic tenets of Cognitive-Behavior

Therapy (CBT)

Discuss a guiding factors that lead to effective

CBT interventions

Case Conceptualization (Content) Session Structure Interventions and Process (Components of Practice) Working Relationship Q&A

• Automatic Thoughts – thoughts that occur without

much consideration (habitual and reflexive)

Core Beliefs – fundamental beliefs that influence

response to a situation (e.g., how we think, feel, and act)

Schema – a cognitive framework that serves as a

basis for screening, organizing, and interpreting situations based on past experiences (e.g., clusters of core beliefs about the self, others, and the future)

• Problem

Situational Cognitive Affective/ Physiological Behavioral

• Cognitive Deficiency – the lack of information

processing

Cognitive Distortions – an active but misguided

way of processing information

Skill Deficiency – the lack of a specific skill Skill Dysfunction – the lack of implementation

• r generalization of skill

Socializing Children to Therapy

• CHANGE
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• Conceptualize the problem

Select problem of focus/intervention point Determine goals Choose interventions and techniques Helps predict behavior Manage noncompliance

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Identifying Data/Personal Information Problem List Relevant Assessment Data Antecedents and Triggers Developmental considerations Cultural consideration Protective/Resiliency Factors Risk Factors Readiness to Change Impediments to Change Working Hypothesis Origins of Working Hypothesis

Assessment Conceptualization Treatment Planning

Progress Monitoring

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Manual-Based Interventions Modular-Based Interventions Benefits

Specific content to be addressed Clearly defined procedures to use Step-by-step procedures to follow Articulated activities to follow Outcome research Difficulties Not meeting the individual needs of clients Difficulty getting clients to attend 15 to 20 sessions Addressing the clients’ skills but not the barriers and

difficulties that affect implementation

Anxiety Coping Cat (Kendall, 1993) Social Effectiveness Therapy for Children (Beidel & Turner, 1998) Child Anxiety Management Program (CAMP; Friedberg & Elamir, in preparation) Cognitive-Behavior Group Therapy - Adolescent (CBGT-A; Albano, 2000) Coping Koala (Barrett, 1995) Anger and Aggression Chill Out Program (Feindler & Ecton, 1986; Feindler & Gutman, 1996) Coping Power Program (Larson & Lochman, 2002) “Keeping Cool” (Dwivedi & Gupta, 2000). Aggression Replacement Training (ART; Goldstein, Glick, & Gibbs, 1998)

• Depression

Coping with Depression (Clarke, Lewinsohn, & Hops, 1990; 2003) ACTION Program (Stark & Kendall, 1996) Social Problem Solving I Can Problem Solve (Shure, 1994) Social Problem Solving (SPS; Elias & Tobias, 1996)

Benefits Decreases the demands of following a manual-based

program

Uses specific techniques from manual-based programs Allows the use of outcome research to develop good

interventions

Bases intervention on specific client needs Difficulties Must have good case conceptualization skills Must use single case design and progress monitoring more

efficiently to measure outcome

Must have a good understanding of the literature across

various disorders Benefits

Decreases the demands of following a manual-based program Uses specific techniques from manual-based programs Allows the use of outcome research to develop good

interventions

Bases intervention on specific client needs

Difficulties

Must have good case conceptualization skills Must use single case design and progress monitoring more

efficiently to measure outcome

Must have a good understanding of the literature across various

disorders

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Goal Setting Cognitive Restructuring/Reattribution Exposure/Response Prevention Relaxation Modeling Psychoeducation Self-Monitoring Self-Praise/Positive Self-Talk Problem Solving Assertiveness Skills Social Skills Communication Skills Activity Scheduling Behavioral Contracting Relapse Prevention/Maintenance Guided Imagery Relationship Building Personal Safety Skills

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• Relational check in

Set agenda for this session Solicit feedback regarding previous session Review current status and events since last

session

Review homework from previous session Focus on main agenda items (e.g., skill

building)

Develop new homework assignment Solicit feedback regarding current session

• CHANGE
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Away from the model of “separate self” Towards a model of connection where we

grow in, through, and toward relationship

Good connection with others is central to

psychological well being

• Disconnection is inevitable and part of being in

relationship

They are often caused by empathic failure Strengthened relationships result when the injured is able

to represent his/her feelings and the other responds empathetically

When he/she receives a response of indifference

additional injury or denial of her experience occurs and leads to failures in growth fostering relationship thus less zest-empowerment-clarity-worth- and desire for connection Make the creation and cultivation of a therapy

relationship a primary aim.

Be up-front Give and gain respect Develop goals together Agree on tasks of treatment Establish and maintain interpersonal bond Provide safety to see and be seen, know and be known

Routinely monitor child’s responses to the

therapy relationship and ongoing treatment.

CHANGE

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CHANGE

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