{"id":44080,"date":"2021-08-01T16:19:00","date_gmt":"2021-08-01T20:19:00","guid":{"rendered":"https:\/\/www.shortform.com\/blog\/?p=44080"},"modified":"2021-08-02T16:21:09","modified_gmt":"2021-08-02T20:21:09","slug":"tips-for-therapists","status":"publish","type":"post","link":"https:\/\/www.shortform.com\/blog\/tips-for-therapists\/","title":{"rendered":"8 Tips for Therapists (and Problems to Avoid)"},"content":{"rendered":"\n<p>What are the best tips for therapists? What are some common problems you should avoid?<\/p>\n\n\n\n<p>From patient engagement, to the structure of a session, to setting feasible expectations, there are many things to consider as a therapist. Knowing some effective tips for therapists can help you navigate this, as well as understanding common issues you might face.\u00a0<\/p>\n\n\n\n<p>Keep reading for the best tips for therapists.&nbsp;<\/p>\n\n\n\n<!--more-->\n\n\n\n<h2 class=\"wp-block-heading\"><strong>8 of the Best Tips for Therapists<\/strong><\/h2>\n\n\n\n<p>Here are some helpful tips for therapists, targeting common problems you might face in your practice: <\/p>\n\n\n\n<h3 class=\"wp-block-heading\">1) <strong>Be Aware of Possible Problems<\/strong><\/h3>\n\n\n\n<p>As a therapist, you may run into the following shortcomings:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Failing to set patient expectations for therapy, and of her responsibilities.<\/li><li>Failing to emphasize key automatic thoughts<\/li><li>Failing to summarize frequently<\/li><li>Failing to summarize using patient\u2019s own words<\/li><li>Failing to ask the patient for depth of understanding<\/li><li>Failing to provide rationale for agenda items or your direction<\/li><li>Failing to make a therapeutic intervention\u2014just <a href=\"https:\/\/www.shortform.com\/blog\/talking-about-problems\/\">talking about problems<\/a> without solving them or assigning homework<\/li><li>Failing to record therapy notes for patient to review<\/li><\/ul>\n\n\n\n<p>Getting feedback on your performance is helpful. Ask the patient if you can record their session, so you can review the session with a colleague.<\/p>\n\n\n\n<p>Beware of your own <a href=\"https:\/\/www.shortform.com\/blog\/negative-automatic-thoughts\/\">negative automatic thoughts<\/a> about the patient, therapy, or yourself. Not all sessions will go well. Instead of catastrophizing the problem and questioning your ability as a therapist, see it as an opportunity to refine your skills.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">2) <strong>Manage Patient Engagement&nbsp;<\/strong><\/h3>\n\n\n\n<p>In general, problems in CBT sessions can be a result of one of two issues: 1) insufficient socialization (the patient lacks training on what to do) or 2) reluctance to comply (the patient knows what to do but doesn&#8217;t want to do it).<\/p>\n\n\n\n<p>Distinguish between the two by socializing the patient to the CBT model.&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>If the patient gives a neutral reaction, then it&#8217;s a socialization problem.<\/li><li>If the patient is frustrated, then follow this standard procedure, 1) thank the patient for expressing her thoughts, 2) investigate automatic thoughts, 3) provide rationale for what you&#8217;re doing. Directly tackling automatic thoughts can work, but sometimes it causes too much friction<\/li><\/ul>\n\n\n\n<p>Causes of reluctance to comply include a weak therapeutic alliance; ineffective structure or pace of session; unrealistic patient expectations; lack of patient understanding of cognitive model; or the patient\u2019s biology or external environment.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">3) <strong>Know How to Interrupt&nbsp;<\/strong><\/h3>\n\n\n\n<p>To get the session on track to cover the most helpful items, you will have to interrupt.&nbsp;<\/p>\n\n\n\n<p>An effective way to do this is to:&nbsp;<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Ask if you can interrupt<\/li><li><a href=\"https:\/\/www.shortform.com\/blog\/ask-for-what-you-want\/\">Ask for what you want<\/a>, or summarize what you&#8217;re hearing<\/li><li>Ask if that sounds right.<\/li><\/ol>\n\n\n\n<p>If the patient is upset at the interruption, follow the standard procedure from above. Also apologize for interrupting, and ask if they would like to continue and leave some topics behind, or to talk uninterrupted.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>4) Don\u2019t Over-Structure<\/strong><\/h3>\n\n\n\n<p>If the patient\u2019s automatic thoughts reveal feeling boxed in by the session, ask if the patient would like to begin the session without agenda setting but just talking at length.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>5) Don\u2019t Challenge&nbsp;<\/strong><\/h3>\n\n\n\n<p><strong>Never challenge a patient\u2019s thought or belief.<\/strong> This violates the collaborative empiricism of CBT. You are to guide the patient to examining her own thought.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>6) Increase Homework Completion Rate&nbsp;<\/strong><\/h3>\n\n\n\n<p>Here are techniques to increase <a href=\"https:\/\/www.shortform.com\/blog\/cbt-homework\/\">CBT homework<\/a> completion rate:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Commitment devices<ul><li>Daily checklists of tasks<\/li><li>Scheduling tasks in the patient\u2019s calendar<\/li><li>Ask the patient to leave a voicemail with you whenever <a href=\"https:\/\/www.shortform.com\/blog\/how-to-complete-a-task-successfully\/\">finishing a task<\/a><\/li><\/ul><\/li><li>Find barriers for doing homework, and problem solve those barriers.<ul><li>Rehearse the situation leading up to doing homework to find issues.<\/li><li>These may be practical barriers, such as lacking time in schedule or forgetting.<\/li><li>They may also be mental barriers, such as overestimating time or effort, overcoming the activation energy to get started, or believing it won\u2019t work.<ul><li>Ask the patient what the worst that can happen is, and the best.<\/li><li>Remind the patient that they\u2019re not aiming for perfection.<\/li><\/ul><\/li><\/ul><\/li><li>Anticipate negative results of homework and address subsequent automatic thoughts<\/li><li>Start homework in session, so that offline homework is merely continuation of the task rather than completion.<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>7) Give Positive Reinforcement<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Positively reinforce patients <\/strong>for <a href=\"https:\/\/www.shortform.com\/blog\/providing-feedback\/\">providing feedback<\/a>. \u201cIt\u2019s great that you recognized your thinking.\u201d<\/li><li>Positively reinforce patients for making strides in their therapy. For example, when the patient notices automatic thoughts, suggests new solutions, or does homework.<\/li><li><strong>Highlight evidence of improvement <\/strong>makes the patient more optimistic that the method is working. Improve the patient\u2019s mood during the session and <a href=\"https:\/\/www.shortform.com\/blog\/create-a-plan\/\">create a plan<\/a> to feel better during the week.<\/li><li><strong>Emphasize the positive<\/strong>.&nbsp;<ul><li>Elicit patient strengths.<\/li><li>Elicit positive data from the preceding week. \u201cWhat positive things happened since I saw you last?\u201d<\/li><li>Elicit data contrary to their negative thoughts.<\/li><li>Ask what positive data means about the patient.<\/li><li>Give positive feedback on adaptive coping mechanisms: \u201cWhat a good idea.\u201d<\/li><\/ul><\/li><li>Don\u2019t attack the core beliefs too early\u2014this can endanger the alliance. Instead, identify the cognitions that are closest to conscious awareness, then work your way down into core beliefs over time.<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>8) Read This Example Discussion<\/strong><\/h3>\n\n\n\n<p>This example dialogue pieces together the three steps of identifying automatic thoughts, evaluating them, and creating a behavioral experiment.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Therapist: OK, Sally, you wanted to talk about getting a part-time job?<\/li><li>Patient: Yeah, I need to work for the money, but&#8230;I don\u2019t know.<\/li><li>Therapist: [noticing Sally\u2019s dysphoria] What\u2019s going through your mind right now?<\/li><li>Patient: [automatic thought] I can\u2019t handle a job.<\/li><li>Therapist: [<a href=\"https:\/\/www.shortform.com\/blog\/negative-labels\/\">labeling<\/a> the idea as a thought and linking to her mood] And how does that thought make you feel?<\/li><li>Patient: [emotion] Really sad. Hopeless.<\/li><li>Therapist: [beginning to evaluate the thought] What\u2019s the evidence that you can\u2019t handle a job?<\/li><li>Patient: Well, I\u2019m already having trouble getting through my classes, so how can I handle a job?<\/li><li>Therapist: Is there anything else?<\/li><li>Patient: I feel so tired everyday. It\u2019s already hard to just <em>look<\/em> for a job\u2014how can I actually go to work everyday?<\/li><li>Therapist: In a minute we\u2019ll look at that. [suggesting an alternative view] It\u2019s possible that looking for a new job is the harder part, and that once you have a job, keeping it is easier. Is there any other evidence that you couldn\u2019t handle a job, assuming you can get one?&nbsp;<\/li><li>Patient: No, nothing comes to mind.<\/li><li>Therapist: [evidence on other side] Is there any evidence on the other side, that you <em>might<\/em> be able to handle a job?<\/li><li>Patient: I <em>did<\/em> keep my part-time job last year, and I was able to do OK in school too. But this year&#8230;I don\u2019t know.<\/li><li>Therapist: Is there any other evidence you could handle it?<\/li><li>Patient: It\u2019s possible if the job didn\u2019t take that much time and wasn\u2019t so hard, I could keep it up.<\/li><li>Therapist: What kind of job might that be?<\/li><li>Patient: Maybe working in a store, like what I did last year.<\/li><li>Therapist: [helping build concrete solutions] Are there any places like that where you could find a job?<\/li><li>Patient: Maybe the college bookstore. I saw they were hiring in an email.<\/li><li>Therapist: OK. And what would be the <em>worst <\/em>that could happen if you got a job there?<\/li><li>Patient: I\u2019d get overwhelmed and fail.<\/li><li>Therapist: If that happened, how would you cope?&nbsp;<\/li><li>Patient: I guess I\u2019d quit.<\/li><li>Therapist: What would be the <em>best <\/em>that could happen if you got a job there?<\/li><li>Patient: I guess it\u2019d be easy like last year and I could do it.<\/li><li>Therapist: What\u2019s the most <em>realistic <\/em>outcome?<\/li><li>Patient: It probably won\u2019t be easy at first, but I might be able to handle that and school at the same time.<\/li><li>Therapist: Sally, what\u2019s the effect of believing your automatic thought, \u201cI can\u2019t handle a job?\u201d<\/li><li>Patient: It makes me feel sad. It makes me stop wanting to try.<\/li><li>Therapist: And what\u2019s the effect of changing your thinking, of realizing that you realistically <em>could<\/em> work in the bookstore?<\/li><li>Patient: I\u2019d feel better. I\u2019d apply for the job.<\/li><li>Therapist: So what do you want to do about this?<\/li><li>Patient: I want to go to the bookstore and apply for the job.<\/li><li>Therapist: When will you go?<\/li><li>Patient: I guess this afternoon.<\/li><li>Therapist: How likely are you to go?&nbsp;<\/li><li>Patient: Pretty likely. I\u2019ll go.<\/li><li>Therapist: How do you feel now?<\/li><li>Patient: Better. A little nervous. But I\u2019m hopeful.<\/li><\/ul>\n\n\n\n<p>Here, Sally can write a coping card that prepares a response to the situation: \u201cIf I\u2019m afraid to go to the bookstore, remind myself that I probably could handle a job there and, in the worst case, I could quit. Even then, it\u2019s not a big deal.\u201d<\/p>\n\n\n\n<p>The above tips for therapists will help you improve your practice and avoid common problems. <\/p>\n","protected":false},"excerpt":{"rendered":"<p>What are the best tips for therapists? What are some common problems you should avoid? From patient engagement, to the structure of a session, to setting feasible expectations, there are many things to consider as a therapist. Knowing some effective tips for therapists can help you navigate this, as well as understanding common issues you might face.\u00a0 Keep reading for the best tips for therapists.&nbsp;<\/p>\n","protected":false},"author":12,"featured_media":44110,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[29,34,15],"tags":[443],"class_list":["post-44080","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-career","category-communication","category-education","tag-cognitive-behavior-therapy-basics-and-beyond","","tg-column-two"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.3 (Yoast SEO v24.3) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>8 Tips for Therapists (and Problems to Avoid) - Shortform Books<\/title>\n<meta name=\"description\" content=\"Here are some helpful tips for therapists, focusing on common problems you might encounter. Find out how to be a better therapist today.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.shortform.com\/blog\/tips-for-therapists\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"8 Tips for Therapists (and Problems to Avoid)\" \/>\n<meta property=\"og:description\" content=\"Here are some helpful tips for therapists, focusing on common problems you might encounter. 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