What are the CBT principles of treatment? - Chapter 2

This chapter will discuss the CBT principles of treatment.

CBT is tailored as much as possible to each individual client, but there are certain principles that apply to most clients. There are 14 principles:

• Principle 1: An ever-evolving cognitive conceptualization is the basis for CBT treatment plans. These conceptualizations are based on the data clients provide at the evaluation, informed by the cognitive formulation. From the start, you can incorporate the client's strengths, resources and posivite qualities into the conceptualization too. The conceptualization will be refined throughout the therapy as additional data will be given. The following factors are of importance and should be identified:
  - Cognitive obstacles.
  - Behavioral obstacles.
  - Precipitating factors.
  - Key developmental events.
  - Enduring patterns of interpreting key events.
• Principle 2: A sound therapeutic relationship is needed for CBT. Clients differ in the degree to which they are able to develop a good therapeutic relationship and how much time and effort is needed to develop a good enough relationship.
• Principle 3: During CBT, the client's progress is continually monitored. When both therapists and clients receive feedback on how clients are progessing, client outcome enhances.
• Principle 4: CBT is culturally adapted and tailors treatment to the individual. When clients' cultures are different from your own, you may need to improve your cultural competency. The clients may differ from you in other ways as well. Educate yourself on these differences and anticipate how this might be relevant to treatment. Be aware that you still need to conceptualize the individual client and refrain from assuming that you will need to vary treatment for a given individual.
• Principle 5: The positive is emphasized in CBT. Research shows that it is important to emphasize positive emotion and cognition in treating depression. It is also important to inspire hope.
• Principle 6: Collaboration and active participation are emphasized in CBT. Encourage the client to see therapy as teamwork.
• Principle 7: CBT is values based, aspirational and goal oriented. During the first session, you should ask the client about their values, aspirations and their specific goals for treatment.
• Principle 8: CBT is mostly about emphasizing the here and now. The therapy focuses strongly on the skills clients need to improve their mood and their lives. In the following three cases can it be wise to shift the focus to the past:
  - The client shows a strong desire to do so.
  - When there is insufficient change after working toward current problems and future aspirations.
  - When it is important for the client to know how and when their key dysfunctional ideas and coping strategies started and became maintained.
  After discussing and understanding the past, you will discuss how clients can make use of their new understanding in the coming week.
• Principle 9: CBT is educative. It is very important to make the process of therapy understandable. Psychoeducation has a big part during treatment too, as well as learning the client helpful techniques.
• Principle 10: CBT is time sensitive, because a therapist should try to make treatment as short as possible while fulfilling the objectives.
• Principle 11: The sessions of CBT are structured. Therapists try to treat clients as efficiently as possible to help them feel better as soon as possible.These objectives are more easliy reached by using a standard format.
• Principle 12: Guided discovery is used in CBT and teaches clients to respond to their dysfunctional cognitions.
• Principle 13: Therapy homework (action plans) is included in the therapy. This usually consits of:
  - Identifying and evaluating automatic thoughts that are obstacles to clients' goals.
  - Implementing solutions to obstacles that may arise in the next week.
  - Practicing behavioral skills learned in session.
  Record anything that the client should remember, because clients tend to forget a lot of what happened during sessions and that tends to lead to poorer outcomes.
• Principle 14: A lot of different techniques can be used to change mood, thinking and behavior.