The treatment plan is developed, and the therapeutic interventions are selected in collaboration with the patient. Aftab : Should CBT in clinical practice be restricted at the outset to a certain number of sessions say sessions the way it is done in research settings?
Or is CBT in clinical practice intended to be more open-ended and goal-dependent? My clinical observation is that when duration of CBT is not individualized and when the number of sessions is capped beforehand often due to insurance restrictions or administrative reasons , a substantial number of patients are forced to end therapy without having experienced meaningful improvement. Beck : CBT in clinical practice should not be limited to a certain number of sessions. Many patients with straightforward cases of depression or anxiety can experience significant improvement within 6 to 12 sessions.
However, patients with personality disorders, medical conditions, trauma histories, environmental stressors, and other complex conditions usually need a longer course of treatment.
Of course, in practice, not all patients are able to complete a longer course of therapy due to monetary or practical constraints. It is important that therapists understand and make every effort to work within these constraints, by being transparent with patients about their progress and making therapy as efficient as possible.
We tell all our patients that it is not enough to come to therapy and talk for 50 minutes a week. The way they get better is to make small changes in their thinking and behavior every day. When therapists and patients finish discussing a problem or goal, therapists ask patients what they want to remember and what they want to do in the coming week. Then therapists motivate them to complete these Action Plans formerly termed homework between sessions to maximize the benefits of CBT and prevent relapse without prolonging treatment.
Booster sessions, appropriately spaced in the weeks and months following the conclusion of treatment, are an effective way to ensure patient progress is maintained and that patients continue to practice their skills, and cope with new challenges that arise. Aftab : Since the initial development of CBT for depression, we have seen the development of CBTs for a multitude of indications and special populations. Where has CBT been successfully applied over the decades?
Beck : This question has been answered by research. Hofmann and colleagues did a review of meta-analyses a few years ago. They also noted the efficacy of CBT in the treatment of depression, substance abuse, psychotic disorders, bipolar disorder, insomnia, personality disorders, criminal behaviors, and distress related to medical conditions.
While most studies focus on adults, other studies show similar results for children and older adults. In addition, research has established the efficacy of appropriately tailored CBT in a multitude of settings: schools, residential programs, inpatient units, long-term psychiatric hospitals, forensic settings, community-based settings, and primary care and specialty medical clinics, to name a few.
Despite these recommendations, the availability of and access to CBTp remains limited. What are some of the difficulties that specialized interventions such as CBTp face with regards to dissemination, and what can be done about it? Beck : One challenge with the dissemination of specialized treatment, perhaps especially one like CBTp, is the lack of availability of individual therapy within different treatment services.
While those who are especially help-seeking or those who have the support of family or other loved ones may be able to access a private practice provider, there are many individuals who cannot. In state hospitals, on community teams, in the forensic system, in residences—this is where you see many individuals who are given serious mental health diagnoses.
These services often do not have the resources to offer individual therapy. Even if they did, a portion of the individuals are not help-seeking or not interested in a treatment focused on symptoms they do not see as obvious problems. My understanding is, that as currently practiced, CBTp is primarily conducted by licensed clinicians, the vast majority of whom are psychologists. In the community and hospital settings where most care is delivered, there are many staff from other disciplines where CBTp training is not offered social workers, licensed counselors, recreational and art therapists, occupational therapists , not to mention nonlicensed and paraprofessional staff such as direct care and peer specialists whose scope of practice does not include CBTp.
It can be the basis for the therapeutic milieu and the basis of treatment planning and team-based work. Licensed and nonlicensed professionals from all disciplines can do it. Straight away Maggie was warm, kind and understanding I cannot recommend Maggie highly enough to you. Whilst life still presents me with challenges I can cope with them as I feel so much stronger now — I owe her much.
My relationship with my partner is now fantastic, as are my relationships with my family I am so much happier now than I have been in many, many, years Take your first steps to lasting change Book Appointment. Client Reviews. Issues Covered:. Contact Us. This field is for validation purposes and should be left unchanged. You may also feel physically drained.
Some forms of CBT, such as exposure therapy, may require you to confront situations you'd rather avoid — such as airplanes if you have a fear of flying. This can lead to temporary stress or anxiety. However, working with a skilled therapist will minimize any risks. The coping skills you learn can help you manage and conquer negative feelings and fears.
You might decide on your own that you want to try cognitive behavioral therapy. Or a doctor or someone else may suggest therapy to you. Here's how to get started:.
Psychotherapist is a general term, rather than a job title or indication of education, training or licensure. Examples of psychotherapists include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, or other licensed professionals with mental health training.
The key is to find a skilled therapist who can match the type and intensity of therapy with your needs. Cognitive behavioral therapy may be done one-on-one or in groups with family members or with people who have similar issues. Online resources are available that may make participating in CBT possible, especially if you live in an area with few local mental health resources.
At your first session, your therapist will typically gather information about you and ask what concerns you'd like to work on. The therapist will likely ask you about your current and past physical and emotional health to gain a deeper understanding of your situation. Your therapist may discuss whether you might benefit from other treatment as well, such as medications.
The first session is also an opportunity for you to interview your therapist to see if he or she will be a good match for you. Make sure you understand:. It might take a few sessions for your therapist to fully understand your situation and concerns, and to determine the best course of action.
If you don't feel comfortable with the first therapist you see, try someone else. Having a good "fit" with your therapist can help you get the most benefit from CBT.
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