Team CBT
The T in TEAM stands for testing, Tesing is done before and after every session. It not only assess symptoms and progress. but testing evaluates the therapist and their relationship to the client by assessing the patients perceived empathy !
E in Team stands for Empathy, it is the foundation of TEAM CBT being empathetic first with the client is integral for success. Without the empathy which the client experiences, there will be a poor therapeutic alliance and minimal progress!
A in team stands for Agenda setting is now referred to as the Assessment of Resistance, I use both names as you will find information under both names. Agenda setting/ Assessment of resistance is the process of dealing with resistance, we all know resistance is always there, TEAM CBT deals with it right up front using paradoxical interventions to engage the client much like motivational interviewing
M stands for Methods. Methods are the essence of TEAM CBT There are approximately 150 CBT methods that are available for Team CBT. The methods are the last step in the treatment process. Once the resistance is gone methods have a much better chance of working
How to use team therapy to get improved results.
TEAM CBT is somewhat unique in how it approaches consumers. The very first step in working with this is to test them, not really a screening like many therapists do, but more of a series of tests to dive deep into what is bothering the consumer and what they’re hoping to achieve in therapy .
The underlying model for TEAM CBT is essentially the same as CBT: “We are not bothered by the things in our life but actually our perception (thoughts ) of them” What we think about our world creates our emotions. We may be aware of it, although we may not be aware of how we think about our world, life, situation, mood, relationships etc. I believe most are not aware on a conscious level. Developing that awareness allows TEAM CBT to focus in on what can be changed to help with the mood, anxiety, relationship etc.
At the point of knowing what the problem is, most therapists, being the good helpers that they are, will try to help the client make the necessary changes in their lives, or thoughts or whatever your school of psychotherapy may say to do to help them. Often suggesting a long course of psychotherapy, if you see an psychoanalyst, that may be weekly sessions for 10 to 11 years. Others 1-2 years. Not in TEAM CBT, in TEAM CBT we empathize, empathize and then empathize some more. How do we know when we have fully empathized with a client. Well, traditionally we have decided as therapists that we empathized enough with a consumer, it is the rare therapist that asks for feedback from the client, regarding whether or not they feel fully understood! To illustrate this point when was the last time you asked a patient:t do you feel I understand you and your issues completely? How many therapists assess how the consumer experiences the therapist’s empathy and work? Consider the power shift between the consumer and therapist, when we begin asking consumers if they are understood by us, it equalizes the playing field and clearly communicates that we care what the client experiences during our sessions. Lets look at some information about empathy Culture of empathy /Tests
Perceived psychotherapists empathy
For those of you who like Git
The Burns Empathy Scale
Using the Burns Empathy Scale you know you have enough empathy when you get a perfect score.
Once your client is engaged and you feel you have developed a good therapeutic alliance with your client it’s time to move into the agenda-setting phase. Paradoxical Agenda Setting now referred to as Assessment of resistance depends on the problem. Dr Burns believe that there are 2 styles of resistance.
The first style outcome resistance refers to subconsciously wanting to avoid the outcome they are coming into therapy for. For example, in a addicted client may have (more than likely) outcome resistance, which is the client not really wanting to give up their best friend/coping skill/the main source of pleasure in their life. While outcome resistance may be quite different in relationship therapy, The client may blame the significant other and believe they really have no responsibility in the deterioration of the relationship but believe they are victims.
Process resistance refers to the difficult work the client has to do to change as well as their resistance to doing that hard work. Patricia Linehan has a great quote about this
“The bottom line is that if you are in hell, the only way out is to go through a period of sustained misery. Misery is, of course, much better than hell, but it is painful nonetheless. By refusing to accept the misery that it takes to climb out of hell, you end up falling back into hell repeatedly, only to have to start over and over again”
This description of how a client with borderline personality disorder may have process resistance is quite profound in my opinion. Dr. Burns has identified four targets of resistance DEPRESSION -ANXIETY-RELATHIONSHIP AND ADDICTION each of these targets will have both process and outcome resistance which has to be managed and dealt with.
For depression the outcome resistance could be that the client will have to accept some things about themselves of their world that they do not want to, while the process resistance could be completing the homework is hard to do while depressed.
Every target has its resistance. It’s up to us to help the client overcome them. When the resistance has been addressed and overcome, it is time to focus on the methods to induce change. Here are some links to help you understand this most important concept, which Dr. Burns calls the advanced calculus of therapy.
Podcast introduction of Paradocical agenda setting
The paradoxical nature of Assessment of Resistance
A great post on resistance in therapy: to contrast with Burns assessment of resistance
Finally, I want to share with you how not dealing with resistance can feel to a therapist, I read this on Reddit a couple of years ago, I truly understood where the author was coming from, it took me a long time to stop blaming myself for not being able to help all of my clients. I wish I knew then what I know now.
Discussion ThreadSomething clicked for me today, and I’m so excited, I want to share with someone who gets it!
The pattern of my sessions with clients who are ambivalent about change goes as follows (forgive the simplification):
Discuss issue, validate, normalize, empathize, etc etc. Experiential exercises/teach skills. Client balks at making change. My mind tells me I’ve done something wrong. I step back and try tip toeing around change in another way or tell myself “this client isn’t ready to change.” We get stuck.
Today I realized, the “resistance” could be something their mind is telling them about change – I can’t do it, it’s too hard, it will never work, this is stupid, I thought I could just vent/talk and I’d get better. These thoughts are where I could turn our attention to, not get stuck in my own “I suck as a therapist” thoughts.
I’m sure many of you figured this out years ago…I had a shitty internship and supervision, so I’m playing catch up.
bouncing with excitement around my office
Anyone else had ah-ha moments this week?
Methods
Now for the EASY PART, just kidding, but it seems easy compared to trying to deal with resistance and intervene at tho same time. Once the consumer is motivated and ready to make the change the originally requested we use methods to make that change. Dr Burns reports that he has over 150 methods to treat depression, anxiety, addiction, and relationship problems. Here is a link to a database of tools. 101 tools database This database breaks down if a technique is an agenda tool, empathy tool, or methods tool I find it quite helpful.
If this information has caught your interest and you want to learn more may I suggest the following links.