CT with more seriously disturbed individuals

Doing CT with this population is different in many ways. (see the discussion of CT with schizophrenia earlier in this forum) While I don't work with this group much myself, I do have some suggestions for adjusting "standard" CT for more seriously distrubed individuals:

1. Work to secure the individual's involvement in therapy before beginning cognitive and behavioral interventions

(a) Establish a warm, genuine, empathic, accepting therapeutic relationship.

(b) Avoid interventions (i.e. interpretation, confrontation) which are likely to increase anxiety

(c) Help the individual articulate his or her goals for therapy and the reasons that trying to change is worth the effort

2. Take the individual's attentional difficulties into account

(a) Emphasize techniques which are likely to capture the individual's attention and involve them actively (such as role-playing)

(b) Use simple, concise explanations and concrete examples

(c) Periodically recap the major points covered in the session or ask the individual to summarize them

3. Give some thought to how to approach cognitive restructuring.

(a) Focus on confirmable reality, oninterpretations of specific events and interactions, not on untestable beliefs

(b) Emphasize less abstract interventions such as behavioral experiments

(c) Consider alternatives to "rational responding" such as stress-innoculation, self-instructional training, and social problem solving

Replies:

Re:CT with more seriously disturbed individuals, by P eter Holmes, 10/04/01

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