Studieboek - The therapeutic relationship

26 important questions on Studieboek - The therapeutic relationship

What is known about the effect of the therapeutic relationship to treatment results? (3)

1. It is a necessary but not a sufficient condition
2. The nature of a client's participation is the most important
3. Client's perception of empathy is better predictor of treatment outcome

How can a working alliance or a therapeutic collaboration be described?

As a particular interpersonal dynamic within CBT that is an active partnership of collaboration and discovery

What are important factors to a working alliance or therapeutic relationship? (3)

1. The client and therapist work as a team with their own expertise and responsibility
2. Based on trust, rapport, and collaboration (empathic collaboration)
3. The therapists' behaviors and characteristics can influence the conversation and the beliefs developed early in life of the client
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In what way is a therapeutic relationship considered as 'a relationship in its own right'?

In that it has the potential fo providing new evidence about the range of possibilities for relationships

When should the alliance be established?

Within the first 3-4 sessions. However, the alliance varies as treatment progresses and should therefore stay a focus of concern

What qualities in the working alliance do clients consider to be important? (4)

1. Helped to understand their problems
2. Encouraged to face whatever situations cause them distress
3. Able to talk to an understanding person
4. At ease with the personality of the therapist

What is important in the role of the therapist? (5)

1. Work collaboratively and empathically to engage the client
2. A guide or mentor rather than an instructor
3. Open-minded curiosity and respect for the client: do not assume that you know how he feels or thinks
4. Tone of interaction is crucial (genuine & concerned interest)  
5. Still maintain scepticism about what the client is saying due to cognitive errors

What different roles can a therapist have? (3)

1. Information-giving
2. Practical scientist
3. Collaborative natures

What is important in the role of a practical scientist as a therapist? (3)

1. Provide a model for the client to adopt in relation to both current/future issues
2. Adopt an open-minded approach
3. Look for evidence that contradict your initial hypotheses

What is important in the collaborative nature of a therapist? (2)

1. Relate to your client in an adult-to-adult way
2. Be open about your ideas and share your take on the formulation in a way that allows the client to give feedback on it's relevance or accuracy

What are the Rogerian values? (4)

1. Warmth
2. Empathy
3. Genuineness
4. Unconditional positive regard

What do clients want their therapist to be/do? (4)

1. Offer a safe setting that is free from distraction
2. Respectful and competent and treating the client's concerns seriously
3. Prioritise client interest over their own
4. Share practical information about how to make life improvements

What are ways to establish a positive and collaborative client-therapist relationship that is connected to the general principles of the CB approach? (4)

1. Careful listening to get a real sense of how it is to be the client
2. Taking time to set a shared agenda
3. Making it clear that feedback is welcome
4. Carefully establishing the client's goals for treatment

What is important to be aware of about the client?

That some may be at a relatively early stage in their preparedness to change. Therefore, collaboration may in that case be better achieved through initial motivational work than through active CBT

What are the signs of a rupture in the therapeutic relationship? (3)

1. Non-verbal cues and emotional state
2. Observation of own feelings
3. Outward signs

What is recommended regarding a rupture that has to do with the client-therapist bond?

To deal with this within your current therapeutic relationship, without assuming that the problem is a reflection of your client's characteristic interpersonal relationships.

What can you do if the issue is on your side? (2)

1. Discuss it with your supervisor
2. Self-supervision (recordings/ATs and images/look for hot cognitions)

What questions can you ask yourself to tackle the client's poor motivation and ambivalence? (5)

1. What function does the behavior have?
2. What idiosyncratic beliefs may be fuelling the impasse?
3. What fears may the client have about complying?
4. What skills may he lack?
5. What environmental features may contribute?

How can the problem of a therapeutic rupture be tackled? (Just like in other problems in CBT? (7)

1. Revisiting the formulation and rationale
2. Use Socratic methods to clarify the issues
3. Collaborating and providing choices while still providing structure
4. Reviewing the pros and cons of change
5. Communication with the client's language, metaphors or images
6. Gently persisting when to client subtly avoids answers
7. Maintaining an empathic attitude, and avoiding blaming or negative interpretations for your client's behavior

What should be the emphasis on when developing a good therapeutic alliance and engagement when working with diversity? (3)

1. Show respect for the client's culture
2. Acknowledge the difficulties he may face through discrimination
3. Be open about issues that have to do with race or minority issues

What is important to keep in mind when working with different groups? (4)

1. CBT translates well to different belief systems
2. Demonstrate your credibility early on
3. Acknowledge differences in belief about the nature of the client's problems
4. Be aware of differences in beliefs about the therapeutic relationship

What is important when using an interpreter? (5)

1. Interpreter should be psychologically minded and receive minimal training in CBT working
2. Should be protected from traumatization or despair
3. Acceptability of the interpreter to the client
4. Interpreter should understand the importance of confidentiality
5. Keep in mind differing non-verbal and social behaviors between groups and the different meanings of words and concepts

What are the main governing principles of therapeutic encounters? (2)

1. Client's needs must have primacy
2. Gratification of the therapist's needs is excluded from consideration in the therapeutic setting

In what ways should therapeutic boundaries be set?

In such a way that the client can feel safe, trust the therapist to act in his interest, feel free to disclose information, and be confident that he understands  the therapist

What are important boundaries within CBT? (5)

1. Maintain confidentiality
2. Evaluate the effect of boundary violation on the client
3. Make choices about boundaries that minimize the risk of harm to the client
4. Do not express opinions about the client's life other than relevant to the therapy
5. Seek to increase the client's independence and autonomy. Increase his freedom to explore and the choices available to him

What three boundary issues are considered? (3)

1. Dual relationships
2. Self-disclosure
3. Physical contact

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