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Strategic decision making in cognitive behavioral therapy

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  • ""It is reasonable to ask why the field needs another book on cognitive behavioral therapy (CBT). After all, high-quality texts and treatment manuals describing specific procedures, strategies, and techniques for the delivery of CBT have been in existence for more than 30 years. These texts and treatment manuals have been invaluable in disseminating CBT and ensuring that CBT is delivered with integrity. Without them, I could not have drafted the present volume. Despite the availability of this vast array of texts and treatment manuals, I continually encounter therapists at all stages of their careers wondering, "How, exactly, do I implement this in the real world with real-life patients?" "That didn't work--what do I do next?" and "I didn't expect that to happen in session--how should I handle it?" In these instances, it seems like there needs to be a "middle step" that translates the procedures, strategies, and techniques described in many CBT texts and treatment manuals to their in-session application. I essentially served as that middle step for the past several years, when I provided intensive training and consultation to therapists, both locally and nationally, who were hoping to achieve competency in CBT. Over time, I developed a "curriculum" of sorts, which contained important pointers and insights that I had developed from my clinical practice, my scholarly work, and my training and consulting work. I found that this curriculum addressed the vast majority of clinical decisions and problems that my trainees encountered in session. At one point, one of my trainees strongly encouraged me to write a book with these pointers and insights so that they could all be found in one place. This volume is the result of that suggestion. The single most important piece of wisdom that I have gained from my clinical, training, and consulting experiences is that strategy is key in the delivery of CBT (as it is with any evidence-based treatment). It is easy to be swept away by our patients' crises and need to vent, or to cautiously explore, but not fully execute, several different directions because we are unsure of what to do next and want to avoid spending too much time on a dead end. And yet, every time I fall into one of these traps, when the session ends, it feels unproductive, and I am unsure whether the patient is leaving the session with anything more than he or she brought to it. Patients invest a great deal of time, energy, and (in many cases) money in psychotherapy. I believe it is the responsibility of clinicians to be respectful of this investment by keeping strategy in the forefront of their minds in order to maximize the benefits that their patients will gain from each session, as well as from the entire course of treatment. These benefits are not only those that promote change (e.g., the development of problem-solving skills) but also those that can be observed in the therapeutic alliance and in patients' capacity to achieve acceptance of aspects of their life circumstances that they cannot change. Strategy means that the therapist is systematically implementing one or more techniques that are associated with a distinct mechanism of change, that are expected to move treatment forward, that are relevant to the central features of the patient's clinical presentation, and that are seen through in their entirety before their effectiveness is evaluated. All the while, the therapist maintains an open, collaborative relationship with the patient, such that the patient understands the rationale for the various techniques that are being implemented and provides feedback in order to customize the techniques to his or her own life circumstances"--Preface. (PsycINFO Database Record (c) 2013 APA, all rights reserved)."
  • "Cognitive behavioral therapists face numerous instances during each session and throughout the course of treatment in which they must make a clinical decision. These "decision points" include instances in which any number of clinical issues could be addressed, a specific intervention is not achieving its desired effect, the patient does not understand or accept the rationale for the technique, or a crisis has emerged that requires a shift in focus. This book describes strategic decision making, a flexible yet evidenced-based approach to working through decision points in order to move treatment forward in cognitive behavioral therapy. It dispels the myth that there is a single "right" therapeutic intervention that must be delivered in any one instance; in fact, many courses of action can facilitate change provided they are implemented strategically."

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  • "Ressources Internet"
  • "Electronic books"@en
  • "Electronic books"

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  • "Strategic decision making in cognitive behavioral therapy"
  • "Strategic decision making in cognitive behavioral therapy"@en

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