Eliciting Key Cognition

7. Eliciting Key Cognition

The main action of the cognitive behavioural therapist is to recognise the client’s problems in a cognitive way (Curwen, Ruddell, and Palmer, 2000).

On the video session, the therapist attempts to elicit automatic negative thoughts, which are ideas that spontaneously intrude into the person’s mind, are plausible to the person and which provoke a negative emotional effect (Clark, 2004). This is common in many clients, especially people with anxiety disorders (Leahy, 2009). The therapist was able to prompt the client to identify the two types of automatic thoughts: verbal thoughts and mental images (Hales et al., 2015). The client elicited verbal thoughts as “I will have a heart attack if I leave the house”. The therapist

First, the therapist attempts to investigate the behaviours that the client presented on the first time that she experiences the problem. Second, the therapist tries to understand the way the client is managing her symptoms and problems (Dobson and Dobson, 2009) by identifying the safety behaviours that the client is adopting to reduce the level of anxiety (Papworth, Marrinan, and Martin, 2013). On the video session, the therapist showed concern about the behaviours that the client was engaging on (Marshall and Turnbull, 1996), however, she should have asked her more about specific behaviours that the client was probably engaging on, based on the information that the client provided (Kinsella and Garland, 2008). The therapist tries to detect behaviours such as avoiding specific situations, like for example leaving the house alone (Papworth, Marrinan, and Martin, 2013), yet she did not explore this enough. The therapist should have also inquired the client about reassurance seeking and safety seeking behaviours, as the client stated that she calls her husband when she is feeling anxious. The therapist should have discussed this in more detail, specifically emphasising the conection between these behaviours and the vicious circle (Kinsella and Garland,

Even though conceptualization may develop along the time, the lack of a firm formulation from the first session is often a factor for delayed results (Curwen, Ruddell, and Palmer, 2000). As perceived on the video, using the Five Areas Model the therapist offers a useful way of accounting for the maintenance of the client’s anxiety (Williams and Garland, 2002). A discussion of the formulation with the client should had occurred more elaborately, as this is a very important step to promote the client in engaging in the therapeutic process (Dobson and Dobson, 2009). At the end of the video session, the therapist gives a summary of the problem currently being experienced using the Five Areas Model (Williams and Garland, 2002), however, this could have been done with more detail. As a formulation is hypothetical and based on a theory, the therapist should have asked for the client’s feedback on the formulation (Butler, Fennell, and Hackmann, 2008). In the first session, the therapist should have educated the client about her diagnosis, explaining the cognitive model. As viewed on the assessment session video, the therapist elicits expectation of the treatment and most important, instils hope by setting specific goals with the client on the first session (Primary Psychiatry,