Fals-Stewart BCT Techniques

My role as the clinician is quite important. The primary task is to engage the client in identifying cognitive errors, refuting them, and replacing them with more adaptive thoughts. A sound therapeutic relationship is necessary for effective therapy, but not the focus of the therapy. Many forms of other counseling believe that the main reason people get better in therapy is because of the positive relationship between the therapist and client. Cognitive-behavioral therapists believe it is important to have a good, trusting relationship, but I know that is not nearly enough. We believe that the clients change because they learn how to think differently and they act on that learning. Therefore, CBT tries and focuses on teaching rational self-counseling skills. CBT is the teamwork that exists between the therapist and the client. This form of therapy is used to seek ways of learning what their clients want out of life and then helping their clients achieve those goals. The therapist's role is to listen, teach, and encourage, while the client's roles is to express concerns, learn, and implement that learning (Pucci1).

Not every addict should be treated the same. The regimen should address all of the aspects of an individual's life, including medical and mental health and follow up options. Behavioral Treatments help patients modify their attitudes and behaviors and increase healthy lifestyle skills and options. They can enhance the effectiveness of medication and help addicts stay committed to the treatment process. Cognitive Behavioral Therapy is a behavioral treatment with the goal of helping the user recognize, avoid, and cope with anything and everything involving their drug use and recovery (Davison, 2007). Therapeutic communities can also be extremely effective, especially for those who are severely addicted. They are highly structured programs that often involve residency for up to 12 months. It is important to recognize that no single treatment is appropriate for all individuals addicted to drugs (National, 2005).

They both have a “positive view of human nature and view the individual as not necessarily being a product of their past experiences, but acknowledge that they are able to determine their own futures” (Holder, 2013). They both attempt to improve their client’s wellbeing by implementing a two-way therapeutic relationship where both client and therapist collaborate to enable the clients coping mechanisms (Holder, 2013). CBT and PCT both instil the three core conditions of empathy, unconditional positive regard and congruence but in CBT it is used mainly in the establishing of the working alliance (Holder, 2013). In both methods, the relationship between client and therapist is congruent and they both use the skills of reflection, paraphrasing and

Based on the participant’s background and history, I determined that an integrative approach using CBT and Reality Therapy was appropriate. Cognitive Behavior Therapy and Reality Therapy are both effective in treating addictions. My participant struggles with negative thinking and irrational thoughts, poor decision making and problem solving which are common for a person struggling with substance use disorders. Therefore, integrating these two treatment modalities will assist the participant in restructuring his thoughts and finding effective ways to bring about changes in his life by taking responsibility for his own actions.

The foundation of therapy starts by building rapport with the client and applying strategies when necessary to overcome a variety of barriers. It is imperative to have rapport with a client and to be aware of barriers to facilitate a good treatment outcome. This will take practice and the use of methods and strategies ready to be implemented when needed. There are many components to building a good client rapport such as: intimacy, vulnerability, exploration of inner challenges, self-awareness, staying present; inner resiliency, empathy, anxiety management, and self-integration, and relationship acceptance. The two types of barriers are internal and external and this is for both the client and the therapist. The common barriers to rapport are countertransference and transference. Strategies for overcoming barriers are: Pause Moment and self-awareness. It also requires skills such as being genuine, sensitive, open, and

CBT therapists use the first session or two to complete a problem analysis, perform a detailed assessment and create a case formulation with the client. The therapist seeks to identify: 1) the behaviors, emotions, and thoughts which make the situation a problem, 2) predisposing factors, often going back to childhood and adolescents, 3) precipitants, 4) protective factors, 5) triggers, 6) symptoms, and 7) maintenance cycles (O’Connell, 2012). This starts the session out with a very problem-focused discussion encouraging growth of the problem, with goal setting often not starting until the second

Research has found CBT to be helpful in reducing relapse with older youth and males (Kaminer, Burleson, & Goldberger, 2002). CBT rate of efficacy diminishes over time which suggest incorporating other methodologies to maintain or increase CBT effectiveness. According to Miller, Forchimes, & Zweben (2011) CBT provides addicts with coping skills that were not learned because of social economic or vareity of other reasons. The intent for CBT is to collaborate with the client using a variety of cognitive, emotive, and behavioral techniques. to identify potential areas where thinking errors have led to a need to use substances or how substances have created change in beliefs and actions. Counselors can use CBT as their behavior through. Corey (2015) describes CBT as active, directive, time-limited, and psychoeducational structured therapy (p. 443). Moreover, according to Griffin & Botvin (2010) these factors consist of three components, (1)

Stevens, P., & Smith, R. L. (2013). Substance abuse counseling: Theory and practice (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.

The couple sees the purpose of counseling to be completely different, which can come to clashing heads during session and not create a positive rapport with the counselor. The most useful treatment approach for Steve and Sarah is Behavioral Couple Therapy (BCT) and Integrative Behavioral Couple Therapy (ICBT). BCT focuses on the reciprocation of the couple and compromise of positive behaviors and allows the clients to learn more about problem solving and communication skills with one another.

Accord to Farrell and Fals-Stewart (2006) BCT is a 12-session process, each session has a corresponding checklist for the therapist to complete. The first session is called: “Introduction, Recovery Contract, Catch Your Partner Doing Something Nice.” The checklist would require the therapist to introduce themselves and make the clients feel welcomed. The therapist would then explain in more detail what BCT is and why it is important. The third part of this checklist would be to explain promises and to ask for a verbal commitment for the clients to keep promises in the upcoming weeks. Part four gives an overview of each session that is to come in the upcoming weeks, while part five discusses trust discussion and a recovery contract. The next part of the checklist would talk about how to catch your partner doing something nice, followed by assigning at home practice.

Behavioral techniques utilized by CBT are designed not only to change certain behaviors, but also to elicit the individual's cognitions associated with specific behaviors.

With these attributes, they will have the fundamentals of creating a strong therapeutic alliance with their clients. The therapists should be encouraged in “treating new cases as unique and constructing new theories to fit them, rather than depending on categories of established theory and technique” (Safran & Muran, 2000). Although this does not mean that standard techniques are useless, flexibility and creativity in application of these theories is considered the most important skill of a good therapist.

The main goal of CBT is to help individuals and families cope with their problems by changing their maladaptive thinking and behavior patterns and improve their moods (Blackburn et al, 1981). Intervention is driven by working hypotheses (formulations) developed jointly by patient, his/her family and therapist from the assessment information. Change is brought about by a variety of possible interventions, including the practice of new behaviors, analysis of faulty thinking patterns, and learning more adaptive and rational self-talk skills. (Hawton, Salkovskis, Kirk, and Clark, 1989).

Many of the early theories of addiction “were based primarily on studying alcohol-dependent individuals” (Hart & Ksir, 2013, p.409). The use of CBT began with the treatment of alcohol dependence or alcoholism. CBT today is not designed for a particular substance but is the treatment for a variety of addictions. Cognitive behavioral therapy is an approach that uses cognitive-therapy techniques with behavioral skills training. With cognitive behavioral therapy individuals learn to identify and change behaviors that may lead to the continuation of drug use. CBT has “been shown to be more effective at decreasing substance use than most standard psychotherapies” (Hart & Ksir, 2013, p.414). CBT has proven to have beneficial effects that last as long as a year following treatment. CBT

This technique is used in couple’s therapy to try to keep the same routine in your life by just removing the substance. Couples sometimes think that life will just go back to normal after sobriety. For example “spouses who have not experienced much genuine intimacy throughout an extended period of their marriage expect that with the onset of sobriety they should suddenly develop closeness.”( Treadway, 1989) . The goal is to try to keep the old habits or old patterns of the relationship while removing the substance use. This will help reduce expectations during recovery. There are three strategies used in this technique, education, structure, and discussion of “the car ride home.”