PT04 Enable the client to understand the rationale for cognitive and behavioural therapy

Overview

This standard is about helping the client to understand how cognitive and behavioural therapy works and how it might relate to their own problems and experience.  The focus is helping them to engage in the therapy, by recognising and empathising with their doubts, uncertainties and vulnerabilities. This standard describes therapeutic practice that has been shown to benefit adult clients engaged in cognitive and behavioural therapy for healthcare reasons, particularly depression and anxiety disorders. (See reference in the additional information section on page 3.) To apply this standard, practitioners also need to take account of the multiple problems and complex co-morbidities that individual clients may bring to therapy. Cognitive and behavioural therapy should be offered as part of an explicit and structured approach agreed within the treatment team and with the client. Users of this standard will need to ensure that they are receiving supervision and that their practice reflects up to date information and policies. This standard should be understood in the context of the Digest of National Occupational Standards for Psychological Therapies. Version No 1

Knowledge and Understanding

You will need to know and understand:

Rationale for cognitive and behavioural therapy

1. the theoretical and evidential basis of cognitive and behavioural therapy models
2. the theoretical and evidential bases for the understanding of clients’ problems
3. how to present complex ideas in ways which the client can understand


Principles and practice of cognitive and behavioural therapy

4. cognitive and behavioural models of depression and anxiety disorders and their underlying mechanisms
5. the principles underlying cognitive and behavioural approaches to common psychological problems
6. how cognitive and behavioural models are translated into treatment
7. evidence based cognitive and behavioural techniques used in treatment of depression and anxiety disorders
8. the main goals of treatment for the client’s psychological problems
9. the effects and impact of prescribed medication, non-prescribed drugs and alcohol on the client’s health and wellbeing
10. how to adapt your communication to the client’s individual needs


Working together in cognitive and behavioural therapy

11. verbal and non verbal behaviours
12. listening skills
13. effective and ineffective interpersonal behaviours
14. personal self awareness
15. how to engender trust
16. how to develop rapport
17. professional boundaries and codes of conduct
18. how to ‘read’ and interpret the client’s emotional reactions

Performance Criteria

You must be able to do the following:

1. help the client explore and understand:
1. how cognitive and behavioural therapy works
2. underlying cognitive and behavioural mechanisms associated with their types of problem
2. work in a collaborative manner to help the client see the potential relevance and utility of cognitive and behavioural therapy to their own difficulties
3. communicate with the client in a way they are likely to understand
4. use examples from the client’s own reports in-session to help them understand the association and associative changes between:
1. situations
2. bodily sensations
3. thoughts
4. feelings
5. behaviour
5. help the client identify the physiological, cognitive, emotional and behavioural components relevant to their own experience and explore how these can interact to maintain the problem
6. help the client understand how change in one component is likely to result in changes in other components
7. where requested, provide the client with a brief account of the efficacy data for treatment programmes for the specific psychological problem
8. explore the client’s understanding of the rationale through their own expression of it
9. discuss any concerns or queries the client has regarding their vulnerability, predisposing or precipitating factors
10. respect the client’s ambiguities, questions or scepticism about  the rationale, openly and non-defensively, inviting consideration of alternatives
11. be supportive in eliciting any beliefs about the difficulties in achieving skills in using cognitive and behavioural therapy
12. where requested, provide clinical information to the client about their difficulties and summarise the cognitive and behavioural model for them

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard is derived from research reported in Roth A D and Pilling S (2007) The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. Department of Health/University College London. This standard has indicative links with the following dimension within the NHS Knowledge and Skills Framework (October 2004). Dimension: HWB4 Enablement to address health and wellbeing needs