PT08 Match the structure and pace of cognitive and behavioural therapy sessions to the needs of the client

Overview

This standard shows how the therapist combines the client’s response, their progress and needs – collaboratively and flexibly with the client – to plan, pace, review and revise session structures. It reflects the reality that therapy sessions often do not progress in the way planned at the outset, and need to remain focused on the client’s needs rather than the original plan. 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:

Structure and pace

1. how the client may reveal their comfort or discomfort with the way in which therapy is going
2. how to identify when you are controlling sessions at the cost of client engagement or collaboration
3. how to evaluate progress toward goals
4. how to evaluate when goals are motivating or demotivating for the client
   
   Collaboration
   
5. how to offer your knowledge without imposing solutions on the client
6. collaborative techniques in cognitive and behavioural therapy
   
   Working together in cognitive and behavioural therapy
   
7. verbal and non verbal behaviours
8. listening skills
9. effective and ineffective interpersonal behaviours
10. personal self awareness
11. how to engender trust
12. how to develop rapport
13. professional boundaries and codes of conduct
14. how to ‘read’ and interpret the client’s emotional reactions
15. possible sources of therapeutic impasse
    
    Principles and practice of cognitive and behavioural therapy
    
16. cognitive and behavioural models of depression and anxiety disorders and their underlying mechanisms
17. the principles underlying cognitive and behavioural approaches to common psychological problems
18. the psychological and social difficulties presented by clients with common psychological problems
19. evidence based cognitive and behavioural techniques used in treatment of depression and anxiety disorders
20. the main goals of treatment for the client’s psychological problems
21. the effects and impact of prescribed medication, non-prescribed drugs and alcohol on the client’s health and wellbeing
22. how to adapt your communication to the client’s individual needs

Performance Criteria

You must be able to do the following:

1. plan the structure of the session according to the needs and capacities of the client, especially in the initial stages of the intervention
2. allow and plan for sufficient time to engage and carry out a cognitive behavioural intervention which is consistent with that demonstrated within the evidence base for the client’s particular problem areas
3. agree with the client how you will share responsibility for session structure and content
4. collaboratively set a mutually agreed, prioritised agenda and content with the client at the start of each session which fits with the time available
5. offer the client capsule summaries throughout the session and chunk important information and topics
6. monitor the client’s response to the session structure and adapt the structure collaboratively
7. detect when your actions may make it harder for the client to work collaboratively or to take responsibility
8. negotiate collaboratively and agree with the client the next steps in contact including organisational and therapeutic arrangements
9. identify and discuss difficulties the client has in participating in a manner which is congruent with the cognitive and behavioural model
10. maximise the client’s sense of control over the pacing of therapy by maintaining a collaborative stance
11. decide when issues need to be pursued and when they could act to divert attention from the agreed focus of the intervention
12. actively negotiate any need for change to the agenda with the client
13. pace the session in a manner that ensures that all agreed items can be given appropriate attention and ensure that significant issues are not rushed
14. ensure that sessions include sufficient opportunity for demonstration and practice of techniques
15. balance the need to adhere to the agreed agenda against following up important issues raised by the client

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