PT09 Plan and review practice assignments in cognitive and behavioural therapy

Overview

This standard is about the cycle of selecting, agreeing, supporting and reviewing practice assignments to allow the client to become their own agent for change. It shows how the cognitive and behavioural therapist treats practice assignments as the central mechanism that permits the client to engage in problem-solving behaviour, directly targeting the overt and covert nature of their difficulties. The therapist recognises that the object of a practice assignment is for the client to complete it to their best ability, but recognises also that there might be specific influences that may make this difficult. 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:

Practice assignments

1. practice assignments tasks or techniques for the range of client problems
2. what motivates the client to complete practice assignments and why they may have problems with them
   
   Collaboration
   
3. conversational and questioning approaches that encourage client participation
4. how to offer your knowledge without imposing solutions on the client
5. collaborative techniques in cognitive and behavioural therapy
6. scaffolding, platforming and sequencing techniques
   
   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. evidence based cognitive and behavioural techniques used in treatment of depression and anxiety disorders
19. the psychological and social difficulties presented by clients with common psychological problems
20. the main goals of treatment for the client’s psychological problems
21. the stages of human development throughout a life span and how they affect people and their needs
22. the impact of social relationships and environment on health and wellbeing
23. the changes in cognitive ability and the impact that age related transitions have on interpersonal networks
24. the effects and impact of prescribed medication, non-prescribed drugs and alcohol on the client’s health and wellbeing
25. how to adapt your communication to the client’s individual needs

Performance Criteria

You must be able to do the following:

1. offer the client a clear rationale for practice assignments, clarify their attitude to them and check their understanding of their importance
2. collaboratively agree practice assignments within each session, at the stages of therapy at which they will be effective and in line with the case formulation
3. ensure the client can demonstrate their understanding of the rationale for undertaking the practice assignments you identify
4. agree practice assignments that are:
1. manageable
2. suited to the individual client
3. with clear, specific and measurable goals
5. identify strategies that will improve the likelihood that practice assignments are carried out
6. identify in advance potential obstacles for the completion of practice assignments
7. ensure that completed practice assignments are positively counted and/or socially reinforced or rewarded
8. work collaboratively with the client to consider with empathy and without blame the reasons for non-completion of practice assignments, expressed in terms of the cognitive model
9. help the client find points of learning:
1. when practice assignment outcomes are in line with their own prior expectations or those of the therapist
2. when there is a different outcome from that which has been predicted
10. help the client identify what they have learned from their practice assignment experiences
11. draw principles which are achieved through the practice assignments in a flexible and idiosyncratic way to suit the client
12. integrate learning from practice assignments into the session, and build on this learning in identifying further practice assignments
13. encourage and support the client to take more responsibility for designing practice assignments as therapy progresses

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