PT06 Collaborate with the client in implementing cognitive and behavioural therapy

Overview

This standard is about achieving collaboration between therapist and client that is at the heart of cognitive and behavioural therapy. It shows how the therapist attends to the markers of collaboration that can ensure that the client is a full participant in their therapy, not someone to whom therapy is being ‘done’. 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:

Collaboration

1. conversational and questioning approaches that encourage client participation
2. how to offer your knowledge without imposing solutions on the client
3. collaborative techniques in cognitive and behavioural therapy
4. scaffolding, platforming and sequencing techniques
   
   Working together in cognitive and behavioural therapy
   
5. verbal and non verbal behaviours
6. listening skills
7. effective and ineffective interpersonal behaviours
8. personal self awareness
9. how to engender trust
10. how to develop rapport
11. professional boundaries and codes of conduct
12. how to ‘read’ and interpret the client’s emotional reactions
13. possible sources of therapeutic impasse
    
    Principles and practice of cognitive and behavioural therapy
    
14. cognitive and behavioural models of depression and anxiety disorders and their underlying mechanisms
15. the principles underlying cognitive and behavioural approaches to common psychological problems
16. evidence based cognitive and behavioural techniques used in treatment of depression and anxiety disorders
17. the psychological and social difficulties presented by clients with common psychological problems
18. the stages of human development throughout a life span and how they affect people and their needs
19. the impact of social relationships and environment on health and wellbeing
20. the changes in cognitive ability and the impact that age related transitions have on interpersonal networks
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. encourage the client to take as active a role as possible throughout the intervention and in each session
2. use approaches that encourage the client to share responsibility for decisions about the direction of therapy throughout the therapy and in each session
3. maintain a consistently open, collaborative inquisitive style that communicates an explicit curiosity about the client’s thoughts and beliefs
4. detect and acknowledge when you make assumptions about the client’s views or beliefs, and, if relevant, ask the client to clarify
5. work with the client openly to build an individualised model of the problem that is validly evidenced for their combination of problems and co-morbidities
6. work within shared agreements about:
1. the issues/problems which the client identifies as important
2. the activities of therapy which will address these problems
3. the goals which are seen as realistic and appropriate
7. employ cognitive and behavioural treatment models and techniques that are consistent with the treatment model and the issues the client raises
8. adapt the therapy to explicit and implicit feedback from the client while remaining within the agreed model
9. identify when psychoeducation is relevant to the client’s difficulties consistent with their presentation
10. engage the client fully in the process of devising practice assignments
11. identify, discuss and manage any difficulties the client has working in a manner that is collaborative and congruent with the cognitive and behavioural model
12. maintain professional boundaries throughout the course of therapy

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