PT11 Conclude cognitive and behavioural therapy with the client

Overview

This standard shows how the planned conclusion of cognitive and behavioural therapy is signalled, how planning for it starts early in the therapy and how it includes preparing the strategies that the client can use to maintain the benefits of therapy and anticipate how to deal with problems that might arise. 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:

Concluding therapy

indications of resistance to concluding therapy
the types of problem that the client might experience after therapy finishes
effective strategies for maintaining therapy gains
techniques and strategies for managing relapse
collaborative techniques in cognitive and behavioural therapy

Goals for cognitive and behavioural therapy
how to evaluate when goals are motivating or demotivating for the client

Measurement for cognitive and behavioural therapy
the use of standardised and non-standardised means of measuring outcome
techniques for the client to self-monitor
how the client may reveal their comfort or discomfort with the way in which therapy is going
methods of measuring behaviour, emotion and cognition

Working together in cognitive and behavioural therapy
verbal and non verbal behaviours
listening skills
effective and ineffective interpersonal behaviours
personal self awareness
how to engender trust
how to develop rapport
professional boundaries and codes of conduct
how to ‘read’ and interpret the client’s emotional reactions
possible sources of therapeutic impasse

Principles and practice of cognitive and behavioural therapy
cognitive and behavioural models of depression and anxiety disorders and their underlying mechanisms
the principles underlying cognitive and behavioural approaches to common psychological problems
the psychological and social difficulties presented by clients with common psychological problems
the stages of human development throughout a life span and how they affect people and their needs
the impact of social relationships and environment on health and wellbeing
the changes in cognitive ability and the impact that age related transitions have on interpersonal networks
the effects and impact of prescribed medication, non-prescribed drugs and alcohol on the client’s health and wellbeing
how to adapt your communication to the client’s individual needs

Performance Criteria

You must be able to do the following:

conclude therapy in a manner that has a clear rationale, is understood by the client and has been collaboratively agreed
share possible plans for the conclusion of therapy at points during therapy when it will be of therapeutic benefit
help the client identify and talk about their concerns about conclusion at any stage of therapy
collaborate with the client to plan strategies and techniques they could use to maintain the achievements made in therapy once therapy has ended
help the client identify events which have led to their problem in the past and plan strategies to manage these events if they recur
help the client understand the nature of a crisis threatening to themselves or others, how it might occur and how to respond to it
help the client identify how they can reconnect with you or others in your service if they need to
complete the final assessment measures relevant to the client’s problems and experience
elicit feedback from the client about their experience of the therapy, its ending and the need for follow up or further support and resources

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