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What is CBT?
combines cognitive theory and behavior theories. great in trauma, criminal justice, depression, anxiety, and addiction. is brief and goal oriented.
The way i think impacts the way that I feel and act about things. uses rewards and punishment to change behavior.
Maslow's Hierarchy of Needs
- Hard to do treatment
- Biological/Physiological - breathing, food, sex, water, excretion, sleep
- Safety - security of body, employment, resources, morality, family, health, property
- Love/Belonging - friendship, family, sexual intimacy
- Treatment much more likely and possible
- Esteem - self-esteem, achievement, confidence, respect of others and by others (start really working with client)
- Self-Actualization - morality, spontaneity, creativity, problem solving, lack of prejudice, acceptance of facts
be concise and objective, not subjective. condense notes and make sure they are done within 48 hours max of session. be thorough and provide details relevant to client.
Discuss Encouraging Body Language, How you ask questions, and active listening:
SOLERF - Square on, open arms, lean forward a bit, eye contact, relax, friendly
get used to feeling uncomfortable with physical posture to be conscious of posture, always give yourself the way out.
- Summarize - leave things open ended
- Paraphrase - provide encouragement and empathy, make them feel heard and comfy. speak appropriately (not too loud or soft, fast or slow), open & closed ended questions
- Tell client if a subject makes you feel uncomfortable and redirect if out of scope of practice. repeat back what you hear, keep mouth closed, 3 syllable minimum in comments. why ?s can come across as judgmental (hows or whats are better)
- open ended - no wrong answer
- closed ended - short answers
- both for getting info about person
12 core functions
- Screening - substance? which? when? how often?
- brief intervention
- treatment referral
- Administrative Intake - admin and assessment procedure for admission to program
- Orientation - how our company's program works
- Assessment - make small interpretation
- Treatment Planning - use of interventions and goals to overcome AOD problems. talk about changing planning if ASUDC
- Counseling - not therapy, just counseling to client and those involved in treatment
- Case Management - point towards resources
- Crisis Intervention - manage problem
- Client Education - teach about disorders & how to identify them
- Reports and Record Keeping - take correct notes
- Consultation with Other Professionals
- Maintain the Professions Code of Ethics at all times - how to ask others for help
Advocate for yourself using these as guide
- Began with Freud. based in childhood experiences
- personality built off 2 structures
- Consciousness structure
- -preconscious - if focused on becomes conscious (breathing)
- -unconscious - comes out in different ways (art, dreams, doing things we don't mean to do)
- Id, ego, superego
- id=instincts, pleasure principle
- ego-moderator between id & superego, rational
- superego=all about society (society tells us what we should think). not feeling these things can cause guilt
- uses neo-analytic theory and psychosexual development
- Defense Mechanisms
- denial, projection, isolation, rationalization, repression, displacement, identification (take on quality of another to quelm fear of him/her)
- oral-birth to 1
- anal-2-3 yrs
- phallic-4-5 yrs
- oedipus and elektra complex (boys and girls fantasize about parent of opposite gender at peril of losing genitals for boys)
Rational Emotive Behavior Therapy (REBT)
Activating event - perceived interpretation of event (not necessarily the
Belief - rational and irrational (irr=we start "awfulizing" the world). the healthier one is, more accurate thoughts are. unhealthy thoughts being with "i should" or "i must"
Consequence - our emotions & actions or reactions to them
Low frustration tolerance (not fair she makes more money than me when we both began working at same place at same time)
Global rating - I'm a loser, You're an idiot, I'm worthless, She's stupid
change irrational thought to rational is REBT goal
- Methods of approach:
- disputing - 2 kinds
- Empirical - show me how it's end of world if dinner is not on table at 6
- Functional - what is being a loser doing for you? is this really where you want to go? Last time you were like this, you went to jail. do you want to go this time?
I see ___________ in you. that doesn't qualify you as a loser.
- Unconditional self - self acceptance
- Other acceptance - accept life outside of you/other variables
- unconditional life acceptance - life does not always go the way you want. for the most part you can always bear this
Combines cognitive theory and behavior theories.
"the way that i think impacts the way that i feel and act." use reinforcement and punishment to change behavior. good in trauma, criminal justice, depression, anxiety, addiction
replaces maladaptive behavior with desired behavior, asks lots of ?s, lots of homework done, educational process, "here and now" focus, is brief and goal oriented.
methods used: relaxation training, mental & emotive imagery, cognitive modeling, covert model (role playing), thought stopper (scream stop!), cognitive restructuring (baby steps replacing maladaptive thought with positive thought), reframing (change how problems are viewed), stress inoculation (set up anxiety inducing moment and clients uses skills to cope with situation), meditation, biofeedback (electrodes), neurolinguistic programming (use senses to sense stress)
Stages of Change
- James Prochaska
- Carlo Diclemente
- 5 experiential between first 3 stages
- Precontemplation - lots of pros for using (>6 months here)
- Contemplation - equal pros and cons for using (<6 months here)
- Preparation - cons outweigh pros (1 month)
- Self-efficacy or temptation construct seen in last 2 stages
- Action - make behavior changes, say "no" (at least 6 months here)
- Maintenance - staying in recovery
- two tools:
- measurement tools to find where on e is on this cycle - decisional balance construct - weight pros and cons of behavior (they make a list)
- Self-efficacy or temptation construct - how often & strong are urges and cravings? urges are increased through: negative affect, emotional distress, positive social situations, craving
Stages of Change (cont.) 1st 5 experiential steps
5 experiential steps - start introducing cons through education. things they have to start thinking
- 1 - consciousness raising
- 2 - dramatic relief - people change when they're tired of the emotional place they're in (role playing, personal testimonies)
- 3 - environmental re-evaluation - start realizing how their behavior impacts their environment (don't leave out bong for 6 yr old to play with)
- 4 - social liberation - show them social opportunities that do not use drugs & can provide support
- 5 - self re-evaluation - get from "drinking is cool" to "I don't want to be in trouble with the law and drinking keeps me there" (find health role models)
Stages of Change (cont.) 2nd 5 experiential steps
Things they have to start doing
- 1 - stimulus control - change their environment and add prompts for healthier alternative actions to using
- 2 - helping relationships - find healthy relationships
- 3 - counter conditioning - learn to say no to peers, now i'll meditate instead of use, now i'll take 10 deep breaths instead of use.
- 4 - reinforcement management - find/create rewards in their environment that merit attention to motivate them towards being clean (teach positive self-statements)
- 5 - self liberation - belief that i can and am changing. look at how far i came. client gives their story as testimonial to others.
- choices empower people. the more choices they have, the better.
what can sudc do vs asudc? (see red book for detail)
ASUDC can help revise treatment plan. sudc cannot.