 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on 10 useful brief interventions and brief therapies. We're going to go through quickly stages of change model and different interventions you want to use for different stages of change. The goals of brief intervention, components of generally all brief therapies, essential knowledge and skills of brief interventions, when to use brief therapy. And, you know, we'll kind of talk about when not to use it, but, you know, good clinical judgment will tell you that approaches to brief therapy that include cognitive behavioral cognitive processing, trauma focused cognitive behavioral therapy. Those three are hyperlinked. If you want to learn more about them, I already have videos on them and classes on them. You can watch the videos on the YouTube channel, all CEUs education. We'll also look at brief strategic interactional therapies, brief humanistic and existential therapies, brief psychodynamic, brief family therapy and time limited group therapy. So pretty much no matter what philosophy you yield from, there is a way to do brief therapy. The benefits, it reduces no-show. It increases treatment engagement, increases compliance, increases self-efficacy, reduces aggression and isolation and provides an interim for clients on waiting lists. So why does it do all this? Well, a lot of times when clients come to us, they are in the later stages of readiness for change. A lot of times they're either in preparation or the action stage. So as soon as they get in, if they can develop rapport and start seeing changes, then it's like, oh, aha, this works awesome. I can get more engaged and I think I can achieve my goals. So they start having me, I think I can't, I think I can't attitude. If that's going well, then you're going to have increased compliance. And typically the goals we're working on are going to help reduce stress, reduce anxiety and depression, which will also lead to reduced aggression and isolation. So the benefits are really fabulous. And one of the caveats, and I'm getting ahead of myself, but that's okay, of brief therapy is the fact that it says we need to pick a part of the overall goal and focus on that for the eight to 16 sessions. And typically brief therapy is eight to 10 sessions, but there are a couple of the protocols we're going to talk about that can go up to 16, but that's it, you know, Ba Da Bing. So we want to be aware that there's a lot of stuff that we can do. Goal should be specific, measurable, achievable in eight to 10 weeks for most of them, realistic and time limited. So this is the acronym SMART that we've talked about before. The purpose of brief interventions is to reduce the likelihood of damage and additional problems from the current issue. So think about it like mountain climbing. You're not going to go scale Mount Everest and do the whole mountain in a day. You're going to do a leg and then rest at some sort of little plateau area and then you're going to do a leg and rest. And that's kind of what we're thinking about with brief therapy. Brief therapy is a leg on the journey to happiness and health. So we're not going to be putting in all these complicated goals that create this whole mishmash of things that we've got to attend to. We're going to look at one very specific issue. One of the cool things to realize with, you know, trans theoretical models of change is the fact that and trans diagnostic is the fact that when we use an intervention of some sort and we have an improvement in one area, it likely will cause positive changes in other areas. So some of the things, you know, you may have 15 presenting symptoms right now. But if we address one, then it's likely those other 14 are going to get a little bit better. Is it going to make them all go away? No, probably not. But, you know, instead of focusing and doing 14 things kind of half past. If we do one thing really well, it increases self-efficacy. The person sees how progress can be made starts learning how to set goals. And we want to look at, you know, which problem, which presenting issue are we going to focus on? So we want to ask the client, which of these symptoms is having the greatest negative impact on your family, your work, your health, you know, upset stomach, headaches, migraines, not sleeping, whatever it is, self-esteem or which one is causing you the most guilt or anger and frustration. So a lot of times if you put it that way to the client and really specify it instead of saying, which one do you want to start with? And they're going to be like, I don't know. I don't even know where to start. If you phrase it in terms of which one is causing the greatest negative impact and you list these things, then they're going to start to make connections to go, you know what, this might work. And they may not be able to pick one. They may say, I don't know what do you suggest? And you can talk about that. But that starts developing rapport and we're still empowering the client to make the final decision. Objectives for brief interventions are to extract at least one measurable change in the client's behavior. So again, we're not changing the world or changing one thing. Can they manage their time better so they don't feel as stressed and they're not making promises and then failing to keep them and doing poorly at work because they're overburdened and not managing time well. You know, there's a lot of places that time management can have a positive or negative effect. So time management may be one expanding the positive support system, improving social skills, changing unhelpful thoughts. And as we go through these, again, I want you to think about for each one of these, you know, normally we would think, you know, if you're going to address depression, you have six different treatment plan issues. We wouldn't think of just honing in on one of these, but if you think about it and think about the impact that any one of these can have on the person's happiness, health and well-being, you can see how, you know, it might make sense to do one at a time. And then just do them successively. Improving health behaviors, vulnerability, awareness and prevention. That's sort of a DBT term when we're talking about preventing those things or addressing those things that make you more likely to respond with depression, anxiety or anger. And it can be lack of sleep. It can be poor eating. It can be certain environments or being around certain people, but having people understand what their vulnerabilities are, what things make them more likely to have an emotional reaction. We can look at vocational issues. A lot of people are stressed about money and work and feel they don't like their job. Think about how much time you spend at your job every day. And you know, I love my job. Don't get me wrong. I absolutely adore what I do. But I do like 50 hours, maybe 60 hours a week, some weeks at work. So, you know, and then look at how much time I spend at home and look at how much time I spend sleeping. And the majority of our work week or is spent usually at work. So if people are really unhappy in their job, then it's going to negatively impact a lot of other areas. We can also look at increasing support group attendance, working on forgiveness and acceptance, staying in the here and now using mindfulness skills in order to be aware. And this is a good staying in the here and now is a good one for later on, but it can work in the beginning to to help people start to become aware of what they need instead of just kind of going on autopilot all the time. Identifying triggers for the mood or behavior. So, you know, what is it that triggers your stuff and how can you deal with those triggers, eliminate the ones you can and deal with the ones that you can't eliminate? Maybe you've got a co-worker that just triggers the heck out of you and you know, you can't get rid of the co-worker. Maybe you can't even switch offices. So what can you do to improve that situation? If you remember back to motivational interviewing and true in brief interventions is the frames concept. You want to provide feedback to the client about where they are, what's going on, how they norm out with the regular population. You know, talk with them and and when you're talking about, you know, time management, we'll just pick that one because that's an easy one and you can provide them feedback with, you know, how can time management skills and improving that help you in all these other areas of your concern. And if you help educate them that way, they might be like, oh, yeah, you got a point there. But help them figure out where they're at. Provide the responsibility for change. Put that on them. They need to identify their future goals for health activities, hobbies and relationships. So in ACT, one of the techniques is to say what, you know, if you had to define what a rich and meaningful life looks like for you, what would it be? Well, we're going to define that and then we're going to step back and we're going to go, okay, what's the first step to getting to that rich and meaningful life? That's what we're going to work on. And if we accomplish that in the eight to 10 weeks and still have time left over, we can move on to the next one. They're responsible for identifying the pros and cons of their current behavior in terms of self, family and community. Now remember from the multicultural presentations that we just went through, not everybody is motivated by changing their behavior in order to do it for some sort of self benefit. Sometimes they're more motivated to change a behavior because they don't want to hurt their family or they don't want to hurt the community. So you need to look at where they're coming from and where their locus really is. We want to have them look at the consequences of staying the same. You know, that is a reasonable choice. If you keep doing what you're doing, what's going to happen? Reasons to change, have them identify, you know, why is it that you want to change what brought you here and what are some sensible strategies for change? And it's their responsibility to be open when you start talking about strategies and providing that menu of options about what's going to work and what they're willing to do and what they're not willing to do. We can provide advice to them. You know, if we ask, we don't want to lecture at them about different steps to take or like about which goal to choose to start on to focus on first. And remember, I use that metaphor of the blanket, you know, if you want to unravel a knitted blanket, you start pulling a string anywhere or a sweater. You start pulling a string anywhere and eventually, you know, you're going to pull all the strings and the whole thing will unravel. So you got to start somewhere and a lot of times it doesn't really matter where either way you're starting to unravel the blanket. And I have them envision that blanket as the one that's hanging over their head right now and feeling very oppressive. Soon as they start pulling that string, that blanket starts to lighten. All right, provide empathy and self-efficacy. So feedback, responsibility, advice, menu, empathy and self-efficacy. So stages of change, we go through this a lot, but why is knowing stage of change important? You know, we talk about it a lot and we talk about interventions to use at each place, but why do we care? You know, we assume if somebody's in our office that they're ready to go. Well, that's not always the case. Sometimes their spouse has told them they have to be there. Sometimes their job has. Sometimes the courts have. And, you know, so you'll get people potentially in multiple stages of change. And if you try and I can tell you this from, you know, the School of Hard Knocks. If you try using action-oriented interventions with somebody who's in pre-contemplation, you're not going to get anywhere. If you're trying to use the same interventions you would use with somebody who's ready to change and use those interventions with somebody who doesn't even see a problem. It doesn't, it doesn't fit. It doesn't mesh. So there are a couple types of pre-contemplators. So when somebody's in pre-contemplation and I'll use the pool metaphor again, they're sitting on the pool deck. They're not hot yet. The sun feels good. Everything's fine. It's not a problem. And somebody else might be saying you're going to get awful hot sitting out there in the sun and you're going, you know what? Now it's not that hot today. I don't have a problem. I'm just fine. So person in pre-contemplation doesn't realize there's a problem. So we want to educate, motivate them by maybe asking what are five ways this issue that brought you here today has impacted your family, your, your work, your school. You know, and they may not have much and that's okay. You know, I'm not going to sit there and hound them and go, well, there's got to be a bunch of negative coming out of it. If they don't have anything, they don't. And you may look at adding family or peer commentary specifically about the client. If you've got family that's in the assessment with you, if you've got family feedback, you know, that can be one place to get a little bit of information. If you're looking at, you know, sometimes this comes up if you're doing groups too, a problem will come up and the peers in the group may identify that, you know, such-and-such client seems to be having a problem. But that's for a different, for a different class. So pre-contemplation, all you're doing is trying to open that door and let the client see through the threshold to see that there might be a problem and they might need to, you know, take a different direction. Types of pre-contemplators, reluctant pre-contemplators don't really understand or see the problem and the personal impact yet. So if we can raise that knowledge, then we might be able to move them on to thinking about change. The rebellious pre-contemplator is terrified of losing control. So they're holding on. They're like, things are okay, you know, if I start to, if I start to try to change, all hell's going to break loose and I just can't do that. The resigned pre-contemplator has probably tried to change before and it hasn't worked or maybe they, it worked for a little while and then they had a relapse and so they're, they're frustrated. They don't feel like anything's going to work. Think about patients that we've worked with who start on psychotropic meds and the first one they start on doesn't work and so they feel really frustrated. They're like, well, I'm not feeling any better. It's been six weeks. So they get started on another one and that one doesn't work either and they get even more frustrated and resigned to I'm okay. This is the way it is. I don't want to get my hopes up again. I don't want the side effects in the medication. Yada, yada, yada. So we need to rekindle hope and optimism in people who've kind of resigned themselves to this is just the way it's going to be and life is not going to get any better. In contemplation, you know, the person sitting on the pool that going, you know what? Maybe that other person was right. I'm starting to get a little hot, but you know what? That pool is really cold and I hate getting splashed. So I'm still okay. You know, I'm starting to get hot, but it's good. In this stage, the person recognizes and they say, yeah, I might smoke a little too much or I might eat a little too much or I'm feeling kind of depressed, but you know, it's just a thing. I'll feel better in a few weeks or whatever their responses. Okay. Well, they realize there's a problem, but they're not quite ready to do anything about it. So we can explore and address ambivalence by tipping the decisional balance scales. What do you have to lose by trying a couple of new things? We can address anxiety and grief about change. They may be fearful that they're going to fail again. So we want to put that out there that we're going to be with them and we're going to help them through the process and we'll help them if they start to backslide. And sometimes there's grief about change. If they're giving up something or they feel like they're giving up something that they really like, you know, I love being a couch potato. Don't get me wrong, but since I want to be healthier and happier, I go to the gym. Now, you know, getting up and going to the gym and working out isn't near as much fun as having Netflix marathons. But I do it anyway. Do I grieve it? No, not really because I get a lot of benefit out of the gym. But some people may look back and go, you know, I really I miss the days when we want to help them deal with that grief and see the benefits to what they're doing now and maybe figure out how to work both of them in. You know, do you have to give up your Netflix binges just to work out or can you go and bring your tablet and watch Netflix there? Score help clients visualize change. You see that, you know, things are not great. What would happen? If you did feel better if you were, you know, happier? What would that look like? What would be different and help them start talking about it and starting to get excited and kind of go, you know, maybe maybe I do want to do something. Think about when you're trying to, you know, you've been living in a house for a while and you start thinking, you know, maybe it's time to get the walls painted. You know, we've been here for a while. I've got four dogs and two children. So we get walls painted. But then you start thinking about what color do I want to do and you start visualizing and you start getting excited about how it's going to look when it's all done. This is what we're doing with clients. In preparation, the person is going, you know what? I think it'd be a good idea to start doing something with the pool. They go over to the edge, stick their toe in, see if it's doable. You know, see if they can tolerate the cold. You want to stick with the paint metaphor. You start calling around and getting bids and going to Lowe's or Home Depot and looking at the paint swatches and thinking about what you might do for color. You haven't scheduled anybody yet. You're just in that preparation process they may come in at this point, especially for mental health counseling and substance abuse, but a lot of people come to mental health counseling and they've been feeling depressed, but they're not really sure we can do anything for them. So they're testing it out. They're trying to figure out if you have anything to offer them. So this is where we see a lot of clients. We need to help them identify the benefits of treatment. We are catalysts. They've been living in their body for 20 and 40 years. They're the experts on them. But we have tools and stuff that they've maybe never heard of. So we can help them speed up their change process. But ultimately they're the expert on them and it's going to be on them. So the benefits of treatment is that we're going to help them get there faster and more efficiently. We can identify and address fears and apprehensions about treatment with a lot of people. They think if I start counseling, I'm going to have to go for years and I just don't really want to make that kind of time commitment. With brief therapy, it's 8 to 10 sessions. So we can say, you know what? It's 8 to 10 sessions and then you'll be out. And if you need to come back or you want to come back to work on something else, that's fabulous. But let's get the first first hurdle done first. When they can see a light at the end of the tunnel when we're saying you're going to feel some benefit and you're going to start feeling better in 8 to 10 sessions. They're like, oh yeah, that I can do 8 to 10 sessions. I can do anything 10 times. Give the client a list of options for treatment here. It can be individual. You could be in group. You know, I could refer you over here. I could make a referral or you could go see your primary care physician. If you also want to start on meds and we could work together. You know, there's a lot of different ways to address this. We can talk about a nutritionist or massage therapy. You know, what do you think is going to help you? So let them see the full range of opportunities out there. We'll clarify goals and strategies with them helping them identify and address barriers to change. And this is big because clients come and they're they come in to our office and they're like, I'm ready to change or maybe they're like, well, I want to see if you can do anything for me. But once they make that decision to change barriers come up. Child care. So how do you handle it if your babysitter calls in sick? It's winter here and theoretically we might get snow this year and if we get more than a half an inch of snow in Nashville everything shuts down. You know, there's no bread on the shelves. Everything shuts down. So what happens if we have extended snow days? What other things can you do? If finance finances are a barrier. What else can you do? What treatment options are available? Maybe your agency does payment plans or you know, whatever. So identify anything that they think might get in the way. If it's the holidays we're almost through the holidays now. But if somebody started treatment say mid October they would still be in treatment during the holiday season especially Thanksgiving. So that's going to be a week or two weeks when they're not in treatment. What might they do during that interim and what might potentially pop up? You know, I know we've been sick. Gosh, we've been sick since Thanksgiving. Somebody in our household. So if their kids get sick what's going to happen that might prevent them from being able to focus on treatment. So we want to talk about all those things. Recognize that they've got a life instead of thinking that okay, you're in treatment. Your focus is on this. They've got a life. So how can we help them work treatment into their life? And I do tell clients that treatment is going to be hard work. You know, so don't be taking on additional stuff right now because it's going to be draining. Just kind of plan for that. Encourage them to garner social support and envision change by finding motivating stories from others. So go online, find stories about other people who have dealt with clinical depression or gotten over anxiety or had ADHD or whatever it is. Find other people to realize reduce that isolation, reduce that sense of I'm the only one. Help them identify motivations in each area and create small successes for components of the goal. So when I say in each area what are your emotional motivations? How is it going to make you feel happier? What are your mental motivations? What do you think are the benefits? What are your physical motivations? How how will it make you feel physically better to do this? What are your social motivations? How will it impact your relationships with your family? Your co-workers? Yada yada. Increase self-efficacy and hardiness and hardiness I say is C cubed. Commitment, control and challenge help them identify those things that they're committed to in their life. So they can focus on those things that are really awesome and treatment is going to help make those things awesomer. Help them focus on those things that are within their control. You know, they can't change their co-worker at work. You know, that person is the way that person is going to be. How can they change the situation or how can they react differently? If that person is you know, not in a good mood. And have them envision this process, this adventure as a challenge instead of something they have to do or treatment or something that's being done to them. You know, get them excited about how much can you accomplish and how will it improve your life so they can start focusing on the positive positives. Strengthen commitment and begin learning about the issues the person has. This is when we're going to say what do you think contributes to your depression to your anxiety? In action, the person is tired of being sick and tired or in the case of the pool, they're tired of being hot. So they decide they're going to jump in the pool. They're going to cool off with mental health. They decide I'm tired of being depressed. I'm going to treatment. I am going to do this. So they come in for their treatment planning session. We help them create a plan help them implement it. We help them learn how to ensure motivation and progress is maintained by using mindfulness skills and motivational enhancement decisional balance activities. At this point, we start helping them identify triggers for the current behavior. So, you know, poor time management. What might be a trigger for that? Maybe somebody a friend of yours asking you to help them move on Saturday and you really hate saying no to people. So, you know, at that point we're going to start talking about boundaries and what you need to do to be happy and healthy. Provide practical tools in each session and discuss and roleplay applications. Continue to address obstacles. You know, anything that might get in their way whether it's transportation child care and acknowledge the client's feelings and experiences are a normal part of recovery. You know, if you're feeling this is too hard if you're getting frustrated if you feel excited whatever's going on is probably a normal part of recovery. So, we want to help them realize that, you know, not every day is a walk in the park. If you're dealing with depression and you go six days with no crying episodes and then the seventh day is just a horrible day. That's okay. You had six days that you didn't cry and that is really awesome. So, instead of focusing on the one thing you know, the one day that was a setback focus on the six days that went really well and then look at that seventh day and go what was different here and you know what do we need to do to address that. Recognizing that it's going to be two steps forward one step back sometimes. And in maintenance they're getting ready to graduate. Encourage them to enjoy their success step back and look how far they've come. Hopefully they've been keeping baselines or journals the whole way so they can look and go wow that's you know a big difference. Stay mindful of continuing to work their program whatever it is they're doing now that's improved the the the goal they need to keep doing that just because they're not in treatment anymore and it's time to quit being mindful and to go back to those old habits you know they need to keep doing it and make minor adjustments as needed. If somebody relapses you know and we relapse with anxiety disorders with depression sometimes you'll have another episode and that's when the change whatever you've been doing a lot of times whatever you've been doing you've quit doing it you've got fallen back into old habits or you've gotten wrapped up with other priorities and you've put yourself on the back burner and so you quit doing it was too uncomfortable or too time-consuming to do the recovery stuff so you just let it go you let it fall to the wayside it's kind of like jumping out of the pool it's too uncomfortable to stay in here I'm going to go back out and you know I'll figure out how to deal with it later so relapse means falling back into old ways of thinking and acting it is not a requirement for recovery but most people are going to have at least what we call a lapse when they start falling into back falling back into old ways of thinking and maybe some of their old behaviors and then they catch it and they're like oh you know I don't want to be doing this I don't want to go back down to having a full blown episode encourage them when if they start having a lapse or a relapse whatever they want to call it to identify what triggered it what changed what did they quit doing the most rewarding choice so other things started to take priority like work maybe they're doing 60 hour days again then we want to say you know what can we do in order to help you back off from work a little bit and so recovery is your priority and sometimes it's not always doable don't get me wrong a good relapse prevention plan will have strategies for identifying early relapse warning signs like getting cranky or not having a lot of energy drinking more caffeine than usual identify identifying relapse triggers what typically triggers your depression and that way people can plan for it and and be able to deal with those triggers when they happen whether it's an environment a time of year a person a situation and they have solutions in maintenance we want to reassure reassure the client that you know what you're doing okay you're doing great we want to evaluate their present actions long-term recovery plans this is your usually your closing session in brief therapy we want to educate them about the relapsing nature of mental health and addictive disorders if you don't stay vigilant and mindful you can fall back into those old behaviors because you were doing those for 30 years you've only been doing these for three months so be aware of that and sometimes you're just going to have a depressive episode so recognizing that and not beating yourself up on those tools that you learned in order to address the depression or the anxiety develop a list of circumstances that might require a return to treatment review problems that emerged but were not addressed and help the client develop a plan for addressing them in the future like we talked about time management and maybe not being able to say no when people ask you you're just the yes man you know so there's an issue with boundaries and maybe fear of rejection you may not have gotten into that so much in this particular set of sessions that may be something they need to address in the future can they do it with self-help workbooks maybe do they maybe need to consider coming back in a couple of months maybe and since insurance a lot of times will only authorize eight to ten sessions at a time you know they kind of emphasize the episodic treatment and encourage the client to continue developing strategies for identifying and coping with high-risk situations and they need to be able to be mindful and when they start feeling their spidey senses going this is not going to be good develop strategies for how to deal with that teach the client how to capitalize on their personal strengths emphasize their self-sufficiency and self-efficacy look look what you did I didn't really do much I was just kind of here to be a sounding board develop a plan for support including family and community support prepare the client to maintain positive change identify potential stressors and challenges prepare the client for changes to the environment and at the end of treatment ask the client to look into the future and describe where he or she intends to be at a certain time six months from now maybe one of the things I'll do with my clients is I will have all these things tasks for maintenance I have them on a worksheet and I have them complete that and bring that to their final session and then we talk about you know what their perception is of all these different things and what they see as stressors and challenges and successes okay so essential knowledge and skills and once you figure out you know where your client is in terms of readiness for change then you and then you know what kinds of strategies are going to work and what kinds of goals are going to be best to select then you've got to figure out well now what skills do we use to implement these changes so we have to have an overall attitude standing and acceptance and your basic counseling skills listening empathy etc remember focus on those intermediate goals hiking up hiking up Mount Everest just we're doing one leg of the trip right now we're not doing the whole mountain in the next 10 weeks characteristics of brief therapies they tend to be problems so focused or solution focused they're not just to treat depression we're going to focus on a solution to a problem we're going to focus on a specific symptom maybe we target the symptom and not necessarily what's behind it so what can help alleviate your fatigue clearly defined goals related to a specific behavior such as improving time management what exactly does that look like for you getting to work on time or maybe even three minutes early every day or and be be clearer about what to do produce immediate results which is how we get clients engaged and really rolling with some momentum there's a rapid establishment of a working relationship if we're excited they're excited they're having successes we're just all gung ho it's highly active empathetic and sometimes directive we don't have a lot of time especially if you're not using a humanistic um approach we typically um direct a little bit more in order to keep people moving forward it's like when you when you're traveling and Google says there is a traffic jam on your route you need to detour in order to have the fastest fastest route you know Google's giving us some advice do we have to take it no but a lot of times we're like oh yeah thanks hey appreciate the heads up responsibility for change is placed on the client and experiences enhance self-efficacy confidence is possible so we want to make sure from the minute they walk out of that assessment they feel like they've got something that is going to help them improve the next moment not six months from now but what's going to make tomorrow better I have something that I can read I can look at I can do that's going to start me on this journey and propel me forward termination is discussed from the beginning you know it's 10 sessions so let's look at how we're going to work on this and outcomes are measurable brief therapy is appropriate for some dual diagnosis issues but not all you know a lot of times you want to pick someone who doesn't have multiple diagnoses for brief therapy you want to look at the range and severity of their presenting issues if somebody has major clinical depression brief therapy is probably not appropriate if they've got mild depressive disorder then then that might be appropriate the duration of substance dependence if they're using substances will impact whether brief is appropriate the longer they've been using likely the longer they'll need to be in treatment the availability of familial and community supports they're only in your office one hour a week so the other however many hours are at a week they need support so are they able to get the support they need are they in a recovery environment that is supportive of recovery the level and type of influence from peers family and community we're again we want to look at the supports are they there if the person has no family around they live by themselves they're pretty much isolated brief therapy may or may not be the best choice you may choose a brief therapy goal that focuses on building up that social support network previous treatment or attempts at recovery what's worked the level of client motivation if they're not motivated you know if they're still in that pre contemplation brief therapy may or may not be effective I like to use it with clients in pre contemplation because you know if they have to be with me then we're focusing on a goal and I'm helping them see that they are able to accomplish change the clarity of the client short and long-term goals the clients belief in the value of brief therapy do they believe they can get anything out of eight to 10 sessions or do they think they need two years and the numbers of clients needing treatment so you know sometimes you got to increase your what is it your dynamic capacity in order to meet the needs of your communities the opening session in brief therapy produces rapid engagement identifies and focuses on prioritizing problems work with the client starts to develop possible solutions in the opening session we're looking at what's worked in the past and how can you start doing that some more you know start thinking back to times when things were better negotiate the plan with the client elicit concerns and develop solutions for those concerns understand the client's expectations and make sure you're on the same page and explain the structural framework and rationale of brief therapy a website video you know on your company's website that explains brief therapy and what to expect can also be helpful so they can look at that before they come in for their session and any referrals that are going to be needed to facilitate this change should be made after the opening session so cognitive behavioral is sort of your standby go-to brief therapeutic model it assumes that problems are caused by deficient coping skills choosing not to use the coping skills they have or on or are inhibited from doing so it also assumes that are emotional distress is caused or can be caused by negative thinking and that negative emotions or you know dysphoric emotions can trigger negative thinking style so it kind of goes both ways it helps clients recognize situations which are likely to trigger or worsen their problem it helps them identify unhelpful thoughts that are maintaining the current situation helps them find ways of avoiding those situations and cope more effectively like I said I have a video on the YouTube channel if you want to learn about CBT in CBT we use functional analysis to help the client identify the antecedents what led up to this depressive episode and the consequences of the condition and so they can identify what the triggering and maintaining factors are so they can see what things are kind of causing this we provide coping skills training a lot of psycho education relapse prevention focuses on identifying high-risk situations and more coping skills training cognitive behavioral is generally not appropriate for people who are in a psychotic episode or have bipolar disorder that's not stabilized on medication now if they're stable you know you may be great to go if they have no stable living arrangement or are not medically stable again think Maslow's hierarchy they're gonna have a hard time thinking about time management if they're worried about where the next meals coming from or where they're gonna sleep tonight need more case management interventions before they can start focusing on brief therapy the initial session in brief CBT explores the reasons the client seeking treatment the extent to which this motivation for treatment is intrinsic whether they're there for themselves or whether they're being told they have to be there that helps you identify the readiness for change to areas of concern that the client and significant others may have about the problem situations in which the problem is worse consequence consequences experienced because of the problem so the three major steps established report ed educate the client about CBT and then ask the client to describe a recent event that triggered some negative feeling triggered depression or anger and then illustrate the CBT process to her in the session so she can see you know this is what we're gonna be working on doing or this is one way you might work on handling the problem cognitive processing therapy CBT is a manualized therapy used by clinicians to help people recover from post-traumatic stress disorder it can be used to treat a variety of other anxiety disorders but it's typically used with PTSD it includes elements of cognitive behavioral therapy treatments CBT can conceptualizes PTSD as a disorder of non-recovery you got there you hit this problematic acute stress period and you didn't come back from it in which a sufferers beliefs about the causes and consequences of traumatic events produce strong negative emotions which prevent accurate processing of the traumatic memory and the emotions resulting from that event which currently affect how they interpret any related imagery there is a manual you can Google CBT manual online if you want to read the processing therapy manual that's out there there are four essential parts in CBT educating the patient about the specific PTSD symptoms and the way treatment will help how can it help with hypervigilance how can it help with you know the detachment exploring the connection between thoughts and feelings how are these thoughts you're having about this event impacting your emotions right now imparting lessons to the patient to help him or her develop skills to challenge or question his or her own thoughts the challenging questions worksheet y'all know I love that one and helping the patient to recognize changes in his or her beliefs that happened after going through the traumatic event so maybe before you saw the world in one way and now you see the world in another way and a not so pleasant way so you know helping them draw connections between how that event is impacting them cpd individual sessions are structured generally 12 50 minute structured session so it's still a pretty brief therapy model sessions are typically conducted once or twice weekly so it could be as short as six weeks that they're going through this and patients as with most brief therapies will be completing out of session practice assignments it is heavily manualized so it's easy to implement trauma focused cognitive behavioral therapy or TF CBT aims to address the needs of children and adults with behavioral difficulties and shame related to traumatic life events whether that be child abuse child sexual trauma anything like that the goal of TF CBT is to provide psycho education to both the child and the caregivers to help them identify and cope with emotions thoughts and behaviors so in this you have certain child sessions and certain sessions with the caregiver and then certain conjoint sessions again is heavily manualized major components of TF CBT are denoted by the practice acronym psycho education and parenting skills relaxation skills affect of expression and regulation cognitive coping trauma narrative development and processing so they're actually going to write out the narrative and process it and get to the point where it doesn't elicit the same emotional response in vivo gradual exposure conjoint paired child sessions and enhancing safety and future development the TF CBT at the medical school of the university of South Carolina they do have a CEU class there for free if you click on this link if you want to learn more about it brief strategic interactional therapies so we're getting away from CBT now focus on the individual strengths the relationship to the therapist is essential and interventions are based on client self-determination with the community serving as a resource rather than an obstacle so we're looking at how the interactions that this person engages in every day impact them and how they can use their community to support their recovery the goals include defining situations that contribute to the problem in terms that are meaningful to the client so what do you think is causing the problem identify steps needed to address the problem heal the family system so it can support change because remember we want the community maintain behaviors that will help support recovery and respond to situations in which the client has relapsed in the past so they've been going along and then all of a sudden they had another episode what triggered that how can we prevent it were there any warning signs yada yada brief humanistic and existential therapies emphasize understanding the human experience and focusing on the client rather than the symptom remember humanistic says if we provide and clear the blockages clients will naturally move towards self-efficacy so we want to help them clear those blocks and experience positive unconditional positive regard this theory views psychological problems as being the result of inhibited ability to make authentic meaningful and self-directed choices about how to live so we're going to really focus on authenticity and meaning okay this choice you're getting ready to make does it fit does it square with who you are and is it helping you move closer to those people places and things that are important to you to create a rich and meaningful life in the initial session you build an alliance develop rapport and create a climate of mutual respect emphasizing the client's freedom of choice and potential for meaningful change now this is really putting a lot of responsibility on the client as being the expert and also obviously how are we going to reach it helping them understand that unlike CBT type therapies this is less directive it will still be a little bit more directive because of the brief nature but we're not going to be given giving them manualized assignments we're going to help them figure out what they need to do next brief psychodynamic therapy enables clients to examine stuff from their past which lead to a desire to abuse substances or develop depression anxiety et cetera so we're looking at how their stuff from the past is impacting their present we're not necessarily processing that stuff right now but we're saying you know when you react negatively to authority figures in the present how where does that come from you know let's think about your past and when something like that happened in your past that might still be impacting you today and is it still an effective response this way to authority figures you want to work with the client's perceptions of reality ask questions and sidestep rather than confronting defenses if they're not ready to change it you know that's okay we can look at other options brief family therapy is based on the belief that interactions with the family sets the pattern and dynamics for people's problems so dysfunctional families tend to create dysfunctional individuals family member interactions can either perpetuate or help resolve the problem family therapy offers an opportunity to focus on the expectations of change within the family ostensibly they're all there for the assessment so we can start saying you know what is your perception generally when people come in for family therapy there is an identified patient and they say we want juniors to get better well that's great junior what do you want to get out of this what do you think needs to change in order for you to start feeling or whatever it is so we want to start getting all that stuff out there in the open to figure out what interactions within the family may be perpetuating or maintaining this problem in one or more of the family members family therapy allows people to test new patterns of behavior you know try it for a week see how it goes and come back and we'll talk about it it teaches a family system to support symptom and maintains needed roles it teaches how a family system supports symptoms and maintains needed roles so it helps people see how enabling for example in addiction happens and how that maintains the problem it helps them see how the family system has actually been you know colluding with the identified patients sometimes or maybe precipitating it or triggering it so people start becoming more aware of their impact on that reciprocal interaction it elicits the strengths of every family member so we can talk about what are your strengths what do you have to contribute how do you see this problem resolving and explores the meaning of the problem within the family not just within the person but what does this mean in terms of the family the initial session clarifies the nature of the problem and identifies the family's goals with open-ended questions such as what's your goal in coming here every single person because mom said I had to or we want junior to get better and we start listing all of those things and then we start saying well what is the what's precipitating this problem you know what do you see is causing this problem educate the family about what's needed to participate effectively and understand key biosocial issues related to the problem developmental levels stress levels you know all the stuff that's going on that we look at that can contribute and impact a family if if dad is depressed that's going to have an impact on other people and the family and even if dad's not the identified patient so we need to be aware of kind of how each person is doing prioritize directions for change or if the direction is sufficiently clear get started it's generally appropriate for families who are able to benefit from teaching and communication to better understand some aspect of the problem if they are highly conflictual and dysfunctional brief family therapy is not the place to start but if it's a family who's you know generally well-functioning you can probably do a fair amount of good work with brief family therapy time-limited group therapy groups can help reduce denial and process ambivalence because if somebody's in there and they're in you know contemplation they're not sure they're ready to do anything yet and they're in a group with other people who are a little bit further along they can start hearing how they're similar to those people and go oh you know maybe I do have a problem they start seeing themselves in other people and they start going oh you know maybe that is a problem it can facilitate acceptance of the problem recognizing they're not alone and that recovery is possible it assists in identifying exacerbating and mitigating factors I love doing whiteboard exercises where we list what are the things that make it worse and what are the things that make it better and everybody just throws out their ideas and generally people haven't thought of every single idea up there on the board or every single trigger up there on the board and they'll see it and they'll be like oh you know what I had never thought about that that's a good point so it can be a really fun exercise and sometimes people come up with you know silly things that make it better it provides a wealth of coping strategies and resources increases motivation for change it can be used to treat co-occurring conditions it increases the capacity to recognize anticipate and cope with situations that may trigger the problem because they may see it in their group mates and go oh I saw that coming from a mile away and after they've seen it coming in other people then they start to become more cognizant of seeing it in themselves and it can help explore whether they believe that they have the ability to choose effective actions so we can talk with them about you know how effective and how powerful they feel in certain situations so brief therapy is a cost-effective technique that can help clients engage in the preparation phase so they're they're you know kind of there they've shown up but they're not sure if we can do anything for them that's fine I am thrilled you showed up today so more of a sales pitch at that point helping them see how therapy can be beneficial and let's talk about some of the ideas that you have and what we might need to do it enhances treatment compliance because clients are really involved in the process and they tend to get that momentum going and keep it going because 10 weeks like I said it's just like doing 10 pushups I can do 10 pushups if somebody tells me to do 50 I'm going to look at them like they're crazy but I can do 10 I can do anything it increases success and client self-efficacy it reduces cost per patient expenses instead of and I don't remember the business theory but there's a theory out there that says the more time you have to accomplish a task the more time it's going to take to accomplish that task because you tend to slow down and get distracted a little easier so if you only have eight to 10 sessions clients tend to be very focused and impede the motivation because generally you can keep motivation going for eight to 10 sessions and people are excited about it it's when you get into that four five six months that there's just like you know I'm feel like we're really not making much progress brief therapy you see progress hopefully you reduce the cost per patient expenses it can be used for a variety of issues to help clients accomplish smart goals so the specific so we want to make sure that whatever we set as the goal can be accomplished in eight to 10 sessions you know recovering from depression and you know that's that's way too big so you want to make sure that whatever you do is is attainable but it does help clients start learning what pot what's possible it's like clients who start their new year resolution and they say I want to lose on January first they say I want to lose 30 pounds by what's that holiday Valentine's Day unless you are morbidly obese and even then a lot of it's probably going to be water or weight is is not even physically possible to lose that much weight safely in that amount of time so that's not one of those achievable or realistic goals so we want to help them see what is realistic to accomplish in 10 weeks and it can be implemented in group or individual settings so you can do psychodynamic approach in group you can do cognitive behavioral in group or you can do it in individual one of the reasons that it can be used really effectively in group a lot of times especially with the seed cognitive behavioral approaches it tends there tends to be a lot of psychoeducation so you're not delving into a lot of the stuff from the past and even psychodynamic does really well in group obviously cognitive processing therapy and trauma-focused cognitive behavioral is not going to be done in group but those are two options that are available for treating PTSD in a short shorter period of time Alrighty are there any questions Alrighty I am going to type in here that is our YouTube channel so if you want to go look at any of those videos on cognitive processing therapy or trauma-focused cognitive behavioral you can otherwise obviously there's a ton of stuff out there on an on the net about it as well have an awesome day and I will see you tomorrow for I don't remember what we're doing tomorrow class is done I just don't remember what it is so I'll see you tomorrow and we'll figure out what we're talking about if you enjoy this podcast please like and subscribe either in your podcast player or on YouTube you can attend and participate in our live webinars with Dr. Snipes by subscribing at all CEUs.com slash 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