Course: Cognitive Behavioural

Therapy (CBT) Diploma

Date: 08/03/2016

Review Questions (1)

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1. What is the underling concept behind Cognitive Behavioral Therapy

(CBT)?
The underlying concept behind CBT is that our thoughts and
feelings play a fundamental role in our behavior. For example, a
person who spends a lot of time thinking about plane crashes,
runway accidents and other air disasters may find themselves
avoiding air travel. The goal of cognitive behavior therapy is to
teach patients that while they cannot control every aspect of the
world around them, they can take control of how they interpret and
deal with things in their environment.
2. List the therapies that merged to form CBT.
CBT is in fact merging of several various theories and research. The
cognitive elements have their roots mostly in the work of
psychoanalysts beginning with Sigmund Freud, and Alfred Adler,
and in part by in the Stoic philosophers of ancient Greece who were
presented to psychology by Albert Ellis. Ellis could be thought
about of as the first psychologist that generated a fully-formed
version of cognitive therapy starting in the 1950s, which is now
called Rational Emotive Behavioral Therapy. Aaron Beck
additionally introduced a rather comparable kind of cognitive
therapy starting in the 1960s. Beck's variation forms the basis of
the most extensively researched and practiced kind of cognitive
therapy today.
The behavioral elements of CBT have their origins in the
behaviorist practice of psychology, specifically influenced by the
study of Ivan Pavlov and John B. Watson early in the 20th century
and B. F. Skinner in the mid-20th century. A vital early behavioral
therapist was Joseph Wolpe, that assisted in bridging the gap
between the cognitive and the behavioral is Albert Bandura. There
are several more theorists and researchers that this short history
leaves out.
3. Who first generated a fully formed version of CBT?
Albert Ellis could be thought about of as the first psychologist that
generated a fully-formed version of cognitive therapy starting in
the 1950s, which is now called Rational Emotive Behavioral
Therapy.
4. What makes CBT so popular in todays world?
Cognitive behavior therapy has become increasingly popular in
recent years with both mental health consumers and treatment
professionals. Because CBT is usually a short-term treatment
option, it is often more affordable than some other types of therapy.
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CBT is also empirically supported and has been shown to effectively

help patients overcome a wide variety of maladaptive behaviors.
5. How does CBT incorporate both cognitive therapy and behavioral
therapy?
People often experience thoughts or feelings that reinforce or
compound faulty beliefs. Such beliefs can result in problematic
behaviors that can affect numerous life areas, including family,
romantic relationships, work and academics. For example, a person
suffering from low self-esteem might experience negative thoughts
about his or her own abilities or appearance. As a result of these
negative thinking patterns, the individual might start avoiding
social situations or pass up opportunities for advancement at work
or at school.
In order to combat these destructive thoughts and behaviors, a
cognitive behavior therapist begins by helping the client to identify
the problematic beliefs. This stage, known as functional analysis, is
important for learning how thoughts, feelings and situations can
contribute to maladaptive behaviors. The process can be difficult,
especially for patients who struggle with introspection, but it can
ultimately lead to self-discovery and insights that are an essential
part of the treatment process.
The second part of cognitive behavior therapy focuses on the
actual behaviors that are contributing to the problem. The client
begins to learn and practice new skills that can then be put into use
in real-world situations. For example, a person suffering from drug
addiction might start practicing new coping skills and rehearsing
ways to avoid or deal with social situations that might trigger a
relapse.
In most cases, CBT is a gradual process that helps a person take
incremental steps towards a behavioral change. Someone suffering
from social anxiety might start by simply imagining himself in an
anxiety- provoking social situation. Next, the client might start
practicing conversations with friends, family and acquaintances. By
progressively working toward a larger goal, the process seems less
daunting and the goals easier to achieve.

Review Questions (2):

1. List the four stages of change and explain each in your own words.
PRECONTEMPLATION STAGE
During the precontemplation stage, patients do not even consider
changing. A smokers, for example, may not see that the advice
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applies to them personally. Clients with high cholesterol levels may

feel immune to the health problems that strike others. Obese
people may have tried unsuccessfully so many times to lose weight
that they have simply given up.
CONTEMPLATION STAGE
During the contemplation stage, clients may be ambivalent about
changing. Giving up an enjoyed behavior causes them to feel a
sense of loss and fear, despite the possible gain. During this stage,
patients assess barriers to moving forward. Such as, time, expense,
hassle, fear, I know I need to but as well as the benefits of
change.
PREPARATION STAGE
During the preparation stage, clients prepare to make a specific
change. They may begin by experimenting with small changes as
their determination to change increases. For example, trying
keeping a food diary to aide in weight control, setting a goal of only
smoking a certain number of cigarette in a day or decreasing their
drinking triggers. The therapist now knows that they have decided
a change is needed but they have not completely committed to
making the change.
ACTION STAGE
This stage sees the patient take action and make the change
happen.
2. Why is it important not to hurry a client through the
precontemplation stage?
The goal for clients at the precontemplation stage is to begin to
think about changing a behavior. The task for physicians is to
empathetically engage patients in contemplating. During this
stage, patients appear argumentative, hopeless or in denial, and
the natural tendency is for physicians to try to convince them,
which usually engenders resistance. This is counterproductive and
should be avoided in the first place.
3. Why is it essential to identify a clients position in the process?
By identifying a patient's position in the change process, therapists
can tailor the intervention, usually with skills they already possess.
Thus, the focus of the office visit is not to convince the patient to
change behavior but to help the patient move along the stages of
change. Using the framework of the Stages of Change model, the
goal for a single therapy session is a shift from the grandiose (Get
patient to change unhealthy behavior.) to the realistic (Identify
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the stage of change and engage patient in a process to move to

the next stage.)
4. What is relapse and how often does it happen?
Relapse is the client reverting to the original
behavior/mindset/lifestyle. Relapse is said to be very common
during lifestyle changes.
5. What does the therapist do if there is a relapse?
Therapists can help by explaining to patients that even though a
relapse has occurred, they have learned something new about
themselves and about the process of changing behavior. Focusing
on the successful part of the agreed plan also shifts the focus from
failure, promotes problem solving and offers encouragement. The
goal is to support patients and re-engage their efforts in the change
process.

Questions for Review (3):

1. Explain the importance of the therapeutic contract.

The therapeutic contract is the tool that helps you manage the
counselling process. It comes out the goals set and is something put
in writing, signed and agreed upon between the client and therapist.
It is nice in therapy to check off the goals as they are achieved and
take on the next one. It shows success and develops a partnership
relationship with your client.
2. Explain the importance of the therapeutic relationship.

A therapeutic relationship does not mean you become friends with

the client. You need to be empathetic, professional but friendly, and
constantly asses where the client is so you stay with them while
always pushing them on gently to success. When they start having
small successes celebrate them giving them all the credit. Build
their belief in themselves. Help them change to healthier thinking.
Stick to the contract.
3. How is supporting a client through a physical illness different from

other counselling?
Support is built on empathy but that is only the foundation. You
must understand the illness and the process of the illness. You can
get permission to talk to the Doctor or the nurse involved in the
medical care for a good understanding. Then make a list of coping
mechanisms in writing for your client and help with work with those
support measures. Involve as much other support, support groups,
family, and friends as you can in this plan. These people need not
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be part of the therapy but they can be part of the plan that your
client can use when needed.
4. How are the therapy plan (contract) and the counselling process

different?
The therapeutic contract comes out of the goals agreed. The
contract is the tool that helps you manage the process.
5. What must a mandated reporter report?

A mandated reporter must report anything illegal or anything that

may lead to harm to others or to the client.
6. What must you know to support a client with medical issues?

You must understand the illness and the process of the illness.
7. What is the importance of diversity awareness?

The therapist must not only we aware of diversities but be as

unbiased as possible in working with people of a different ethnic
group, culture, gender, gender choice, political and world views
beliefs and much more. This does not mean ignoring differences but
rather to be open to exploring differences with the client is it has
baring on the mental health issue being explored.
8. What is the difference between being a friend and being a

counsellor?
The primary difference is that this is a professional relationship. You
are there to assess recommend treatment and implement the
treatment. This involves support and empathy as well as
intervention.
9. What are the Values of counselling psychology?

Values of counselling:
The fundamental values of counselling include a commitment to:

Respecting human rights and dignity

Protecting the safety of clients

Ensuring the integrity of practitioner-client relationships

Enhancing the quality of professional knowledge and its

application

Alleviating personal distress and suffering

Fostering a sense of self that is meaningful to the person(s)

concerned

Increasing personal effectiveness

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Enhancing the quality of relationships between people

Appreciating the variety of human experience and culture

Striving for the fair and adequate provision of counselling and

psychotherapy services

Values inform principles. They represent an important way of

expressing a general ethical commitment that becomes more
precisely defined and action-orientated when expressed as a
principle.
10. List ethical principles required of the counsellor

Ethical principles of counselling:

Being trustworthy: honouring the trust placed in the

practitioner (also referred to as fidelity)

Autonomy: respect for the clients right to be self-governing

Beneficence: a commitment to promoting the clients wellbeing

Non-maleficence: a commitment to avoiding harm to the

client

Justice: the fair and impartial treatment of all clients and the
provision of adequate services

Self-respect: fostering the practitioners self-knowledge and

care for self

11. What personal morals values are expected of the counsellor?

Empathy: the ability to communicate understanding of another

persons experience from that persons perspective.
Sincerity: a personal commitment to consistency between what is
professed and what is done.
Integrity: commitment to being moral in dealings with others,
personal straightforwardness, honesty and coherence.
Resilience: the capacity to work with the clients concerns without
being personally diminished.
Respect: showing appropriate esteem to others and their
understanding of themselves.
Humility: the ability to assess accurately and acknowledge ones
own strengths and weaknesses.
Competence: the effective deployment of the skills and knowledge
needed to do what is required.

Fairness: the consistent application of appropriate criteria to inform

decisions and actions.
Wisdom: possession of sound judgement that informs practice.
Courage: the capacity to act in spite of known fears, risks and
uncertainty.
12. Of all the expectations in this Ethical Framework which do you think

will be the hardest for you to adhere to?

If I was forced to choose between the framework provided in the
workbook then I would have to choose: The clients choices many
not be the same as the therapists choice but if they are functional
they should be accepted
The reason for the above choice is because you may see what the
correct pathway to recovery is and the client may be road blocking
this. However the process must be respected and there are tools
such as the therapeutic contract which can help guide the process if
used in an intelligent manner.

Study Questions (4):

1. What are the ethical rules for working with your client for
counsellors?

The client is always to be respected in the counselling room.

The clients choices many not be the same as the therapists

choice but if they are functional they should be accepted.

Cultural differences should be understood and accepted if they

are functional.

While the therapist helps form goals for therapy it is a

collaboration responding to the needs of the client.

This is a professional relationship and that line can never be

crossed.

Your personal information other than professional information

does not belong in the counselling room.

The counsellor is also a mandated reporter so you client needs to

know you need to report anything illegal or anything that may
lead to harm to others or to your client.

2. Why is supervision important to your personal and professional wellbeing?

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Self-care is essential. You must evaluate you fitness to practice on a

regular basis. The truth is the counsellor has things going on in their
own life as well and that cannot get in the way of your fitness. You
must know about reflexivity. That is how who you are effects your
practice. This should be contemplated personally and also
addressed in supervision. You the individual is important to your
client so learn your positive traits and use them. Know the negative
traits or feelings and control them. Your supervisor can help you
with this.

3. Why is supervision important to your therapeutic process with your

client?
Reflect upon you client through supervision. Be open with your
supervisor and be open to what they say to you. Go over your notes
about each client to prepare for each session. This will allow you to
gain clarity and refocus yourself for your client.

4. How could a death or a loves one or a major disaster in your life

effect your professional ability? What should be done in such a
case?
A death or a major disaster could have a significant emotional
impact on an individual. This can affect how a therapist interacts
with a client, which may very well not follow the contract and derail
the therapeutic process.

5. Why do you want to be a counsellor/? Why is this knowledge

important for you to know? Why is it important to discuss this with a
supervisor?
I wish to be a counsellor in order to help other people achieve their
goals and objectives, whilst freeing them from any negative life
choice habits, destructive beliefs etc. All this knowledge will allow
me to move down the learning curve quickly and apply the
knowledge learnt in a practical scenario and develop deep practical
insight thereby becoming an expert after a longitudinal period of
time.
Discussing this with a supervisor is important so that he/she
understands my motivations and gains an insight into my drive. It
will also be useful in setting goals (Therefore the contract) and
hence the therapeutic process can be informed.

Study Questions (5):

1.

What is a stage theory and why is it important to know if a theory

is a stage theory.
Erik Erikson (1950, 1963) does not talk about psychosexual
Stages, he discusses psychosocial stages. His ideas were greatly
influenced by Freud, going along with Freuds (1923) theory
regarding the structure and topography of personality.
However, whereas Freud was an id psychologist, Erikson was an
ego psychologist. He emphasized the role of culture and society
and the conflicts that can take place within the ego itself,
whereas Freud emphasized the conflict between the id and the
superego.
According to Erikson, the ego develops as it successfully resolves
crises that are distinctly social in nature. These involve
establishing a sense of trust in others, developing a sense of
identity in society, and helping the next generation prepare for
the future.
Erikson extends on Freudian thoughts by focusing on the
adaptive and creative characteristic of the ego, and expanding
the notion of the stages of personality development to include
the entire lifespan.
Erikson proposed a lifespan model of development, taking in five
stages up to the age of 18 years and three further stages
beyond, well into adulthood. Erikson suggests that there is still
plenty of room for continued growth and development
throughout ones life. Erikson puts a great deal of emphasis on
the adolescent period, feeling it was a crucial stage for
developing a persons identity.
Like Freud and many others, Erik Erikson maintained that
personality develops in a predetermined order, and builds upon
each previous stage. This is called the epigenic principle.
The outcome of this 'maturation timetable' is a wide and
integrated set of life skills and abilities that function together
within the autonomous individual. However, instead of focusing
on sexual development (like Freud), he was interested in how
children socialize and how this affects their sense of self.
It is important to know if a theory is a stage theory because
these theories help us understand development and they also
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help us understand our clients. Therefore correct identification

and application is important.

2.

We know now that the human brain is not complete until the
individual reaches the age of 25 to 27 years. What does that say
about Piaget's theory?
Piaget thought the brain was complete at age 12. Piaget would
then say that by that age we can all solve the same problems
using their full set of problem solving skills which are the same
skills available to all adults. This is not to be confused with IQ.
He is talking about problem solving skills or our approach to
solving a problem. IQ is our differing ability to use those skills.
Problem solving is qualitative, IQ is quantitative.
The problem that arises with Piagets theory and many others
that end around the age of 12 is that it is very evident that
adolescents do not problem solve like most adults. All adults do
not all problem solve in the same way and older adults do not
problem solve like younger adults.
It changes the way we guide and approach clients. We have a
better idea of when to teach and guide something because we
know the brain is not complete until an individual is 25 to 27
years old.
It also draws attention to the fact that theory may not be
complete and other theories and reading as a counsellor are
needed to get a full picture.

3.

In what way could Erickson's theory be seen as a diagnostic tool

for therapy?
It has pre-defined steps we can follow to see which stage of
development the child/client is in. As this is a stage theory you
must accomplish the positive side of the theory or you are stuck
there until you do accomplish it. If you are stuck it will influence
your behaviour and this can be observed by the counsellor and
therefore guide the process. Sometimes all people need is to get
un-stuck and then continue to develop.

4.

How does Kohlberg define Morality? Why is that important to the

therapist?
Kohlberg defined moral reasoning as judgements about right and
wrong. His studies of moral reasoning are based on the use of
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moral dilemmas, or hypothetical situations in which people must

make a difficult decision.
Kohlberg defined a subject's level of moral reasoning from the
reasoning used to defend his or her position when faced with a
moral dilemma. He thought this more important than the actual
choice made, since the choices people make in such a dilemma
aren't always clearly and indisputably right.
He noted that development of moral reasoning seemed to be
related to one's age. However, he also determined that the
highest level of moral reasoning was not reached by all of his
subjects.

5.

At what ages is biological development most important? Why?

Biological development is important at all of the ages. This is
because without adequate development at a previous stage the
next stage may not become fully realise.

Review Questions (6):

1. How is humanistic psychotherapy like existential psychology and
how are they different?
Two theories that are often confused in psychology are humanistic
and existential theories of psychology. The humanistic theory of
psychology says that humans are constantly striving to become the
best version of themselves that they can be. The existential theory
of psychology says that humans are searching for the meaning of
life.
Similarities: As we mentioned above, humanistic psychology says
that people strive to be the best versions of themselves, while
existential psychology says that people are searching for the
meaning of life. They are very similar, though, in the way that
people achieve those ends - through personal responsibility and free
will. Essentially, both humanistic and existential psychologists value
the ability of humans to make their own choices and lead their own
lives.
Differences: Humanistic and existential psychologies differ can be
explained by referencing humanistic psychologys acorn metaphor,
where the acorn will automatically grow into an oak if given the
appropriate conditions. Humanistic psychology focuses on growth
and stimulating positive change in others. Existentialists, on the
other hand, believe that humans do not have an internal nature we
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can count on. They believe that at every moment, we are given the
choice about what to make of our conditions. Similarly,
psychologists state that although humanistic psychology is rooted in
existential thought, humanistic and existential psychologists value
different aspects of human existence. For example, existentialism
emphasizes the boundaries of human existence while the
humanistic stance puts the accent on human choice.

2. While it may be thought that CBT has its roots in Behavioural

Psychology, explain how it is different?
Behavioural therapies usually are short-term treatments that focus
on teaching clients specific skills. CBT is different from many other
therapy approaches by focusing on the ways that a person's
cognitions (i.e., thoughts), emotions, and behaviours are connected
and affect one another. Because emotions, thoughts, and
behaviours are all linked, CBT approaches allow for therapists to
intervene at different points in the cycle.

3. Which theory seems must interesting to you and explain why?

CBT is the most interesting for me as it combines a vast number of
techniques, theories and addresses both cognitive and behavioural
aspects of a clients needs.

4. Take the time to look into Humanistic theory. Students often like this
theory. Explain why its outcomes do not compare well to CBT in
cases where there is a mental health diagnosis.
CBT is more structured and focused, and the therapist is more
active in the session than is typical of humanistic therapists. This
may be a crucial aspect in keeping individuals with mental illness
engaged in the process. CBT has been demonstrated by many
research studies to be the most effective approach to therapy for a
variety of psychological problems. The therapy is goal-oriented, and
the focus on thoughts, assumptions, beliefs, and behaviours is key.
In CBT, the person develops more realistic and rational perspectives,
and makes healthier behavioural choices, which results in relief from
negative emotional states. Specific techniques, strategies and
methods are used to help people to improve their mood,
relationships and work performance.
5. What part of Carl Jungs theory might be helpful for all therapists to
know in todays world?
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Jung believed that each person strives to achieve wholeness by

attaining a harmony within consciousness and unconsciousness.
Activities that achieve this balance, for example dream study may
be a useful tool.

Study Questions (7):

1. How the therapeutic relationship is different in person centered

therapy from any other form of therapy?
The client-centered therapist stands at an opposite pole, both
theoretically and practically. He has learned that the constructive
forces in the individual can be trusted and that the more deeply
they are relied upon, the more deeply they are released. He has
come to build his procedures upon these hypotheses, which are
rapidly becoming established as facts; that the client knows the
areas of concern which he is ready to explore; that the client is the
best judge as to the most desirable frequency of interviews; that
the client can lead the way more efficiently than the therapist into
deeper concerns; that the client will protect himself from panic by
ceasing to explore an area which is becoming too painful; that the
client can and will uncover all the repressed elements which it is
necessary to uncover in order to build a comfortable adjustment;
that the client can achieve for himself far truer and more sensitive
and accurate insights than can possibly be given to him; that the
client is capable of translating these insights into constructive
behavior which weigh his own needs and desires realistically
against the demands of society; that the client knows when therapy
is completed and he is ready to cope with life independently. Only
one condition is necessary for all these forces to be released, and
that is the proper psychological atmosphere between client and
therapist.
Case records and increasingly research bear out these statements.
One might suppose that there would be a generally favorable
reaction to this discovery, since it amounts in effect to tapping
great reservoirs of hitherto little-used energy. Quite the contrary is
true, however, in professional groups.
There is no other aspect of client-centered therapy which comes
under such vigorous attack. It seems to be genuinely disturbing to
many professional people to entertain the thought that this client
upon whom they have been exercising their professional skill
actually knows more about his inner psychological self than they
can possibly know, and that he possesses constructive strengths
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which make the constructive push by the therapist seem puny

indeed by comparison. The willingness fully to accept this strength
of the client, with all the re-orientation of therapeutic procedure
which it implies, is one of the ways in which client-centered therapy
differs most sharply from other therapeutic approaches.
The third distinctive feature of this type of therapy is the character
of the relationship between therapist and client. Unlike other
therapies in which the skills of the therapist are to be exercised
upon the client. In this approach the skills of the therapist are
focused upon creating a psychological atmosphere in which the
client can work. If the counselor can create a relationship
permeated by warmth, understanding, safety from any type of
attack, no matter how trivial, and basic acceptance of the person
as he is, then the client will drop his natural defensiveness and use
the situation. As we have puzzled over the characteristics of a
successful therapeutic relationship, we have come to feel that the
sense of communication is very important. If the client feels that he
is actually communicating his present attitudes, superficial,
confused, or conflicted as they may be, and that his communication
is understood rather than evaluated in any way, then he is freed to
communicate more deeply. A relationship in which the client thus
feels that he is communicating is almost certain to be fruitful.

2. While Maslows theory may not be a stand along therapy how is it

important in understanding Humanistic therapy?
Humanistic therapy helps individuals access and understand their
feelings, gain a sense of meaning in life, and reach selfactualization.
Maslows Hierarchy of Needs serves as a useful linear guide/map
as to position clients and see what is needed to move them to the
ultimate goal of self-actualization.
3. In what type of cases may a therapist not choose to use Humanistic
Therapy?
Humanistic / Person-Centred therapy does not focus specifically on
issues from the past. If these need to be explored further, other
therapies that include the role of past experiences may be more
suitable e.g. Integrative, Psychodynamic, Psychoanalytic, Systemic,
Transactional, Trauma Training
4. How did you decide in what cases you may choose to use
Humanistic Therapy?

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In cases where the client has clear present and future focused
goals on which he/she wishes to work with.
5. If you used comparative outcome studies on this type of therapy to
answer question number 4 you have already done this question. If
you did not, what do outcome studies show as the type of cases in
which Humanistic therapy works best?
Please see this website for a comprehensive list of studies
performed: http://www.bacp.co.uk/research/resources/

Study Questions (8):

1. What are cognitive distortions?
Cognitive therapy recognizes 10 common patterns of faulty thinking,
which are known as cognitive distortions.
2. What major component does cognitive psychology add to CBT?
It is important to understand the cognitive component as the underlying
beliefs and assumption as the basis of understanding the CBT therapeutic
process. Its major application is in understanding the client and allowing
the client to understand their destructive thing in the cognitive
distortions. The behavioral part giving the client the tools for changing
that thinking and thereby changing their behavior.
3. What is the role of the therapist in meeting the goals of Cognitive
psychology?
Therapists plan treatment on the basis of a cognitive formulation of
patients disorders and an ongoing individualized cognitive
conceptualization of patients and their difficulties
4. What is Socratic Dialogue? Write a short example.
Socratic Dialogue: the major therapeutic device is questioning through
the Socratic method, which involves the creation of a series of questions
to a)clarify and define problems, b) assist in the identification of
thoughts, images and assumptions, c)examine the meanings of events
for the patient, and d) assess the consequences of maintaining
maladaptive thoughts and behaviors.
Example: Clarification Questions:
What do you mean when you say?
How do you understand this?
Why do you say that?
What exactly does this mean?
What do we already know about this?
Can you give me an example?
Are you sayingor?
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Can you say that another way?

5. Give an example of how you would use Guided Discovery?
A useful analogy for guided discovery is to think about going to an
opticians for an eye test. The optician may initially put a contraption on
their clients head with a range of lenses on it. Initially, their clients
cannot see through this contraption very well (i.e., what they perceive is
a blur). The optician then sets about gradually removing or replacing
lenses, and after a while, through a process of trial and error (and
feedback from the client) each individual begins to see more clearly.
Guided discovery works in exactly the same way as the above example.
Except, instead of using optical lenses, the therapist helps the client use
lenses of perception. Perceiving information is a different way allows each
client to access a range of choices in their life, ostensibly, to see their life
through different lenses. When we view life in a different way our
emotional reaction to events also shifts. These types of continued
conscious re-evaluations in CBT are very important because they lay the
foundations of future automatic thinking and make relapse less likely.

Study Questions (9):

1. How do you see the second I related to Eric Ericksons
psychosocial developmental theory?
Eriksons theory of psychosocial development has eight distinct
stages. Like Freud, Erikson assumes that a crisis occurs at each stage
of development. For Erikson, these crises are of a psychosocial nature
because they involve psychological needs of the individual (i.e.
psycho) conflicting with the needs of society (i.e. social).
According to the theory, successful completion of each stage results
in a healthy personality and the acquisition of basic virtues. Basic
virtues are characteristic strengths which the ego can use to resolve
subsequent crises.
Failure to successfully complete a stage can result in a reduced ability
to complete further stages and therefore a more unhealthy
personality and sense of self. These stages, however, can be
resolved successfully at a later time.
2. If you were to find an individual was stuck, what would you need to
address in therapy. Give an example using a hypothetical situation where
an adult is stuck in mistrust.
When a client stops making progress or takes a few steps back i.e. gets
stuck, I would contemplate my role in the stagnation. Then I have an
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honest conversation with the clients to pinpoint the problem. And then I
work on getting unstuck together.
An example could be where someone feels they have been taken
advantage of all their lives. This can transfer (perceived) to the
therapists genuine offer of help and advice as a thinly disguised
attempts to lead him/her astray and take advantage.
3. What would be an example of a troubling mental picture from the first I?
Flashbacks to unhappy or traumatic experiences, for example abuse or
other forms of violence.
4. How might dimension S and the first I be helpful in forensic therapy?
By allowing the client to understand S and I the Forensic Therapist
working from the premise that the offender has a complex internal world
which may be characterized by punitive and unreliable internal
representations of paternal and other figures, psychotherapy can shed
light on the unconscious impulses, conflicts, and primitive defense
mechanisms, involved in his or her destructive actions and "acting out". It
helps to understand the triggers to the violent acts and timing of the
acts. Forensic psychotherapy aims to help the offender understand why
they committed the act and take responsibility for it, aiming to prevent
future crimes committed
5. Compare and contrast personality traits to dimensions.
The basic belief here is that different people are more influenced by some
personality traits or dimensions than others. People deal with problems on
their own differently so everything must be looked at. All of our reactions
are a combination of all seven dimensions and work together uniquely in
each individual so they must all be examined and addressed in therapy.

Study Questions (10):

1. Do you agree with the three beliefs with which Ellis starts? How
have you observed them in your own life?
All his advice is based on the core philosophy of rationality and
unconditional acceptance. This unconditional acceptance of
humanity and the human condition seems almost spiritual in its
completeness, and I sometimes fear it is unattainable. But I keep
returning to this philosophy having observed them in my life and
keep seeing the wisdom of it. A rational/realist view of humanity and
the human condition seems to provide a more efficient way to
navigate through lifes problems.
2. What elements of humanism do you see in this theory?
18

The similarity to Humanism in this approach emphasizes people's

capacity to make rational choices and develop to their maximum
potential.
3. How is the ABC model different from Becks irrational beliefs?
The cognitive approach believes that abnormality stems from faulty
cognitions about others, our world and us. This faulty thinking may
be through cognitive deficiencies (lack of planning) or cognitive
distortions (processing information inaccurately).
These cognitions cause distortions in the way we see things; Ellis
suggested it is through irrational thinking, while Beck proposed
basic irrational assumptions.
4. Explain the cause and effect component of emotions and belief in
this model and how it would work in therapy.
In the ABC model the cause could be a trigger, for the purposes of
this example a drunk person making noise outside your house. You
have a belief that they should not be making noise outside your
house when you are asleep. The emotion is anger that they are
disturbing you (possibly on purpose).
In a therapy setting you as the therapist could provide positive
feedback on the homework the client has completed. The belief
generated in the client is one of pride, trust and progress in the
process. The client feels positive emotions in his/herself.

Study Questions (11)

1. How is coaching different from counselling?
The objective of counseling is to help people address and resolve
problems that make them feel bad emotionally, or are impairing
their ability to function well. This can include healing from Anxiety,
Depression, Mood Disorders, Trauma, issues with their family of
origin, their relationships, ADHD, Addictions and many other
common problems. Its understood that unless and until these
problems are resolved it will be difficult for people to make
significant changes in their lives. Counselling also deals with
resolving issues that are most commonly connected to the past
The objective of coaching is to help people achieve their goals. The
basic presumption of coaching is that coaching clients are in a good
place mentally and emotionally, and ready to receive guidance and
instruction on how to make changes that will help them achieve
their goals. The work focuses on creating and maintaining
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motivation for change, exploring obstacles to change, and creating

plans for change. Coaching also deals with present and future only.
2. How might a coach use CBT techniques without violating the six

requirements for coaching? Give an example.

The coach may use CBT techniques without violating the six
requirements for coaching by focusing on the clients goals in the
present and future.
3. What is the most important tool of the coach?
The coach must be a good listener and have very strong
communication skills.
4. How much advice does a coach need to give?
The coach does not give any advice.
5. What communication skills do you think might be helpful in
coaching? ( i.e. using the clients language CBT skill language
matching)
Language skills such as NLP would be very useful in coaching.

Study Questions (12)

1. What medical or mental health disorders do you think this coaching
would be good with? Explain why you think so.
Long term disorders such as anxiety, depression or a long term
physical health issue such as multiple sclerosis. This is because this
type of coaching provides them with the tools and techniques to live
and deal with symptoms of the illness they face on a daily basis. It
provides a practical solution that they can work with themselves
with some practice.
2. How could you use these techniques with children will a serious
medical problem?
When dealing with children it is important to keep them feeling
secure and it would be prudent that one or more of their caregiver
be present when these techniques are present. In addition a
complete explanation of the technique should be given and
understanding verified.
3. What would you tell people about self-hypnosis if they were afraid to
try it because they think they would be giving up control of their
brain?
In a hypnotherapy session you are always in control and you are not
made to do anything. It is generally accepted that all hypnosis is
20

ultimately self-hypnosis. A hypnotist merely helps to facilitate your

experience - hypnotherapy is not about being made to do things, in
fact it is the opposite, it is about empowerment. You are in full
control.
4. To do this well, you need to practice these techniques. Keep a diary
for each one and practice them for two weeks. What do you learn
from the experience?
I learnt that progressive relaxation improved my insomnia
significantly and allowed me to fall asleep very quickly. I found this
to be very beneficial.

Study Questions (13)

1. How do you see questions used differently in Solution/Problem
Solving coaching?
Solution talk or problem-free talk is talk about solutions and
resources.
2. Why is the wrap-up so crucial to this kind of coaching?
Wrap up is the crucial part of the coaching session where the
coachee and coach commit to some action, define a time frame and
identify how to overcome any obstacles
3. Why is brain storming so important?
Examine a range of possibilities
Uncover blind spots
Invite suggestions from coachees - this empowers and fosters selfreliance
Offer suggestions carefully - coachees often like guidance not
orders
Ensure choices are made and owned
Explore coast and benefit of choices
4. Other types of coaching and even by definition coaching says not to
look at the past. This coaching does look at the past. Do you think
that part of this plan is necessary? Why or why not.
In this style of coaching the past will come up at some point as we
will be discussing what the problem is in detail and then formulate a
solution. SO yes it is necessary.

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5. This is the only type of coaching that requests time framed goals. Is
this a good thing? Would you consider doing this in other types of
coaching? Why?
Time framed goals can be advantageous as they can focus both the
client and coach. However in other forms of coaching and even
therapy there may be deeper issues to be worked through,, more
ossified personalities and setting arbitrary time frames maybe
counterproductive.

Study Questions (14):

1. What is the difference between supervision and consultation?
There is a difference between supervision and consultation.
Whereas supervision involves the direct oversight of clinical cases
over a period of time (often involving evaluation of the clinician),
consultation refers to a relationship that is designed to assist in
professional development but does not involve formal oversight of
clinical cases and may or may not continue over time. In essence,
consultation involves a growth-oriented discussion of cases or issues
without oversight or evaluation of the Counsellor. It may just provide
the clinician with more information about diagnosis and severity of a
case so a decision can be made about moving forward with the
client. In the first session evaluation of sundial ideation and selfharm must be made and addressed if present. The Counselor is
responsible for immediate care for these items even if they do not
accept the case. The client should not leave without resources and
having someone take responsibility for his/her well- being.
All counselors should have supervision at all times. They should also
have a list of diagnosticians, medical experts and therapy experts
upon which they can call to help with unique questions and
diagnosis and choice of treatment plans.
2. When should a consultation be used?
Consultation is often used as a way to expand a therapists ideas for
working with a client. Consultation is also considered a risk
management tool but obligates you to take no specific action other
than that based on your own professional judgment.
3. Why might a counsellor not take a case that is not too severe for
CBT therapy?
Anything that comes into professional conflict- e.g. if the client is a
friend, lover, business associate, or some other role in their life,
which is known as a dual relationship then it would be strongly
advisable not to take the case and refer it on.
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4. What is the GAF and how is it used.

GAF is the Global Assessment of Functioning Rating and is used in
assessing severity of mental illness.
5. What responsibility does the counsellor have for the clients wellbeing even if they do not accept the case?
The principle of Beneficence: i.e. a commitment to promoting the
clients well-being is paramount. Therefore if they do not accept a
case ensuring that the clients case is referred on to someone
competent is important.

Study Questions (15):

1. Why is it important for your client to have an internal locus of
control?
People with an internal locus of control tend to believe that they
control their own reactions and emotional states. Psychotherapy,
almost by definition, helps people to better regulate their internal
processing and focus on developing a stronger internal locus of
control. Therefore control over it by the client is paramount.
2. Can you help your client gain an internal locus of control and if so
how?
You can encourage your client to:

Realise that by not making a decision, is, in fact, already a

choice. The choice to let others (or life) decide for them.

Pay close attention to their own internal dialogue if you hear

yourself saying I cant do that or There is nothing I can do
about it recognise that they have just made a decision and
ask yourself if it is the only option? What would a person with
an Internal LoC do?

Plan their future, set goals, take time to visualise a big bright
future that they feel compelled to step into.

Explore their values, what values would really focus them?

Integrity, honesty, compassion, humility, commitment

Dont be afraid to have fun, to talk to people, to let your guard

down occasionally

Dont fear failure, fear not even trying

Learn new things

23

3. Would it be necessary to adapt this therapy for postpartum

depression? If so how?
In addition to CBT antidepressants prescribed by a licensed
physician may be required for this condition.
4. Why is problem solving a big part of working with depression?
Problem solving is a key part of working with depression as it gets to
the root causes of what is affecting the client, designing effective
solutions which are tailor made to the causes and then ensuring
SMART goals are set with an understanding of what resources are
required in order to tackle the issues.
5. Why do you think it would be best to recommend using CBT therapy
along with medication for depression?
The combination of CBT and an antidepressant is particularly
powerful because it provides a "one-two" punch against the
powerful symptoms of depression. Medicines target brain chemistry
problems that can impact mood. CBT steps in to provide a person
with skills that they can use whenever and wherever they happen to
be. These new skills can improve a current depressed mood, as well
as help to prevent (or decrease the severity of) future depressive
episodes.

Study Questions (16):

1. What is a negative thought and why is it important in therapy?
Intrusive thoughts that are unwelcome, involuntary thoughts,
images or unpleasant ideas that may become obsessions, are
upsetting or distressing, and can be difficult to be free of and
manage. Identifying your negative thinking is the first step
towards letting it go. The goal of cognitive behavioral therapy is
to identify and correct these negative thoughts and beliefs. The
idea is that if you change the way you think, you can change the
way you feel.
2. What is thought challenging and how is it used in therapy?
Thought challengingalso known as cognitive restructuringis a
process in which you challenge the negative thinking patterns
that contribute to your anxiety, replacing them with more
positive, realistic thoughts.
It involves three steps (Overview):
1. Identifying your negative thoughts.
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2. Challenging your negative thoughts.

3. Replacing negative thoughts with realistic thoughts.
3. Why is it important to work on changing both thoughts and
behaviors?
This is because both thoughts (cognitions) and behaviours can
contribute to anxiety and negative behavior. Thoughts also influence
behaviours and behaviours influence emotions and thought
processes. Therefore it is important to address both.

Study Questions (17):

1. Explain what keeping a journal would do for the maintenance of
depression?
Writing down your thoughts and feelings helps to understand them more
clearly. And if you struggle with stress, depression, or anxiety, keeping a
journal can help you gain control of your emotions and improve your
mental health.
2. Explain the biological effects of exercise (activity) on the brain in
relationship to depression and its maintenance.
While the research is consistent and points to a relationship between
exercise and depression, the mechanisms underlying the antidepressant
effects of exercise remain unclear. Several credible physiologic and
psychological mechanisms have been described, such as the thermogenic
hypothesis, the endorphin hypothesis, the monoamine hypothesis, the
distraction hypothesis, and the enhancement of self-efficacy.

Thermogenic Hypothesis
The thermogenic hypothesis suggests that a rise in core body temperature
following exercise is responsible for the reduction in symptoms of
depression. DeVries explains that increases in temperature of specific
brain regions, such as the brain stem, can lead to an overall feeling of
relaxation and reduction in muscular tension. While this idea of increased
body temperature has been proposed as a mechanism for the relationship
between exercise and depression, the research conducted on the
thermogenic hypothesis has examined the effect of exercise only on
feelings of anxiety rather than depression.

Endorphin Hypothesis

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The endorphin hypothesis predicts that exercise has a positive effect on

depression due to an increased release of -endorphins following exercise.
Endorphins are related to a positive mood and an overall enhanced sense
of well-being. This line of research has not been without criticism. The
debate remains as to whether plasma endorphins reflect endorphin
activity in the brain. Some have argued that even if peripheral endorphin
levels are not reflective of brain chemistry, they could still be associated
with a change in mood or feelings of depression. Several studies have
shown increases in plasma endorphins following acute and chronic
exercise; yet, it remains unclear if these elevations in plasma endorphins
are directly linked to a reduction in depression. Lastly, the phenomenon of
runner's high, often attributed to endorphin release, is not blocked by
naloxone injection, an opiate antagonist.

Monoamine Hypothesis
The monoamine hypothesis appears to be the most promising of the
proposed physiologic mechanisms. This hypothesis states that exercise
leads to an increase in the availability of brain neurotransmitters (e.g.,
serotonin, dopamine, and norepinephrine) that are diminished with
depression. These neurotransmitters increase in plasma and urine
following exercise, but whether exercise leads to an increase in
neurotransmitters in the brain remains unknown. Animal studies suggest
that exercise increases serotonin and norepinephrine in various brain
regions, but, to date, this relationship has not been studied in humans.

Therefore, while several physiologic mechanisms remain plausible,

methodological difficulties have prevented this line of research from
advancing. Martinsen discusses how testing biochemical hypotheses is
often difficult in humans due to the invasive procedures necessary to
obtain samples (e.g., spinal taps for cerebrospinal fluid samples). Further,
biochemical samples obtained from blood or other bodily fluids may not
directly reflect the activity of these compounds in the brain. Hopefully,
with the advent of new less invasive neuroimaging techniques, future
researchers can examine whether exercise leads to the neurochemical
changes in the brain predicted by these physiologic hypotheses.

Distraction Hypothesis
Several psychological mechanisms have also been proposed. As was the
case with the physiologic mechanisms, many of these theories have not
been tested extensively. The distraction hypothesis suggests that physical
activity serves as a distraction from worries and depressing thoughts. In
general, the use of distracting activities as a means of coping with
26

depression has been shown to have a more positive influence on the

management of depression and to result in a greater reduction in
depression than the use of more self-focused or introspective activities
such as journal keeping or identifying positive and negative adjectives
that describe one's current mood.

Exercise has been compared with other distracting activities such as

relaxation, assertiveness training, health education, and social contact.
Results have been inconclusive, with exercise being more effective than
some activities and similar to others in its ability to aid in the reduction of
depression. However, exercise is known to increase positive affect, which
is diminished in depressed patients and is not augmented by distraction
activities. The diminished capacity to experience positive affect is an
essential distinguishing symptom in clinical depression.

Self-Efficacy Hypothesis
The enhancement of self-efficacy through exercise involvement may be
another way in which exercise exerts its antidepressant effects. Selfefficacy refers to the belief that one possesses the necessary skills to
complete a task as well as the confidence that the task can actually be
completed with the desired outcome obtained. Bandura describes how
depressed people often feel inefficacious to bring about positive desired
outcomes in their lives and have low efficacy to cope with the symptoms
of their depression. This can lead to negative self-evaluation, negative
ruminations, and faulty styles of thinking. It has been suggested that
exercise may provide an effective mode through which self-efficacy can be
enhanced based on its ability to provide the individual with a meaningful
mastery experience. Research examining the association between
physical activity and self-efficacy in the general population has focused
predominantly on the enhancement of physical self-efficacy and efficacy
to regulate exercise behaviors. The relationship between exercise and selfefficacy in the clinically depressed has received far less attention. The
findings of the few studies that have examined this relationship have been
equivocal as to whether exercise leads to an enhancement of generalized
feelings of efficacy. However, recent study has reported that involvement
in an exercise program was associated with enhanced feelings of coping
self-efficacy, which, in turn, were inversely related to feelings of
depression.
More research is needed to determine which, if any, of the mechanisms
described herein are important moderators of the exercise effect. It is
highly likely that a combination of biological, psychological, and
sociological factors influence the relationship between exercise and
depression. This is consistent with current treatment for depression in
27

which the effects of pharmacotherapy and psychotherapy on depression

are additive and address biological, psychological, and sociological
aspects of the patient. There may also be individual variation in the
mechanisms or combination of mechanisms mediating this relationship.
Additionally, different mechanisms may be important at specific times in
the natural course of depression. Until more is known about the possible
mechanisms, this relationship may be best studied utilizing a
biopsychosocial approach.

3. How would you explain to a client that maintenance is often necessary

for living with depression of dysthymia?
I would have to explain what it is: Persistent depressive disorder
(dysthymia) is a form of depression. It may be less severe than major
depression, but as the name suggests it lasts longer. Many people
with this type of depression describe having been depressed as long as
they can remember, or they feel they are going in and out of depression
all the time.
Then I would need to explain that to treat it successfully and with the long
term view in mind maintenance treatment and activities would be
beneficial.

Study Questions (18):

1. What is the role of using desire fulfillment in this therapy?
Theoretically, Rational Living Therapy assumes that the main reason
partners have relationship problems is that they are not receiving
what they want from each other (Pucci, 2001). While this theory
might seem very basic, the reason partners become dissatisfied
with each other becomes more complicated.
Couples are taught the various reasons partners are not fulfilled in
their relationship, including: discomfort with receiving, discomfort
with giving, inability to receive, inability to give, unwillingness to
receive, unwillingness to give, difficulty communicating desires, and
impatience. As they are taught about these various factors, the
partners are asked to share to what degree they believe that their
relationship is affected by them.
After the relevant barriers to desire fulfillment are identified and
addressed, the partners begin fulfilling each others desires.
Therapeutic contracts are developed, including the allocation of
time for each other (scheduling dates). Partners are taught a
rational approach to compromise. This approach to compromise
begins with the goal of both partners obtaining what they want and
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working at compromising on a method to achieve that goal. If the

partners discover that this goal is unattainable, they then begin
compromising in relation to their desires.
2. What is the role of the internal Locus of control in this therapy?
At the very heart of this therapy is the core belief that the only
person the client can really control is him or herself. This is to say
they can choose to react to the partners behaviours.
3. What are the ABCs of Emotions?
The ABC Theory of Emotion represents a widely-accepted model of
how one's feelings and behavioral patterns are created. It asserts
that the emotions we experience such as, for example, frustration or
anxiety, and resulting behavior, do not come directly from the
events in our lives, but from the interpretations we make of those
events, i.e. from conscious or subconscious beliefs we bring to that
situation.
The basic model:
The model's fundamental principle can be outlined as follows:
A...stands for Activating events in people's lives; these events
represent what happens.
B...stands for people's conscious or subconscious Beliefs about
these events and their meaning.
C...stands for emotional and behavioural Consequences or
Concomitants of their beliefs; they represent the feelings and
behavioural patterns (Conduct) these people have as a result.
After identifying these elements the central proposition of the theory
is that the emotional and behavioural consequence (C) is not caused
by the Activating event (A) directly, but by interpretation or belief
(B) one has of the meaning of the activating event.

Study Questions (19):

1. While we are dealing with the same Beck depression therapy when
working with children and adolescent what changes would you make
for each of these two groups?
Treatment of childhood and adolescent depression consists of
psychotherapy, pharmacotherapy, or a combination of these.
Treatment should correspond to the level of depression, patient
preferences, the developmental level of the patient, associated risk
factors, and availability of services. Patient and family education
29

about the associated risks and benefits of treatment, expectations

regarding patient monitoring, and follow-up should be included.
2. What outside elements become part of the childs therapy and how
would you deal with each?
When dealing with a childs therapy parents, teachers and other
influencers in a childs life may become involved. They would need
to be briefed about the process and involved to a degree that is
appropriate.
3. At what age do you think you could begin to use CBT therapy with a
child? Why did you make that choice?
Research protocols have documented efficacy in children as young
as age 8. With parental direction, children as young as 2 or 3 can
learn how to use non-anxious self-talk (using puppets or dolls as
models) and desensitization through gradual exposure, even if it is
from the vantage point of the parents' arms.
It would be beneficial before therapy proper is begun, many children
and young adolescents will benefit from a period of emotional
education, during which they learn to distinguish different emotional
states and link emotions with thoughts and events.

Study Questions (20):

1. What are the personal traits that contribute to Positive Psychology?
There are four different personal traits that contribute to positive
psychology: subjective well-being, optimism, happiness, and selfdetermination.
2. What are the implication of Positive Psychology on mental and
physical health?
Positive psychology shares a strong connection clinical psychology
with overall mental health. This is because one of positive
psychologys goals is to focus on what is right about a person and
how those traits can be increased. The desired result being a
happier, more fulfilled life. Similarly, clinical psychology also tries to
increase positive traits to help people deal with mental disorders.
Here the end goal is to help people function in everyday life and
lead a normal life. As they are the not the same thing, their goals
will not be identical, but they are remarkably similar!
Some of the methodology, the devices that help psychologist
(positive or not) achieve their goals, are shared between the two
genres of psychology.
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One tool that a positive psychologist might use is something called

Learned Optimism. This technique was pioneered by Martin
Seligman in the 1990s. Learned Optimism targets a persons
negative cognitions and systematically replaces them with more
positive affirmations. Eventually, the person will be thinking more
optimistically than they had before. Clinicians use techniques based
on cognition in therapy to combat conditions. From the clinicians
standpoint, they try to heighten a clients coping skills to decease
helplessness. The difference here is that the coping is the key focus
and the life fulfillment is secondary.
Secondly, there is positive psychotherapy, which combines positive
behavioral approaches with the world of psychotherapy.
Psychotherapy seeks to reduce the negative functioning of a client.
Positive Psychotherapy adds one step onto the process. Instead of
just reducing symptoms, positive psychotherapy works on
increasing a persons positive emotions and behaviors.
Third, there is another concept that draws upon similarities. Positive
Psychology and Clinical Psychology encourage people to engage in
states of flow. According to research done by Mihaly
Csikszentmihalyi, a leading positive psychologist, flow is unique to
each person; however, the people who experience flow report
similar characteristics.
Flow is a higher state of consciousness. It is said to be achieved
when youre super focused on an activity. A loss of temporal
awareness is also reported when in the flow state. People have said
they felt perfectly challengednot bored or overwhelmed. Those who
regularly experience flow report that it is extremely intrinsically
rewarding. As such, people who experience flow on a regular basis
tend to have more stable mental health (as they are self-actualizing
and reaching fulfilment).
Both positive and clinical psychologists use states of flow to help
their patients. Positive psychology uses flow to enrich peoples lives.
They use flow to encourage positive emotions, which can broaden
and build a persons mind, and help to attain long standing life
goals. Clinical psychologist use the flow state in slightly different,
but still effective ways. Clinical psychologists may engage their
patients in flow to distract them from things that might trigger their
negative thoughts. If used correctly, it can boost self-esteem and if
endured regularly it can help battle symptoms of depression.
3. Where would you expect to practice Positive Psychology and why do
you choose those locations?

31

Excellent locations to practice positive psychology would be schools

as it plays a role in efforts to curb bullying and can be very valuable
counselling for many.
4. In what way could you incorporate Positive Psychology into CBT
therapy for depression or anxiety?
You could use uses positivity-building exercises alongside
psychological techniques used in cognitive behavioural therapy.

Study Questions (21):

1. What aspect of DBT come from cognitive behavioral thinking?
One of DBT's several elements is cognitive behavioural therapy
(CBT). DBT espouses the scientific ethos. It makes use of selfmonitoring, there is an emphasis on the here and now and much of
the therapeutic technique is borrowed from CBT, including the style
of open and explicit collaboration between patient and therapist.
Furthermore, the treatment has a manual. The bible of DBT is
Linehan's Cognitive Behavior Treatment of Borderline Personality
Disorder (1993a).
2. What is ageism?
Prejudice or discrimination on the grounds of a person's age.
3. What are your feelings about working with the elderly? Do you think
it is worth you time to work with people who are soon going to die?
As a therapist it is my belief that everyone deserves equal access to
care regardless of age. Just because a person is elderly I cannot
assume they are going to die sooner than a younger client will.
Everyone deserves the right to an equal level of care.

Study Questions (22):

1. This is basically a list of techniques. In using the anger management
techniques what CBT basics would you also need to teach to your
client?
The use of cognitive behavioral therapy (CBT) is something that
many anger management treatment concoctions incorporate. By
trying to get a patient to open up about their emotions and feelings
and being driven to accomplish a specific task (in this case
controlling anger), a person is cognitively motivated to use positive
skills towards their behavior.
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Studies show using a mix of CBT as well as other therapies on the

participants/clients increased the effective usage of the anger
management techniques and that they also felt more in control of
their own anger. Personal changes like these can lead to less
aggression and cut down on violent acts. The use of play therapy
with this is also found efficient in tackling anger issues among
children.
2. In using the stress management techniques what CBT basics would
you also need to teach to your client?
Use a blend of cognitive, behavioral and some humanistic training
techniques to target the stressors of the client. This usually is used
to help clients better cope with their stress or anxiety after stressful
events. This is a three phase process that trains the client to use
skills that they already have to better adapt to their current
stressors. The first phase is an interview phase that includes
psychological testing, client self-monitoring, and a variety of reading
materials. This allows the therapist to individually tailor the training
process to the client. Clients learn how to categorize problems into
emotion- focused or problem focused, so that they can better treat
their negative situations. This phase ultimately prepares the client
to eventually confront and reflect upon their current reactions to
stressors, before looking at ways to change their reactions and
emotions in relation to their stressors. The focus is
conceptualization.
The second phase emphasizes the aspect of skills acquisition and
rehearsal that continues from the earlier phase of conceptualization.
The client is taught skill that help them cope with their stressors.
These skills are then practiced in the space of therapy. These skills
involve self-regulation, problem solving, interpersonal
communication skills, etc.
The third and final phase is the application and following through of
the skills learned in the training process. This gives the client
opportunities to apply their learned skills to a wide range of
stressors. Activities include role-playing, imagery, modeling, etc. In
the end, the client will have been trained on a preventative basis to
inoculate personal, chronic, and future stressors by breaking down
their stressors into problems they will address in long-term, shortterm, and intermediate coping goals.

3. Why is journaling or writing things down and essential in both of

these therapies?
A stress journal can help you identify the regular stressors in your
life and the way you deal with them.
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Study Questions (23):

1. When does a counsellor need to worry about the ethical code?
A counsellor should always be worried about his/her integrity and
maintaining the Ethical code.
2. Who wrote the ethical code and who enforces it?
British Association for Counselling and Psychotherapy
3. What are the consequences of breaking an ethical code?
Breaking the ethical code means your could lose your right to
practice.
4. What is the most important thing a counsellor should do before
thinking about working on their own?
Think about working for an established group rather than trying to
set up your own shop right away. By joining a group practice or
taking a job in a community agency or medical setting, you can gain
experience, connect with colleagues and have a guaranteed
paycheck with benefits. It can also give you an inside look at how to
run a business.

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