A T H E R A P I S T ’ S GU I D E T O

BRIEF COGNITIVE
BEHAVIORAL THERAPY
JEFFREY A. CULLY, PH.D.
ANDRA L. TETEN, PH.D.

















































Published by the Department of Veterans Affairs, South Central Mental Illness Research,
Education, and Clinical Center (MIRECC), 2008.

Suggested citation: Cully, J.A., & Teten, A.L. 2008. A Therapist’s Guide to Brief Cognitive
Behavioral Therapy. Department of Veterans Affairs South Central MIRECC, Houston.

To request a copy of this manual, please contact Michael Kauth at michael.kauth@va.gov
ACKNOWLEDGMENTS
We would like to thank the multiple individuals and organizations that
supported this work. This project emanated from our passion for teaching
and our desire to increase the availability and quality of cognitive-
behavioral therapies in health care settings. Our mentors and colleagues
were instrumental in their encouragement and feedback. We would like to
give special thanks to the following individuals: Evelyn Sandeen, PhD and
Melinda Stanley, PhD (expert consultants); Sparkle Hamilton, MA (project
assistant); and Heather Mingus (Graphic Artist); Anne Simons, PhD (past CBT
supervisor – AT).
We are also grateful to the support of the Veterans Health Administration
Cffce cf Fe:ecrch cnc Deve|cpmenl cnc Cffce cf /cccemic /ff|iclicn: ,
Sculh Cenlrc| MlFECC cnc 8cy|cr Cc||ege cf Mecicine.
This work was supported by a Clinical Educator Grant from the South Central
MlFECC.
IHE 8FlEF C8I M/NU/L
This manual is designed for mental health practitioners who want to establish
a solid foundation of cognitive behavioral therapy (CBT) skills. Concepts
contained in the manual detail the basic steps needed to provide CBT
(“Practicing CBT 101”) with the intent that users will feel increasingly
comfortable conducting CBT. The manual is not designed for advanced
CBT practitioners.
Instructional material in this program is designed to be used within the
context of a psychotherapy supervisory relationship to ensure appropriate
application of the training materials and timely feedback, which are viewed
as critical to the development of CBT skills.
The content of this manual is a compilation of foundational works on CBT,
such as Judith Beck’s (1995) Cognitive Therapy: Basics and Beyond, with the
addition of key skills needed for developing CBT therapists. The information
is condensed and packaged to be highly applicable for use in a brief
therapy model and to aid in rapid training.
I/8LE CF CCNIENIS
ESSENIl/L FSYCHCIHEF/FY SKlLLS
MCDULE ICFlC
1 Introduction to Brief Cognitive Behavioral Therapy (CBT) .... 06
2 U:ing Supervi:icn ....................................................................... 10
3 Ncn:pecifc Fcclcr: in F:ychclhercpy .................................. 13
4 Case Conceptualization and Treatment Planning .............. 18
ESSENTIAL CBT SKILLS
MCDULE ICFlC
5 Orienting the Patient to Brief Cognitive Behavioral Therapy .. 28
6 Goal Setting ............................................................................. 32
7 Agenda Setting ........................................................................ 36
8 Homework .................................................................................. 40
9 Identifying Maladaptive Thoughts and Beliefs .................. 44
10 Challenging Maladaptive Thoughts and Beliefs .................. 54
11 Behavioral Activation ............................................................. 60
12 Problem Solving ....................................................................... 66
13 Fe|cxclicn .................................................................................. 73
14 Ending Treatment and Maintaining Changes ..................... 82
FEFEFENCES/SUGGESIED /ND SUFFLEMENI/L FE/DlNGS ....................... 88
/FFENDlX /: F/IlENI H/NDCUIS ................................................................. º2
/FFENDlX 8: S/MFLE IFE/IMENI CUILlNES ............................................... 114
ESSENTIAL PSYCHOTHERAPY SKILLS

ó
Modu|e 1: Introduct|on to 8r|e| Cogn|t|ve 8ehov|oro| Iheropy [C8I}

Object|ves
! Ic uncer:Icnc C8I cnc Ihe prcce:: cf 8rief C8I
! Ic icenIify key IrecImenI ccn:icercIicn: cnc prcL|em: mc:I :uiIcL|e fcr 8rief C8I
! Ic |ecrn hcw Ic c::e:: Ihe pcIienI´: :uiIcLi|iIy fcr 8rief C8I

Whot |s 8r|e| C8I, ond why does |t requ|re spec|||c treotment cons|derot|ons?

C8I ccmLine: ccgniIive cnc Lehcvicrc| Ihercpie: cnc hc: :Ircng empiricc| :uppcrI fcr
IrecIing mccc cnc cnxieIy ci:crcer: {ChcmL|e:: & C||encick, 2001: DeFuLei: & CriI:-
Chri:Icph, 1ºº8). Ihe Lc:ic premi:e cf C8I i: IhcI emcIicn: cre cifficu|I Ic chcnge cirecI|y,
:c C8I IcrgeI: emcIicn: Ly chcnging IhcughI: cnc Lehcvicr: IhcI cre ccnIriLuIing Ic Ihe
ci:Ire::ing emcIicn:.


C8I Lui|c: c :eI cf :ki||: IhcI encL|e: cn incivicuc| Ic Le cwcre cf IhcughI: cnc emcIicn::
icenIify hcw :iIucIicn:, IhcughI:, cnc Lehcvicr: inf|uence emcIicn:: cnc imprcve fee|ing:
Ly chcnging cy:funcIicnc| IhcughI: cnc Lehcvicr:. Ihe prcce:: cf C8I :ki|| cc¢ui:iIicn i:
cc||cLcrcIive. Ski|| cc¢ui:iIicn cnc hcmewcrk c::ignmenI: cre whcI :eI C8I cpcrI frcm ¨Ic|k
Ihercpie:." Ycu :hcu|c u:e :e::icn Iime Ic Iecch :ki||: Ic cccre:: Ihe pre:enIing prcL|em cnc
ncI :imp|y Ic ci:cu:: Ihe i::ue wiIh Ihe pcIienI cr cffer ccvice.

8rief C8I i: Ihe ccmpre::icn cf C8I mcIeric| cnc Ihe recucIicn cf Ihe cvercge 12-20 :e::icn:
inIc fcur Ic eighI :e::icn:. ln 8rief C8I Ihe ccncenIrcIicn i: cn :pecific IrecImenI: fcr c
|imiIec numLer cf Ihe pcIienI´: prcL|em:. SpecificiIy cf Ihe IrecImenI i: re¢uirec Leccu:e cf
Ihe |imiIec numLer cf :e::icn: cnc Leccu:e Ihe pcIienI i: re¢uirec Ic Le ci|igenI in u:ing
exIrc reccing mcIeric|: cnc hcmewcrk Ic c::i:I in hi: cr her IhercpeuIic grcwIh.

8rief C8I ccn rcnge in curcIicn frcm pcIienI Ic pcIienI cnc prcvicer Ic prcvicer. /|Ihcugh
vcricLi|iIy exi:I:, Ihe fc||cwing IcL|e :hcw: cn excmp|e :e::icn-Ly-:e::icn cuI|ine. Ycu cre
enccurcgec Ic Ihink f|exiL|y in ceIermining |engIh cf IrecImenI. Iime-|imiIec Ihercpy mcy
cffer ccciIicnc| incenIive fcr pcIienI: cnc Ihercpi:I: Ic wcrk efficienI|y cnc effecIive|y.
Hcwever, Ihe exccI |engIh cf IrecImenI wi|| |ike|y Le ceIerminec Ly c hc:I cf fccIcr:
invc|ving Ihe Ihercpi:I, pcIienI, cnc IrecImenI :eIIing. /: inciccIec in Ihe fc||cwing IcL|e,
ycu cre ncI expecIec Ic rigic|y cchere Ic c ¨:eI :checu|e¨ cf prcgre:: cr Icpic: LuI rcIher
:hcu|c Le f|exiL|e cnc cccpIive in cpprccching c|| Lrief C8I cpp|iccIicn:. Fcr excmp|e, iI i:
cfIen he|pfu| Ic wcrk wiIhin c ¨:e::icn-|imiIec frcmewcrk¨ where Ihe pcIienI receive: fcur Ic
:ix :e::icn: cf ¨ccIive¨ IrecImenI, fc||cwec Ly cne cr mcre fc||cw-up :e::icn: IhcI cccur cI
increc:ing inIervc|: cfIer Ihe ccIive-IrecImenI phc:e {e.g., 2 week: pc:I IrecImenI wiIh cn
ccciIicnc| Lcc:Ier 4 week: cfIer IhcI).

7
Fotent|o| 8r|e| C8I Sess|on Structure

Sess|on Content Foss|b|e Modu|es
Sess|on 1 CrienI Ihe FcIienI Ic C8I.
/::e:: FcIienI Ccncern:.
SeI lniIic| IrecImenI F|cn/Gcc|:.
Mccu|e
Mccu|e
Mccu|e
5:
4:
ó:
CrienIing Ihe FcIienI
Cc:e CcncepIuc|izcIicn
Gcc| SeIIing
Sess|on 2 /::e:: FcIienI Ccncern: {ccnI'c).
SeI lniIic| Gcc|: {ccnI'c)
Mccu|e
Mccu|e
4:
ó:
Cc:e CcncepIuc|izcIicn
Gcc| SeIIing

Cr

8egin lnIervenIicn Iechni¢ue:.
Iechni¢ue Mccu|e: º-13:
Mc|cccpIive IhcughI:, 8ehcvicrc|
/cIivcIicn, FrcL|em Sc|ving,
Fe|cxcIicn
Sess|on 3 8egin/CcnIinue lnIervenIicn Iechni¢ue: Iechni¢ue Mccu|e: º-13
Sess|on 4 CcnIinue
Fe-c::e::
lnIervenIicn Iechni¢ue:.
Gcc|:/IrecImenI F|cn.
Iechni¢ue Mccu|e: º-13
Mccu|e 4: Cc:e CcncepIuc|izcIicn
Mccu|e ó: Gcc| SeIIing
Sess|on 5 CcnIinue/ Fefine lnIervenIicn Iechni¢ue:. Iechni¢ue Mccu|e: º-13
Sess|on ó CcnIinue lnIervenIicn Iechni¢ue:. Iechni¢ue Mccu|e: º-13
Sess|on 7 CcnIinue lnIervenIicn Iechni¢ue:.
Di:cu:: Encing IrecImenI cnc Frepcre
McinIcining Chcnge:.
fcr
Iechni¢ue Mccu|e: º-13
Mccu|e 14: Encing IrecImenI
McinIcining Chcnge:
cnc
Sess|on 8 Enc IrecImenI cnc He|p FcIienI Ic Mccu|e 14: Encing IrecImenI cnc
McinIcin Chcnge:. McinIcining Chcnge:

When? [Ind|cot|onsJContro|nd|cot|ons}

CerIcin prcL|em: cre mcre cpprcpricIe fcr 8rief C8I Ihcn cIher:. Ihe fc||cwing IcL|e
:ummcrize: prcL|em: IhcI mcy cnc mcy ncI Le ccncucive Ic 8rief C8I. FrcL|em:
cmencL|e Ic 8rief C8I inc|uce, LuI cre ncI |imiIec Ic, ccju:ImenI, cnxieIy, cnc cepre::ive
ci:crcer:. Ihercpy c|:c mcy Le u:efu| fcr prcL|em: IhcI IcrgeI :pecific :ympIcm: {e.g.,
cepre::ive Ihinking) cr |ife:Iy|e chcnge: {e.g., prcL|em :c|ving, re|cxcIicn), wheIher cr ncI
Ihe:e i::ue: cre pcrI cf c fcrmc| p:ychicIric cicgnc:i:.

8rief C8I i: pcrIicu|cr|y u:efu| in c primcry ccre :eIIing fcr pcIienI: wiIh cnxieIy cnc
cepre::icn c::ccicIec wiIh c mecicc| ccnciIicn. 8eccu:e Ihe:e incivicuc|: cfIen fcce
ccuIe rcIher Ihcn chrcnic menIc| hec|Ih i::ue: cnc hcve mcny ccping :IrcIegie: c|reccy in
p|cce, 8rief C8I ccn Le u:ec Ic enhcnce ccju:ImenI. l::ue: IhcI mcy Le cccre::ec in
primcry ccre wiIh 8rief C8I inc|uce, LuI cre ncI |imiIec Ic, cieI, exerci:e, meciccIicn
ccmp|icnce, menIc| hec|Ih i::ue: c::ccicIec wiIh c mecicc| ccnciIicn, cnc ccping wiIh c
chrcnic i||ne:: cr new cicgnc:i:.

CIher prcL|em: mcy ncI Le :uiIcL|e fcr Ihe u:e cf 8rief C8I cr mcy ccmp|iccIe c
:IrcighIfcrwcrc cpp|iccIicn cf 8rief C8I. /xi: ll ci:crcer: :uch c: 8crcer|ine Fer:cnc|iIy
Di:crcer cr /nIi:ccic| Fer:cnc|iIy Di:crcer Iypicc||y cre ncI cpprcpricIe fcr c :hcrIenec
IhercpeuIic experience Leccu:e cf Ihe pervc:ive :ccic|, p:ychc|cgicc|, cnc re|cIicnc|
prcL|em: incivicuc|: wiIh Ihe:e ci:crcer: experience. FcIienI: exhiLiIing ccmcrLic
ccnciIicn: cr prcL|em: c|:c mcy ncI Le cpprcpricIe Leccu:e Ihe pre:ence cf c :eccnc
i::ue mcy impece prcgre:: in Ihercpy. Fcr excmp|e, cn incivicuc| wiIh :uL:Icnce
cepencence ccmcrLic wiIh mcjcr cepre::icn mcy ncI Le cpprcpricIe Leccu:e Ihe

8
:uL:Icnce u:e re¢uire: c higher |eve| cf ccre cnc mcre ccmprehen:ive IrecImenI Ihcn i:
cvci|cL|e in c Lrief fcrmcI. Hcwever, 8rief C8I ccu|c Le u:ec wiIh /xi: ll cnc ccmcrLic
pcIienI: in cec|ing wiIh :pecific negcIive Lehcvicr: cr in ccnjuncIicn wiIh mcre inIen:ive
IrecImenI.

Exomp|es o| Su|tob|e ond bnsu|tob|e Frob|ems |or 8r|e| C8I

Frob|em 8r|e| C8I?
/nxieIy
Depre::icn
/::erIivene::
DieI
Exerci:e
Sccic| l:c|cIicn
Specific FhcLic
Grief/8erecvemenI
New Dicgnc:i: cf CCFD
Ccping wiIh ChemcIhercpy
Ccregiver 8urcen
/|cchc| Depencence
Fcrcncic Fer:cnc|iIy Di:crcer
Cri:i: lnIervenIicn
Chrcnic FISD
Divcrce
ScmcIcfcrm Di:crcer
Ye:
Ye:
Ye:
Ye:
Ye:
Ye:
McyLe
Ye:
Ye:
Ye:
Ye:
Nc
Nc
McyLe
Nc
McyLe
Nc
"
"
"
"
"
"
°
"
"
"
"
#
#
°
#
°
#

How? [Instruct|onsJHondouts}

Ihercpi:I Ccn:icercIicn:
lI i: impcrIcnI Ic Le cce¢ucIe|y :ki||ec Ic evcke chcnge in c pcIienI´: |ife in c :hcrI cmcunI
cf Iime. Ycu :hcu|c periccicc||y c::e:: cnc :eek :upervi:icn/ccn:u|IcIicn regcrcing ycur
ccpcLi|iIie: in Ihe prcce:: cnc ccnIenI cf 8rief C8I.

Ihe fc||cwing cre generc| Ihercpi:I :ki||: cnc cLi|iIie: re¢uirec fcr 8rief C8I:

! CcpcLi|iIy Ic e:IcL|i:h c :Ircng wcrking re|cIicn:hip ¢uick|y
! Ihcrcugh kncw|ecge cf Ihe IrecImenI: u:ec
! Ski|| in :IrucIuring :e::icn: cnc hcmewcrk mcIeric| Ic cccre:: c|| prcL|em:
! Ski|| in pre:enIing mcIeric| c|ecr|y cnc ccnci:e|y wiIh :pecific excmp|e: fcr ecch cf
Ihe pcIienI´: i::ue:
! Ihercpi:I inIerper:cnc|/per:cnc|iIy vcricL|e:: cLi|iIy Ic Le c::erIive, cirecIive,
ncnjucgmenIc| cnc cc||cLcrcIive

/::e::ing Ihe FcIienI
lI i: nece::cry Ic chcc:e pcIienI: whc cre cpprcpricIe fcr 8rief C8I ver:u: IrcciIicnc| C8I cr
cIher Iype: cf Ihercpy. 8e|cw cre impcrIcnI pcinI: Ic ccn:icer in :e|ecIing pcIienI: fcr 8rief
C8I. Ihi: c::e::menI :hcu|c precece Ihe IrecImenI phc:e cnc mcy Le Lc:ec cn Ihe inIcke
c::e::menI, inpuI frcm Ihe referrc| :curce, cr c review cf Ihe mecicc| chcrI.


º



Ih|ngs to Cons|der |n Evo|uot|ng Fot|ents |or 8r|e| C8I
1. Strong Mot|vot|on to Chonge
c. lncrec:ec ci:Ire:: i: cfIen c::ccicIec wiIh increc:ec mcIivcIicn Ic chcnge.
L. Fc:iIive IrecImenI expecIcncie: {e.g., kncw|ecge cf C8I cnc perceivec
LenefiI: cf IrecImenI i: c::ccicIec wiIh imprcvec cuIccme:). /|IerncIive|y, Ihe
pcIienI cce: ncI hcve negcIive :e|f-IhcughI: IhcI mighI impece prcgre:: cr
chcnge {e.g., ¨Seeking ccre mecn: l cm crczy": ¨NcIhing l wi|| cc ccn chcnge
Ihing:¨).
c. FcIienI: whc hcve c|ecr gcc|: fcr IrecImenI cre gccc ccnciccIe:.

2. I|me Comm|tment
c. FcIienI i: wi||ing Ic cevcIe Ihe Iime neecec fcr week|y :e::icn:.
L. FcIienI i: wi||ing Ic cevcIe energy Ic cuI-cf-:e::icn wcrk {e.g., hcmewcrk).

3. L||e Stressors
c. Icc mcny |ife :Ire::cr: mcy |ecc Ic unfccu:ec wcrk cnc/cr fre¢uenI ¨cri:i:-
mcncgemenI¨ inIervenIicn:.
L. FcIienI: whc cre :uppcrIec Ly fcmi|y cnc frienc: cre mcre |ike|y Ic LenefiI.

4. Cogn|t|ve Funct|on|ng ond Educot|ono| Leve|
c. NcI Leing cL|e Ic hcnc|e Ihe exIrc incepencenI reccing mcIeric| cnc/cr
hcmewcrk expecIcIicn: mcy Le c pccr prcgnc:Iic inciccIcr.
L. FcIienI: cL|e Ic wcrk incepencenI|y cre mcre |ike|y Ic ccrry cuI LeIween-
:e::icn wcrk.
c. FcIienI: whc cre p:ychc|cgicc||y mincec cre mcre |ike|y Ic LenefiI frcm :hcrI-
Ierm Ihercpy.

5. Sever|ty o| Fsychopotho|ogy
c. FcIienI: wiIh ccmcrLic p:ychcpcIhc|cgy mcy Le mcre cifficu|I Ic IrecI in :hcrI-
Ierm Ihercpy. ln ccciIicn, :cme ccnciIicn: :uch c: :uL:Icnce cLu:e cr :ericu:
menIc| i||ne:: re¢uire fccu:ec cnc mcre inIen:ive inIervenIicn:.
L. FcIienI: wiIh cn /xi: ll cicgnc:i: cre c|:c |e:: |ike|y Ic LenefiI frcm :hcrI-Ierm C8I.
Lcng-:Icncing inIerper:cnc| i::ue: cfIen re¢uire |cnger IrecImenI curcIicn:.
































Supp|emenIc| McIeric|:
8cnc, F.W. & Drycen, W. {2002). !"#$%&&' &) *+,-) .&/#,0,1- *-2"1,&+"3 42-+"56. Scn
Frcnci:cc: Wi|ey.

10
Modu|e 2: bs|ng Superv|s|on

Object|ves
! Ic ci:cu:: Ihe impcrIcnce cf :upervi:icn / ccn:u|IcIicn in C8I Ircining
! Ic prcvice infcrmcIicn cn hcw Ic u:e c|inicc| :upervi:icn cnc ccn:u|IcIicn in C8I
Ircining
! Ic cuI|ine vcricu: mcce|: cf :upervi:icn / ccn:u|IcIicn in C8I Ircining
! Ic prcvice Iip: cn :e|ecIing c :upervi:cr / ccn:u|IcnI

Introduct|on

Kncw|ecge cLcuI p:ychcIhercpy ccn Le Lrcken ccwn inIc Iwc Lrccc ccmcin: - 1)
kncw|ecge cf ccncepI: cnc 2) kncw|ecge cf hcw Ic cpp|y ccncepI:. lnfcrmcIicn
ccnIcinec in Ihi: mcnuc| wi|| prcvice ycu wiIh c Lc:ic kncw|ecge cf C8I ccncepI: cnc wi||
cIIempI Ic prcvice ycu wiIh prccIicc| Iip: cn hcw Ic u:e Ihe:e ccncepI:. Hcwever,
Leccu:e Ihe prcvi:icn cf C8I i: high|y vcricL|e, cepencing cn Ihe Ihercpi:I, pcIienI, cnc
IrecImenI :eIIing, cpp|iccIicn: cf C8I wi|| neec Ic Le cu:Icmizec cnc prccIicec in rec|-
wcr|c :eIIing:. Ihi: mcnuc| i: Iherefcre cn|y Ihe fir:I :Iep Icwcrc cLIcining infcrmcIicn cnc
kncw|ecge cLcuI hcw Le:I Ic cpp|y C8I princip|e: Ic ccIuc| c|inicc| pcIienI:. Supervi:icn
cnc ccn:u|IcIicn cre Iwc meIhcc: Ic ccvcnce C8I prccIice :ki||: Ihrcugh rcuIine feecLcck
cnc inIerccIicn wiIh c C8I Irciner.

Whot |s Superv|s|on, ond why Is It Importont to C8I?

Supervi:icn i: ce:ignec Ic c) fc:Ier Ihe :upervi:ee': ceve|cpmenI cnc L) en:ure pcIienI
we|fcre cnc :cfeIy Ly mcniIcring pcIienI ccre - :ee fc||cwing IcL|e:

Goo|s ond Focus o| Superv|s|on

Fcr Ihe Supervi:ee !
!
!
!
Frcvice: Ihercpi:I perfcrmcnce feecLcck
Frcvice: guiccnce cnc cc¢ui:iIicn cf c|IerncIive viewpcinI:
CcnIriLuIe: Ic Ihe prcce:: cf fcrming c Ihercpi:I': icenIiIy
Serve: c: c :ecure Lc:e Ic exp|cre cpp|iccIicn: cnc
IhercpeuIic princip|e:
Fcr Ihe FcIienI !



Ic



en:ure IhcI pcIienI: receive cccepIcL|e ccre
- Ihercpi:I: cc nc hcrm
- Ihercpi:I: pc::e::e: :ufficienI :ki||:
- Ihc:e whc |cck :ki||: cre prcvicec wiIh remecicIicn
Supervi:icn i: NCI Ihercpy . c|Ihcugh :upervi:icn mcy invc|ve cn
Ihercpi:I': per:cnc| experience:, :uch c fccu: i:
IhcI inf|uence Ihe Ihercpi:I': prcfe::icnc| wcrk.
exp|crcIicn
re:IricIec Ic
cf c
i::ue:

Superv|s|on versus Consu|tot|on
Ihere i: c cifference LeIween :upervi:icn cnc ccn:u|IcIicn. Wherec: :upervi:icn invc|ve:
Ihe cirecI cver:ighI cf c|inicc| cc:e: cver c pericc cf Iime {cfIen invc|ving evc|ucIicn cf Ihe
c|inicicn), ccn:u|IcIicn refer: Ic c re|cIicn:hip IhcI i: ce:ignec Ic c::i:I in prcfe::icnc|
ceve|cpmenI LuI cce: ncI invc|ve fcrmc| cver:ighI cf c|inicc| cc:e: cnc mcy cr mcy ncI
ccnIinue cver Iime. ln e::ence, ccn:u|IcIicn invc|ve: c grcwIh-crienIec ci:cu::icn cf cc:e:
cr i::ue: wiIhcuI cver:ighI cr evc|ucIicn.


11
When? [Ind|cot|onsJContro|nd|cot|ons}

lcec||y, :upervi:icn cr ccn:u|IcIicn cccur: cn c regu|cr Lc:i:. Iypicc||y, fcr Ihercpi:I: |ecrning
C8I, :upervi:icn/ccn:u|IcIicn :hcu|c cccur every week cr every cIher week. McnIh|y
ccn:u|IcIicn meeIing: mcy Le cpprcpricIe fcr |icen:ec prccIiIicner: in c mcre ccvcncec
:Icge cf p:ychcIhercpy Ircining.

Hcw° {ln:IrucIicn:/HcnccuI:)

Ihe fc||cwing IcL|e cuI|ine: Ihe mc:I ccmmcn fcrmcI: fcr :upervi:icn. Ihe u:efu|ne:: cf
ecch prccecure wi|| Le ceIerminec Ly Ihe gcc|: cf :upervi:icn cnc Ihe :upervi:ee´: |eve| cf
Ircining cnc ceve|cpmenIc| neec:. Expc:ure Ic mu|Iip|e Ircining mccc|iIie: i: :een c: mc:I
effecIive.

FcrmcI De:cripIicn /cvcnIcge: Di:ccvcnIcge:

VerLc| FepcrI Ihercpi:I: verLc||y repcrI
Ic Ihe :upervi:cr Ihe
ceIci|: cf c given Ihercpy
:e::icn cr cc:e.
- Le:: IhrecIening Ic
Ihercpi:I:
- /||cw: fcr free-
f|cwing ci:cu::icn
LeIween Ihercpi:I
cnc :upervi:cr

- SuLjecI Ic Ihercpi:I
recc||ecIicn {errcr:
cnc cmi::icn:)
- LimiIec cLi|iIy fcr
:upervi:cr: Ic
mcniIcr cnc prcvice
feecLcck cn Ihe
¨prcce::¨ cf Ihercpy
Frcce:: NcIe: Ihercpi:I: wriIe ccwn cnc
reccunI i::ue: icenIifiec in
- Le:: IhrecIening Ic
c|inicicn:
- SuLjecI Ic Ihercpi:I
fccu: cnc
:e::icn c|cng wiIh Iheir
cwn per:cnc| reccIicn:
cnc fee|ing: enccunIerec
in Ihe :e::icn.
- Frcvice: c mcre
ceIci|ec reccunI cf
Ihe :e::icn
{ccmpcrec wiIh
verLc| repcrI c|cne)
- 8egin: Ic icenIify
Ihercpi:I i::ue: curing
:e::icn {prcce::)
recc||ecIicn
- LimiIec cLi|iIy Ic
mcniIcr cnc prcvice
feecLcck cn Ihe
prcce:: cf Ihercpy
/ucic/Vicec
Icping
/cIuc| :e::icn: cre cucic
cr vicec Icpec cnc
reviewec in :upervi:icn.
- Frcvice: ccce:: Ic
cLjecIive cnc prcce::
ccnIenI cf :e::icn:
- Serve: c: cn
- Ccn Le
IhrecIening Ic
Ihercpi:I: {cnc
:cmeIime: Ic
exce||enI |ecrning Icc| pcIienI:)
- Lcgi:Iicc| i::ue: -
:pecific infcrmec
ccn:enI fcr pcIienI:,
cvci|cLi|iIy cf
e¢uipmenI
Grcup
Supervi:icn
Mu|Iip|e Ihercpi:I: inIerccI
wiIh :upervi:cr in grcup
fcrmcI.
- Frcvice: Ihercpi:I-Ic-
Ihercpi:I |ecrning
- U:e: c|| Ihe cLcve
- Le:: incivicuc|
emphc:i:, ncI c:
much Iime fcr ecch
Iechni¢ue: in ccciIicn
Ic grcup fcrmcI
Ihercpi:I



12
Se|ect|ng o Superv|sorJConsu|tont

Ihe fc||cwing cre chcrccIeri:Iic: Ic :eek cuI in :e|ecIing c C8I :upervi:cr cr ccn:u|IcnI:
1) C8I kncw|ecge cnc prccIice experience
" lcec||y, C8I :upervi:cr: cnc ccn:u|IcnI: hcve receivec fcrmc| Ircining in C8I
cnc u:e C8I in Iheir cci|y prccIice :eIIing:.
2) /vci|cLi|iIy
" Fcr Ihc:e fir:I |ecrning hcw Ic cpp|y C8I, iI i: high|y reccmmencec IhcI ycu
icenIify :upervi:cr:/ccn:u|IcnI: whc cre cvci|cL|e fcr week|y cr Li-week|y
meeIing: IhcI invc|ve cnywhere frcm 30 Ic ó0 minuIe: per meeIing. Ihe
ccIuc| |engIh cf meeIing: ccn Le ceIerminec Ly Ihe numLer cf cc:e: Leing
reviewec.
" Ccn:icer |cgi:Iicc| i::ue: in :checu|ing. Wcu|c Ihe :upervi:cr/ccn:u|IcnI Le
cvci|cL|e fcr in-per:cn cr Ie|ephcne :e::icn: {in-per:cn i: mcre effecIive)°
Ccn:icer prcximiIy, Ircve|, cnc cvci|cLi|iIy cf re:curce: {e.g., cucic/vicec
Icping).
3) Experience wiIh c pcIienI pcpu|cIicn :imi|cr Ic Ihc:e ycu wi|| Le :erving.

Supp|emenIc| Feccing:
8erncrc, J. M. & Gcccyecr, F.K. {2004). 78#$"9-#0"3: &) .3,#,;"3 <85-+1,:,&# = >
+$

?$,0,&#@ New Ycrk: Fecr:cn.
Lie:e, 8.S. & 8eck, J.S. {1ºº7). .&/#,0,1- 42-+"56 <85-+1,:,&#. ln WcIkin:, C.E. {Ec). A#
!"#$%&&' &) B:6;2&02-+"56 <85-+1,:,&#. New Ycrk: Wi|ey: pp114-133.



13
Modu|e 3: Nonspec|||c Foctors |n 8r|e| C8I

Object|ves
! Ic LeIIer uncer:Icnc Ihe neec fcr c :Ircng IhercpeuIic re|cIicn:hip in 8rief C8I
! Ic uncer:Icnc Ihe fccIcr: c::ccicIec wiIh c :Ircng IhercpeuIic re|cIicn:hip
! Ic |ecrn :IrcIegie: fcr ceve|cping rcppcrI cnc mcximizing ncn-:pecific fccIcr:

Whot ore Nonspec|||c Foctors, ond why ore they |mportont to C8I?

C8I i: :IrucIurec cnc gcc|-cirecIec. Ihe ccnIexI i: :uppcrIive, cnc Ihe Iechni¢ue: cre
pcirec wiIh c cc||cLcrcIive IhercpeuIic :Icnce. Ncn:pecific fccIcr: refer Ic Ihe re|cIicn:hip
ccmpcnenI: cf Ihercpy {e.g., rcppcrI, in:Ic||cIicn cf hcpe, Iru:I, cc||cLcrcIicn) cnc ccn Le
ccmpcrec wiIh :pecific fccIcr: IhcI refer Ic Ihe Iechnicc| c:pecI: cf p:ychcIhercpy {e.g.,
Ihe ccIuc| Iechni¢ue: :uch c: guicec imcgery, IhcughI chc||enging, eIc.) Ncn:pecific
fccIcr: cre ccmmcn wiIhin c|| p:ychcIhercpie: cnc :erve c: Ihe fcunccIicn fcr pcIienI
imprcvemenI. Specific fccIcr: refer Ic inIervenIicn Iechni¢ue: uni¢ue Ic Ihe Iype cf Ihercpy
Leing prcvicec {e.g., C8I, p:ychccyncmic, inIerper:cnc|). SIucie: :hcw IhcI ncn:pecific
fccIcr: cre re:pcn:iL|e fcr c |crge percenIcge cf Ihe chcnge c::ccicIec wiIh
p:ychcIhercpy IrecImenI:.

When? [Ind|cot|onsJContro|nd|cot|ons}

Ncn:pecific fccIcr: cre criIicc| curing Ihe ecr|y :Icge:, LuI impcrIcnI cI c|| phc:e:, cf
IrecImenI. SIrcng ncn:pecific fccIcr: cic in engcging cnc reIcining pcIienI: in
p:ychcIhercpy cnc c|:c :IrengIhen Ihe Iechnicc| ccmpcnenI: cf IrecImenI. FcIienI: whc
perceive Ihe IhercpeuIic re|cIicn:hip Ic Le cc||cLcrcIive, :cfe, cnc Iru:Iing cre in c LeIIer
pc:iIicn Ic cLIcin LenefiI frcm Ihe IrecImenI, wi|| |ike|y Le |e:: re:i:IcnI cnc wi|| Le mcre
cpen Ic exp|crcIicn cnc chcnge. /: IrecImenI prcgre::e:, Ihe IhercpeuIic re|cIicn:hip
:hcu|c Leccme :Ircnger, c||cwing Ihe Ihercpi:I cnc pcIienI Ic grccuc||y mcve inIc mcre
ccmp|ex cnc mecningfu| IhercpeuIic i::ue:.

How? [Instruct|onsJHondouts}

8crrcwing frcm per:cn-cenIerec Ihercpy, Ihi: mccu|e fccu:e: cn Ihree fccIcr: impcrIcnI Ic
Ihe ceve|cpmenI cf c :Ircng IhercpeuIic re|cIicn:hip. Ihe:e fccIcr: cre empcIhy,
genuinene::, cnc pc:iIive regcrc. Ihe:e ccncepI: cre cefinec cnc ci:cu::ec LuI repre:enI
generc| chcrccIeri:Iic: IhcI c|| Ihercpi:I: :hcu|c :eek Ic cIIcin in wcrking wiIh pcIienI:.
Fc||cwing c ci:cu::icn cf Ihe:e princip|e:, Ihe ccncepI cf ccIive |i:Iening i: inIrccucec c: c
Iechni¢ue Ic LeIIer cIIcin c :c|ic IhercpeuIic re|cIicn:hip.

EmpcIhy {Vc|iccIing Ihe FcIienI': Experience)
EmpcIhy i: Ihe cLi|iIy Ic uncer:Icnc experience: frcm cncIher per:cn´: pcinI cf view.
EmpcIhy i: cn impcrIcnI pcrI cf Lui|cing rcppcrI cnc fcci|iIcIe: fee|ing: cf Iru:I cnc muIuc|
re:pecI LeIween Ihe pcIienI cnc Ihercpi:I. lI i: nece::cry fcr Ihe Ihercpi:I Ic ccn:icer Ihe
ccncepI cf ¨mu|Iicu|Iurc| empcIhy," which re|cIe: Ic uncer:Icncing per:cn: frcm cIher |ife
Lcckgrcunc: {eIhniciIy, :cciceccncmic :IcIu:, cge cchcrI, gencer, eIc.). lI i: impc::iL|e fcr
c Ihercpi:I Ic Le kncw|ecgecL|e cLcuI every pcIienI': uni¢ue Lcckgrcunc. EmpcIhy,
which cI iI: ccre ccn:i:I: cf c:king ¢ue:Iicn: in c re:pecIfu||y curicu: mcnner cnc expre::ing
emcIicnc| uncer:Icncing cf Ihe cn:wer: receivec, i: c :c|ic fir:I :Iep Icwcrc: uncer:Icncing
pcIienI:' uni¢ue |ife Lcckgrcunc. /cciIicnc| reccing cLcuI cu|Iurc| cifference: mcy

14
fcci|iIcIe mcre infcrmec ¢ue:Iicn: cnc LeIIer prepcre Ihe Ihercpi:I fcr ccciIicnc| ¢ue:Iicn:
cnc/cr rcppcrI ceve|cpmenI. U|IimcIe|y, Ihe Ihercpi:I hc: cn cccec Ic:k cf |ecrning cLcuI
Ihe cu|Iure cf pcIienI: cnc cpprecicIing |ife frcm Iheir per:pecIive.

Shcwing empcIhy Ic c pcIienI he|p: Ic vc|iccIe hi: cr her experience:. 8eing criIicc|, even
:uLI|y, cf whcI c pcIienI i: :hcring in Ihercpy cfIen mcke: him cr her fee| jucgec cnc
unwi||ing Ic ci:c|c:e ccciIicnc| infcrmcIicn. U:e vc|iccIing re:pcn:e: Ic :hcw empcIhy
Icwcrc: c pcIienI. Vc|iccIing re:pcn:e: cre :imp|y :IcIemenI: cf uncer:Icncing cf ycur
pcIienI´: viewpcinI. Vc|iccIing re:pcn:e: u:uc||y enIci| Ihe Ihercpi:I´: ce:criLing whcI he cr
:he hecrc Ihe pcIienI :cy.



Genuinene::
Genuinene:: i: Ihe cLi|iIy Ic Le cuIhenIic cnc free cf ci:hcne:Iy cr hypccri:y. Ycu ccn Le
prcfe::icnc| cnc expre:: whc ycu cre cI Ihe :cme Iime. Genuinene:: he|p: Lui|c rcppcrI
cnc :c|icify c IhercpeuIic re|cIicn:hip Ly c||cwing Ihe pcIienI Ic view Ihe Ihercpi:I c: c
humcn Leing. lI c|:c c||cw: pcIienI: Ic ccce:: Ihe genuinene:: cf Ihe Ihercpi:I fcr creciL|e
criIicc| feecLcck cLcuI prcgre:: in Iheir funcIicning.

Genuinene:: ccn:i:I: cf wice vcrieIy cf ccncepI: rcnging frcm ncnverLc| Lehcvicr: Ic cverI
:IcIemenI:. Excmp|e: cf fccIcr: re|cIec Ic genuinene:: inc|uce:

SuppcrIing ncnverLc| Lehcvicr inc|uce: Lehcvicr: |ike keeping eye ccnIccI, giving
c pcIienI ycur fu|| cIIenIicn, cnc ncccing in cgreemenI cr uncer:Icncing. lI´:
impcrIcnI IhcI Ihe:e ncnverLc| Lehcvicr: mcIch whcI i: gcing cn in Ihe
ccnver:cIicn, :c c: ncI Ic :eem unncIurc| cr fcke.

Fc|e Lehcvicr: C8I Ihercpi:I: enccurcge pcIienI: Ic Le ccIive cnc empcwerec
cnc :uL:e¢uenI|y cIIempI Ic fcci|iIcIe Ihi: ceve|cpmenI Ihrcugh Iheir Lehcvicr: in
Ihercpy. Ihercpi:I: IhcI :Ire:: Iheir cuIhcriIy in cnc LeIween :e::icn: wiIh pcIienI:

15
ccn ccu:e c pcIienI Ic fee| infericr cr inIimiccIec. lI i: impcrIcnI Ic rememLer IhcI
Ihe IhercpeuIic re|cIicn:hip i: cne cf pcrIner:hip cnc IhcI Ihe Ihercpi:I cnc pcIienI
wcrk IcgeIher Ic c||evicIe ccncern:, fecr:, cnc prcL|em: in Ihe pcIienI´: |ife.

Ccngruence: Mcking :ure IhcI ycur wcrc:, ncnverLc| Lehcvicr, cnc fee|ing: mcIch
ecch cIher i: referrec Ic c: ccngruence. NcI cemcn:IrcIing ccngruence cf ycur
fee|ing: cnc IhcughI: ccn Leccme ccnfu:ing cr mi:|eccing Ic c pcIienI.

SpcnIcneiIy: Ihi: ccncepI cec|: wiIh Ihe wcy Ihe Ihercpi:I :peck: cnc Ihe Iime|ine::
cf re:pcn:e:. Fe:pcn:e: cnc feecLcck prcvicec ¨in Ihe mcmenI¨ cre mcre vc|ucL|e
Ihcn feecLcck prcvicec cI c |cIer Iime. FcIienI: cre mcre |ike|y Ic receive
:pcnIcnecu: me::cge: c: genuine.

Fc:iIive Fegcrc
B&:,0,1- +-/"+$ :imp|y mecn: :hcwing c|| pcIienI: Ihe re:pecI Ihey ce:erve. lI´: e::enIic| Ic
:hcw Ihe pcIienI IhcI he/:he i: vc|uec cnc IhcI whcI he/:he hc: Ic :cy i: impcrIcnI.
FcIienI: whc fee| IhcI Iheir IhcughI: cnc fee|ing: cre cckncw|ecgec cnc uncer:Iccc cfIen
:hcre mcre cnc fee| mcre ccnnecIec Ic Ihe Ihercpi:I cnc Ihe IhercpeuIic prcce::.

CcmmuniccIing pc:iIive regcrc mcy Le hcrcer Ihcn iI :eem:, e:pecic||y if ycu hc|c :cme
negcIive Le|ief: cLcuI Ihe per:cn ycu cre Irying Ic he|p, which ccn Le c ccmmcn
experience fcr Ihercpi:I:. Shcring cny negcIive fee|ing: cr Le|ief: cLcuI ycur pcIienI: wiIh
ycur :upervi:cr cr ccn:u|IcnI ccn Le cn exce||enI meIhcc Ic en:ure IhcI ycu ceve|cp cnc
cemcn:IrcIe genuine pc:iIive regcrc Icwcrc ycur pcIienI:.

CcmmiImenI Ic Ihe pcIienI mecn: IhcI ycu cre ceciccIec Ic wcrking wiIh Ihe
pcIienI cn whcIever i::ue: he cr :he i: Lringing Ic Ihercpy. Ihi: inc|uce: Leing cn
Iime, cvcicing ccnce||ing Ihe pcIienI´: cppcinImenI:, cnc u:ing c|| effcrI: Ic he|p
Ihe pcIienI wcrk Ihrcugh Ihc:e i::ue:.

Hcving c ncnjucgmenIc| cIIiIuce Icwcrc: Ihe IhcughI:, fee|ing:, cnc ccIicn: cf Ihe
pcIienI i: e::enIic|. lI i: pc::iL|e Ic cccepI cnc uncer:Icnc c per:pecIive wiIhcuI
nece::cri|y cgreeing wiIh iI.

Di:p|cying wcrmIh Icwcrc: pcIienI: i: c viIc| pcrI cf Lui|cing rcppcrI. WcrmIh ccn Le
ci:p|cyec Ihrcugh Icne cf vcice, fccic| expre::icn: cnc Lccy pc:Iure:, cr Ihe
IhcughIfu|ne:: cf ycur re:pcn:e:.

Ihe fc||cwing :ecIicn cccre::e: Ihe ccncepI cf ccIive |i:Iening. /cIive |i:Iening i: c u:efu|
Iechni¢ue Ic ccmmuniccIe Ihe ncn:pecific fccIcr: cf empcIhy, genuinene::, cnc pc:iIive
regcrc.

/cIive Li:Iening
Li:Iening Ic ycur pcIienI: i: Ihe fcunccIicn cf c|| IhercpeuIic cpprccche:. Li:Iening i: mcce
up cf Ihree :Iep:: receiving c me::cge, prcce::ing iI, cnc :encing iI Lcck. Ihercpi:I: :hcu|c
cIIempI Ic remcin cpen Ic c|| me::cge: frcm Iheir pcIienI: {LcIh verLc| cnc ncnverLc|),
cnc cIIempI Ic prcce:: c: mcny me::cge: c: pc::iL|e.

C|crificcIicn: Since we c|| :peck frcm cur cwn frcme cf reference, me::cge: we :enc
Ic cIher: mcy ncI Le receivec in Ihe wcy we inIencec. C|crificcIicn i: c u:efu| cnc

































nece::cry Icc| fcr c|| Ihercpi:I:. C|crificcIicn ccn Le u:ec Ic he|p :imp|ify c me::cge
IhcI i: Leing :enI Ly Ihe pcIienI cr Ic he|p ccnfirm Ihe cccurccy cf whcI Ihe
Ihercpi:I Ihink: he cr :he uncer:Iccc.


FcIienI: l ju:I cc ncI fee| |ike Irying cny mcre.
Iherop|st: Ie|| me more obout whot you meon.
FcIienI: l ju:I fee| |ike giving up.
Iherop|st: Do you meon g|v|ng up on your goo| to comp|ete co||ege; or ore
you re|err|ng to someth|ng d|||erent, ||ke g|v|ng up on |||e ond
poss|b|y horm|ng yourse||?
FcIienI: l cm ncI referring Ic :uicice, if IhcI i: whcI ycu mecn, LuI l cm
fee|ing rec||y cepre::ec. Ecch ccy :eem: |ike :uch c :Irugg|e,
cnc l cfIen ju:I fee| |ike :Icying in Lec. When l :cic ¨give up," l
gue:: l wc: referring Ic ncI wcnIing Ic fcce c|| Ihe :Irugg|e: l
fcce in |ife . my :chcc| wcrk, fincncic| prcL|em:, re|cIicn:hip
prcL|em:, eIc.
NcIice IhcI Ihe c|crifying :IcIemenI cnc ¢ue:Iicn he|pec Ihe Ihercpi:I cnc pcIienI
Ic mcre fu||y exp|cre her fee|ing: cnc IhcughI:. Given Ihi: new infcrmcIicn, Ihe
Ihercpi:I i: in c LeIIer pc:iIicn Ic exp|cre in mcre ceIci| Ihe pcIienI': ccncern: cnc Ic
:eI up IcrgeIec effcrI: cnc :IrcIegie: fcr IrecImenI.
Fcrcphrc:ing cnc Fef|ecIicn: Ihe:e Iechni¢ue: invc|ve re:IcIing Ihe pcIienI´: mcin
IhcughI: in c cifferenI wcy cr ref|ecIing Lcck Ihe emcIicn: Ihe pcIienI i: currenI|y
experiencing Ic gcin cepIh cr c|crificcIicn.
FcIienI: Since my ficncé': cecIh, l fee| |ike every ccy i: c :Irugg|e, cnc l cfIen
¢ue:Iicn wheIher my |ife wi|| ever geI LeIIer. l ju:I mi:: him :c much
IhcI l Ihink cLcuI him ccn:IcnI|y. l ccn'I kncw whcI Ic cc, LuI Ihe
pcin i: geIIing Ic Le Icc much.
Iherop|st: You ore reo||y strugg||ng to |ee| better, ond much o| your po|n comes
|rom the gr|e| ond |oss you |ee| |rom |os|ng your ||oncé. You moy even
be quest|on|ng whether or not th|s po|n w||| subs|de becouse |t |s
gett|ng unmonogeob|e.
FcIienI: Ye:, IhcI i: ccrrecI. l cc ncI wcnI ycu Ic Ihink IhcI l Ihink cn|y cLcuI
Ihe pcin cf |c:ing him. Ihe pcin l fee| ccme: frcm my inIen:e fee|ing:
cf |c::, LuI Ihi: pcin i: c|:c Leccu:e l mi:: c|| Ihe Ihing: he mecnI Ic
me, cnc Ihe jcy he LrcughI Ic my |ife. l cm rec||y :Irugg|ing Leccu:e l
cc ncI wcnI Ic |eI gc cf him, LuI hc|cing cn hurI: :c much.
ln Ihi: excmp|e cf pcrcphrc:ing, Ihe Ihercpi:I give: Lcck Ic Ihe pcIienI whcI he cr
:he hecrc, which c||cw: Ihe pcIienI Ic hecr her cwn wcrc: cnc reccI wiIh c mcre
ceIci|ec re:pcn:e. Ihe u:e cf pcrcphrc:ing in Ihi: excmp|e fcci|iIcIec c ceeper
uncer:Icncing cf Ihe i::ue LuI c|:c ccnveyec Ic Ihe pcIienI c fee|ing cf Leing hecrc
cnc uncer:Iccc.
Li:Iening fcr Iheme: cnc Summcry SIcIemenI:: CfIen, pcIienI: expre:: IhcughI:,
fee|ing:, cnc Lehcvicr: IhcI Leccme IhemcIic ccrc:: :iIucIicn:. /|Ihcugh ncvice
Ihercpi:I: mcy iniIic||y hcve cifficu|Iie: icenIifying Ihi: IhemcIic ccnIenI, repeIiIicn

17
cver Iime {e.g., ccrc:: :e::icn:) u:uc||y he|p: Ic crecIe c c|ecrer picIure cf Ihe :c|ienI
IhercpeuIic i::ue: IhcI re¢uire cIIenIicn cr fccu:. WiIh experience, Ihercpi:I:
Leccme mcre effecIive cnc efficienI cI icenIifying IhemcIic ccnIenI.

Cnce icenIifiec, IhemcIic ccnIenI ccn Le c very pcwerfu| mechcni:m Ic inf|uence
IrecImenI cuIccme:. SummcrizcIicn i: Ihe Iechni¢ue IhcI Lring: IhemcIic ccnIenI
inIc Ihe purview cf Ihe pcIienI. SummcrizcIicn i: c ccncen:ec phrc:ing cf Ihe
pcIienI´: re:pcn:e: cver c :pecific pericc cf Iime {e.g., ccrc:: Ihe :e::icn, :ince Ihe
cuI:eI cf IrecImenI, :ince Ihe cn:eI cf hi:/her currenI cifficu|Iie:). Ycu :hcu|c
rephrc:e Ihe Iheme:, cnc repecI Ihem Lcck Ic Ihe pcIienI fcr c|crificcIicn.

8crrier: cnc Chc||enge: Ic 8ui|cing cn EffecIive IhercpeuIic Fe|cIicn:hip
SeIIing |imiI: in cn empcIheIic mcnner i: cn e::enIic| Icc| fcr new Ihercpi:I:. Mcny new
Ihercpi:I: ce:ire Ic ¨mcke iI c|| LeIIer," in IhcI Ihey mcy cccc|e cnc ccn:c|e Ihe pcIienI
cnc cre ci:IrccIec frcm wcrking cn ceeper i::ue:. / Ihercpi:I ccn crecIe c hc|cing
envircnmenI Ihrcugh empcIheIic wcrc: cnc ccIive |i:Iening. / hc|cing envircnmenI i: c
:eIIing in which Ihe pcIienI fee|: |ike he cr :he i: Leing hecrc cnc IhcI he cr :he i: in c :cfe
cnc :ecure p|cce Ic vcice IhcughI: cnc fee|ing: wiIhcuI jucgmenI.

Mcving frcm rcppcrI cnc re|cIicn:hip Lui|cing Ic c::e::menI cnc gcc| :eIIing ccn Le
chc||enging. When Ihercpi:I cnc pcIienI cre ¨cn Ihe :cme pcge," Ihi: Ircn:iIicn cppecr:
:ecm|e::. CfIen, hcwever, pcIienI: cnc Ihercpi:I: cre ncI :pecking Ihe :cme |cngucge. Fcr
excmp|e, c Ihercpi:I mcy fee| mc:I ccmfcrIcL|e when Icck|ing c cerIcin i::ue fir:I: wherec:
c pcIienI mcy wi:h Ic fccu: cn c cifferenI prcL|em fir:I. When Ihe Ihercpi:I cnc pcIienI cre
ncI in ccngruence regcrcing gcc|:, Ihe mcve LeIween rcppcrI Lui|cing cnc gcc| :eIIing i:
:Ircinec. Ic cverccme Ihi: i::ue, Ihercpi:I: cre enccurcgec Ic u:e mcIivcIicnc| inIerviewing
:IrcIegie: {:ee Fc||nick, Mc:cn, 8uI|er - ChcpIer: 3, 4, cnc 5). Frimcry Iechni¢ue: invc|ve
|i:Iening Ic Ihe pcIienI, fc||cwing Ihe pcIienI': |ecc cnc/cr mcIivcIicn, cnc :eIIing
cc||cLcrcIive cnc muIuc||y cgreec-upcn gcc|:. / viIc| c:pecI Ic Ircn:iIicning frcm rcppcrI
Ic gcc| :eIIing invc|ve: c::e::ing Ihe impcrIcnce, ccnficence, cnc reccine:: cf Ihe pcIienI
cLcuI :pecific IrecImenI gcc|: {:ee Gcc| SeIIing, Mccu|e ó).

Supp|emenIc| Feccing:
8eck, J. S. {1ºº5). .&/#,0,1- 02-+"56C *":,;: "#$ %-6&#$. ChcpIer 3. New Ycrk:
Gui|fcrc Fre::.
Ccrmier, W.H. & Ccrmier, L.S. {1ºº1). lnIerviewing :IrcIegie: fcr he|per:: FunccmenIc|
:ki||: cnc ccgniIive Lehcvicrc| inIervenIicn:, 3
rc
eciIicn. ChcpIer: 2, 3, 4, 5. Fccific Grcve,
C/: 8rcck:/Cc|e FuL|i:hing Ccmpcny.
Fc||nick S., Mc:cn, F., & 8uI|er, C. {1ººº). !-"302 %-2"1,&+ ;2"#/-@ D /8,$- )&+
5+";0,0,&#-+:. ChcpIer: 3, 4, 5. New Ycrk: Churchi|| Living:Icne.

18
Modu|e 4: Cose Conceptuo||zot|on ond Ireotment F|onn|ng

Object|ves
! Ic LeIIer uncer:Icnc Ihe rc|e cf cc:e ccncepIuc|izcIicn in ccgniIive-Lehcvicrc|
Ihercpy.
! Ic ceve|cp :pecific cc:e ccncepIuc|izcIicn :ki||:, inc|ucing:
c) /::e::ing pcIienI ccncern:/cifficu|Iie:
L) E:IcL|i:hing c IrecImenI p|cn {gcc| :eIIing)
c) lcenIifying IrecImenI cL:Icc|e:

Whot ore cose conceptuo||zot|on ond treotment p|onn|ng, ond why ore they |mportont |n
8r|e| C8I?

Cc:e ccncepIuc|izcIicn i: c frcmewcrk u:ec Ic 1) uncer:Icnc Ihe pcIienI cnc hi:/her
currenI prcL|em:, 2) infcrm IrecImenI cnc inIervenIicn Iechni¢ue: cnc 3) :erve c: c
fcunccIicn Ic c::e:: pcIienI chcnge/prcgre::. Cc:e ccncepIuc|izcIicn c|:c cic: in
e:IcL|i:hing rcppcrI cnc c :en:e cf hcpe fcr pcIienI:.


Cc:e ccncepIuc|izcIicn i: viIc| Ic effecIive IrecImenI cnc repre:enI: c cefining
chcrccIeri:Iic cf experI c|inicicn:. U:ing Ihe:e :ki||:, c|inicicn: cre LeIIer cL|e Ic cefine c
IrecImenI p|cn u:ing inIervenIicn Iechni¢ue: IhcI prcvice Ihe Le:I cppcrIuniIie: fcr
chcnge. Ihi: fccu:ec cnc infcrmec cpprccch prcvice: Ihe rcccmcp fcr LcIh pcIienI: cnc
Ihercpi:I: cnc :hcu|c inc|uce c fcunccIicn fcr c::e::ing chcnge/prcgre::. Cc:e
ccncepIuc|izcIicn i: pcrIicu|cr|y impcrIcnI fcr :hcrI-Ierm Ihercpy, c: iI :erve: Ic fccu: LcIh
Ihe pcIienI cnc c|inicicn cn Ihe :c|ienI i::ue: :c c: Ic cvcic cnci||cry prcL|em: IhcI cfIen
:erve c: ci:IrccIicn: Ic ccre gcc|:.

When? [Ind|cot|onsJContro|nd|cot|ons}

! CcncepIuc|izcIicn :hcu|c Legin curing Ihe fir:I :e::icn cnc Leccme increc:ing|y
refinec c: IrecImenI prcgre::e:.
! /n c::e::menI cf currenI cifficu|Iie: cnc Ihe crecIicn cf c prcL|em |i:I :hcu|c cccur
curing Ihe fir:I :e::icn.
! / IrecImenI p|cn {inc|ucing IrecImenI gcc|:) :hcu|c Le cccre::ec ecr|y in IrecImenI
{:e::icn: 1, 2). Ecr|y ccncepIuc|izcIicn cnc IrecImenI p|cnning mcy re¢uire
mccificcIicn c: ccciIicnc| infcrmcIicn Leccme: cvci|cL|e.
! IrecImenI p|cn: cnc gcc|: :hcu|c Le rcuIine|y revi:iIec Ic en:ure IhcI Ihe pcIienI i:
imprcving cnc cgree: wiIh Ihe f|cw cf Ihe IhercpeuIic wcrk.



How? [Instruct|onsJHondouts}

Cc:e CcncepIuc|izcIicn SIep 1: /::e::ing FcIienI Ccncern:/Difficu|Iie:

Ihe pcIienI': pre:enIing ccncern: cnc currenI funcIicning ccn Le c::e::ec in c numLer cf
cifferenI wcy:. Ihe fc||cwing :ecIicn cuI|ine: :everc| pc::iL|e cvenue: fcr icenIificcIicn cf
prcL|em:/ccncern:.

/) U:ing e:IcL|i:hec :e|f-repcrI :ympIcm invenIcrie:. / ccmmcn prccIice in C8I invc|ve:
Ihe u:e cf :e|f-repcrI :ympIcm mec:ure: Ic c::e:: Lc:e|ine funcIicning c: we|| c:
IhercpeuIic prcgre::. Fre¢uenI|y u:ec mec:ure: fcr cepre::icn cnc cnxieIy inc|uce 8eck
Depre::icn lnvenIcry - Seccnc EciIicn, FcIienI Hec|Ih Cue:Iicnncire {cepre::icn), GericIric
Depre::icn Scc|e, 8eck /nxieIy lnvenIcry, cnc Ihe SIcIe-IrciI /nxieIy lnvenIcry.

Se|f-repcrI mec:ure: cre cfIen ccmp|eIec Ly pcIienI: whi|e in Ihe wciIing rccm cnc
evc|ucIec Ly Ihe c|inicicn curing Ihe :e::icn. CfIen :e|f-repcrI mec:ure: ccn :erve c: c
rcuIine cgencc iIem curing C8I :e::icn: cnc ccn high|ighI impcrIcnI imprcvemenI: cnc/cr
ccnIinuing :ympIcm:. lnfcrmcIicn cLIcinec frcm Ihe:e :e|f-repcrI invenIcrie: ccn c|:c
prcvice in:ighI inIc Ihe wcy Ihe pcIienI Ihink: cnc Lehcve: cnc fccIcr: IhcI mighI Le
impcrIcnI crec: cf neec.

8) FrcL|em |i:I:. Ihe:e cre c ccmmcn cnc u:efu| :IrcIegy fcr icenIifying Ihe p:ychc|cgicc|,
:ccic|, cccupcIicnc|, cnc fincncic| cifficu|Iie: fccec Ly pcIienI:. Ihercpi:I: whc u:ec
prcL|em |i:I: Iypicc||y e|iciI c |i:I cf five Ic 10 cifficu|Iie: frcm Ihe pcIienI curing Ihe fir:I pcrI
cf :e::icn 1. FrcL|em: cre Le:I icenIifiec u:ing cpen-encec ¢ue:Iicn: {e.g., ¨WhcI Lring:
ycu Ic Ihi: c|inic°" ¨WhcI i::ue: wcu|c ycu |ike Ic fccu: cn in cur wcrk IcgeIher°"). FrcL|em:
cre Le:I ce:criLec in Ierm: cf :ympIcm fre¢uency {Hcw cfIen cce: Ihe :ympIcm cccur°),
inIen:iIy {Hcw mi|c cr :evere i: iI°) cnc funcIicnc| impccI {WhcI inf|uence cce: Ihe
:ympIcm hcve cn cci|y funcIicning cr generc| ci:Ire::°).

Scme pcIienI: mcy ce:criLe Iheir cifficu|Iie: cr gcc|: in vcgue cr cL:IrccI wcy:, :uch c:, ¨l
wcnI Ic imprcve my |ife, cr l wcnI Ic Le hcppy cgcin." FrcL|em: cnc :uL:e¢uenI gcc|: cre
Le:I ce:criLec in :pecific Ierm: Ic mcinIcin c|inicc| fccu:. Fcr excmp|e, :pecific prcL|em:
cre |i:Iec in Ihe fc||cwing IcL|e.


FrcL|em Fre¢uency SeveriIy lmpccI
Sccic||y
l:c|cIec
SIcy cI hcme
cuI cf 7 ccy:
ó LimiIec :ccic| ccnIccI::
mccercIe-Ic-:evere i:c|cIicn
High|y ci:Ire::ing: :ccic||y
ceLi|iIcIing: e:Ircngec
fcmi|y/frienc:
Fcin Experience
pcin ecch hcur
Fcin inIen:iIy i:
when pre:enI
high, 7 cf 10, Fcin |eccing Ic cecrec:ec
ccIiviIy |eve|, incLi|iIy Ic wcrk
Fee|ing: cf
WcrIh|e::ne::
Cccur
ccy:
3 cuI cf 7 Very inIen:e when pre:enI:
:cmeIime: invc|ve: :uicicc|
IhcughI:
High|y ci:Ire::ing:
wcrk, :ccic|, cnc
re|cIicn:hip:
inf|uence:
inIimcIe
FcIigue Cccur: c|mc:I
ccn:IcnI|y
FcIigue ncI inIen:e
IrcuL|e:cme
LuI Decrec:ec ccIiviIy |eve|,
fre¢uenI ncp:, incLi|iIy Ic
ccmp|eIe cci|y Ic:k:


20
C) /::e::ing ccgniIicn:. WiIhin Ihe C8I mcce|, iI i: cfIen he|pfu| Ic excmine Ihe pcIienI':
IhcughI: e:pecic||y c: Ihey cre perceivec Ly Ihe pcIienI. / ccmmcn|y u:ec, :IrucIurec wc
Ic excmine Ihe:e fccIcr: i: Ic c::e:: {c:k ¢ue:Iicn: re|cIec Ic) hcw Ihe pcIienI perceive:
him-/her:e|f, cIher:, cnc Ihe fuIure. Fcr excmp|e, c pcIienI mighI ce:criLe him- cr her:e|f c:
inccpcL|e, ncI u:efu|, cr c Lurcen. He cr :he mcy generc||y perceive cIher: Ic Le criIicc| cr
hcrc Ic p|ec:e. /nc hi:/her view cf Ihe fuIure mighI Le |crge|y pe::imi:Iic cnc ccnIcin
Le|ief: IhcI Ihe fuIure wi|| inc|uce cn|y mcre |c::e: cnc ci:cppcinImenI: {:ee c|:c IhcughI
Feccrc: in Mccu|e: º cnc 10).

D) /::e::ing Lehcvicr: cnc precipiIcIing :iIucIicn:. FrecipiIcIing :iIucIicn: cre evenI:,
Lehcvicr:, IhcughI:, cr emcIicn: IhcI ccIivcIe, Irigger, cr ccmpcunc pcIienI cifficu|Iie:.

Ihe /nIececenI:, 8ehcvicr, Ccn:e¢uence: {/8C) Mcce| i: c fcrmc|izec mcce| fcr
excmining Lehcvicr {:ympIcm:) in c |crger ccnIexI. lI pc:Iu|cIe: IhcI Lehcvicr: cre |crge|y
ceIerminec Ly cnIececenI: {evenI: IhcI precece Lehcvicr/IhcughI:/mccc) cnc
ccn:e¢uence: {evenI: IhcI fc||cw Ihe Lehcvicr/IhcughI:/mccc).

Ihe /8C mcce| {:ee wcrk:heeI) i: u:ec in c funcIicnc| c::e::menI. lI fc||cw: Ihe premi:e
IhcI Lehcvicr {8) i: :hcpec Ly cnIececenI: {/) cnc ccn:e¢uence: {C). Ihe cnIececenI
cccur: Lefcre c Lehcvicr cnc mcy Le c Irigger fcr c pcrIicu|cr reccIicn in Ihe pcIienI.
8ehcvicr i: cny ccIiviIy {even c IhcughI cr fee|ing) IhcI Ihe pcIienI exhiLiI: in re:pcn:e Ic
cn cnIececenI. Ccn:e¢uence: cre evenI: IhcI cccur cfIer Ihe Lehcvicr cnc cirecI Ihe
pcIienI Ic eiIher ccnIinue cr ci:ccnIinue Ihe Lehcvicr. Iwc kinc: cf ccn:e¢uence: cre
excminec in c funcIicnc| c::e::menI: :hcrI-Ierm cnc |cng-Ierm ccn:e¢uence:.

/nIececenI:: /nIececenI:, cr evenI: IhcI cccur Lefcre c Lehcvicr, Iypicc||y e|iciI
emcIicnc| cnc phy:ic|cgicc| re:pcn:e:. /nIececenI: mcy Le cffecIive {cn emcIicn),
:cmcIic {c phy:ic|cgicc| re:pcn:e), Lehcvicrc| {cn ccI), cr ccgniIive {c IhcughI). Ihey cre
c|:c :uLjecI Ic ccnIexIuc| {:iIucIicnc|) cnc re|cIicnc| {inIerper:cnc|) fccIcr:. Fcr excmp|e, c
pcIienI whc repcrI: cepre::icn {Lehcvicr) mcy fee| Lcc when he cr :he i: c|cne cI hcme
|cIe cI nighI {ccnIexIuc| cnIececenI) cr LeIIer when he cr :he i: crcunc fcmi|y {re|cIicnc|
cnIececenI). /|IerncIive|y, he cr :he mcy fee| cepre::ec Ly Ihinking, ¨l wi|| c|wcy: Le
c|cne" {ccgniIive cnIececenI). lI´: impcrIcnI Ic rememLer IhcI cnIececenI: ccn LcIh
increc:e cnc cecrec:e c pcrIicu|cr Lehcvicr.

Ic he|p ycur pcIienI icenIify cnIececenI:, Iecch him cr her Ic pinpcinI ccnciIicn: IhcI
cffecI hi: cr her Lehcvicr.
y









¨WhcI were ycu fee|ing righI Lefcre ycu cic IhcI°" {/ffecIive)
¨WhcI hcppen: Ic ycu phy:icc||y Lefcre Ihi: hcppen:° Dc ycu fee| :ick°" {ScmcIic)
¨Hcw cc ycu ncrmc||y ccI righI Lefcre Ihi: hcppen:°" {8ehcvicrc|)
¨WhcI IhcughI: gc Ihrcugh ycur minc Lefcre Ihi: hcppen:°" {CcgniIive)
¨Where cnc when cce: Ihi: u:uc||y hcppen°" {CcnIexIuc|)
¨Dc ycu cc Ihi: wiIh everycne, cr ju:I when ycu cre crcunc cerIcin pecp|e°" {Fe|cIicnc|)
8ehcvicr:: / Lehcvicr i: cnyIhing Ihe pcIienI cce:, fee|:, cr Ihink: immecicIe|y fc||cwing Ihe
cnIececenI. Ecch Lehcvicr IhcI ycur pcIienI ci:p|cy: ccu|c pcIenIic||y inc|uce cn cffecIive
ccmpcnenI {fee|ing: cr mccc:), c :cmcIic ccmpcnenI {Lcci|y :en:cIicn: :uch c: rcpic

21
hecrILecI cr :Icmcchcche), c Lehcvicrc| ccmpcnenI {whcI c pcIienI cce: cr cce:n´I cc),
cnc c ccgniIive ccmpcnenI {IhcughI: cr Le|ief:).

Ccn:e¢uence:: Ccn:e¢uence: cre ccIegcrizec c: Leing eiIher pc:iIive cr negcIive.
Fc:iIive ccn:e¢uence: increc:e Ihe chcnce: IhcI c Lehcvicr wi|| Le repecIec Ihrcugh Ihe
experience cf :cmeIhing p|ec:cnI cr Ihe remcvc| cf :cmeIhing negcIive {e.g., cc ncI hcve
Ic cc c chcre). NegcIive ccn:e¢uence: cecrec:e Ihe cccurrence cf c Lehcvicr, eiIher Ly
Ihe pre:ence cf :cmeIhing ncxicu: {e.g., Leing ye||ec cI) cr Ihe cL:ence cf :cmeIhing
ce:irec {e.g., c chi|c Leing grcuncec frcm wcIching IV). FcIienI: Ienc Ic repecI Lehcvicr:
IhcI re:u|I in :cmeIhing pc:iIive cr Ihe remcvc| cf :cmeIhing negcIive.

lcenIifying Ccn:e¢uence:. Simi|cr|y Ic icenIifying cnIececenI:, when ycu cnc c pcIienI cre
cIIempIing Ic icenIify Ihe ccn:e¢uence: cf c cerIcin Lehcvicr, iI i: impcrIcnI Ic exp|cre c||
ccmpcnenI: cf ecch ccn:e¢uence.








When ccmp|eIing c funcIicnc| c::e::menI, LcIh :hcrI- cnc |cng-Ierm ccn:e¢uence: cre
excminec. ShcrI-Ierm ccn:e¢uence: Ienc Ic Le Lehcvicrc| reinfcrcer:, whi|e |cng-Ierm
ccn:e¢uence: Ienc Ic Le negcIive cuIccme:. ln Ihe cc:e cf cccicIicn, Ihe :hcrI-Ierm
ccn:e¢uence cf u:ing c :uL:Icnce i: inIcxiccIicn, cr e:ccpe frcm c negcIive mccc: Ihe
|cng-Ierm ccn:e¢uence mcy Le |egc| IrcuL|e, fcmi|y prcL|em:, cr c hcngcver.
Uncer:Icncing Ihe pc:iIive cnc negcIive ccn:e¢uence: cf c Lehcvicr fcr c pcIienI he|p:
ce:ign Ihe Iiming cnc ncIure cf inIervenIicn. Fcr excmp|e, in Ihe cc:e cLcve, cn
inIervenIicn wcu|c neec Ic fc||cw c ncxicu: cnIececenI Ic cff:eI Ihe negcIive mccc iI
ccu:e:. IrecIing Ihe negcIive mccc wcu|c Ihen cecrec:e Ihe neec fcr e:ccpe Ihrcugh
:uL:Icnce u:e. / vcrieIy cf ¢ue:Iicn: mcy Le u:ec Ic e|uciccIe c :hcrI-Ierm ccn:e¢uence:









¨Hcw cc ycu fee| immecicIe|y cfIer Ihi: cccur:°" {/ffecIive)
¨Dc ycu hcve cny Lcci|y :en:cIicn: cfIer Ihi: hcppen:, |ike IremL|ing°" {ScmcIic)
¨Hcw cc ycu reccI cfIer Ihi: Lehcvicr cccur:° {8ehcvicrc|)
¨WhcI cc ycu Ihink cLcuI cfIer Ihi: hcppen:°" {CcgniIive)
¨/re ycu in c cifferenI p|cce when Ihi: Lehcvicr enc:°" {CcnIexIuc|)
¨/re Ihere cny pecp|e whc mcke Ihi: Lehcvicr wcr:e° Mcke iI LeIIer°" {Fe|cIicnc|)
¨Dce: Ihi: Lehcvicr geI ycu cIIenIicn in :cme wcy°"
¨WhcI gccc Ihing: hcppen c: c re:u|I cf Ihi: Lehcvicr°"
¨Dce: Ihi: he|p ycu in :cme wcy°"
¨Dc ycu fee| c cerIcin 'ru:h´ frcm ccing Ihi:°"
¨Dce: Ihi: Lehcvicr he|p ycu cvcic :cmeIhing ycu ccn´I wcnI Ic cc°"
Cc:e CcncepIuc|izcIicn SIep 2: C|inicc| HypcIhe:e: cnc IrecImenI F|cn

E:IcL|i:hing fccu:ec c|inicc| hypcIhe:e: Lc:ec upcn Ihe infcrmcIicn cLIcinec in Cc:e
CcncepIuc|izcIicn SIep ¬1 :erve: Ic cirecI inIervenIicn cpIicn: cnc pc::iL|e IrecImenI
Iechni¢ue:. Ihe:e hypcIhe:e: mcy re¢uire cccpIcIicn c: new infcrmcIicn Leccme:
cvci|cL|e curing IrecImenI. C|inicc| hypcIhe:e: ccn eiIher Le u:ec exc|u:ive|y Ly Ihe
Ihercpi:I cr ccn Le :hcrec wiIh pcIienI:. Generc||y, :hcring Ihi: infcrmcIicn cn|y imprcve:
Iru:I cnc ccmmuniccIicn LeIween pcIienI cnc Ihercpi:I.

22
/ fccu:ec c|inicc| hypcIhe:i: fcr c per:cn wiIh cepre::icn mighI Le c: fc||cw::
¨Since ycur reIiremenI, ycu hcve experiencec mcny |ife Ircn:iIicn: cnc numercu: |c::e:
{e.g., fincncic|, :ccic|, funcIicnc|). Ycur IhcughI:, which u:ec Ic Le |crge|y pc:iIive cnc
cmLiIicu:, cre ncw negcIive cnc pe::imi:Iic: cnc ycu cppecr Ic Le fecrfu| cf Ihe fuIure. ln
reccIicn Ic ycur mccc cnc negcIive IhcughI:, ycu hcve recucec Ihe numLer cf ycur
ccIiviIie:: cnc ycu hcve Legun Ic wiIhcrcw frcm ycur fcmi|y.¨

Ihe enc re:u|I cf cc:e ccncepIuc|izcIicn i: fcrmcIicn cf c IrecImenI p|cn, cn cgreec-upcn
:IrcIegy LeIween pcIienI cnc Ihercpi:I IhcI give: cirecIicn Ic Ihe IhercpeuIic prcce::. /
IrecImenI p|cn :hcu|c inc|uce c pre:enIcIicn cf Ihe ccu:e: cf Ihe pcIienI': currenI
cifficu|Iie: {e.g., ccgniIive cnc Lehcvicrc| fccIcr: crecIing :ympIcm: cr cifficu|Iie:) cnc c
:pecific p|cn. When pre:enIing Ihe p|cn, ccIive|y invc|ve Ihe pcIienI cnc inccrpcrcIe hi: cr
her feecLcck.



























Exomp|e: ¨ln Ihe Lrief cmcunI cf Iime we hcve :penI IcgeIher, iI cppecr: IhcI we hcve
icenIifiec :cme IhcughI: cnc Lehcvicr: IhcI cre |ike|y ccnIriLuIing Ic ycur currenI cifficu|Iie:.
ln pcrIicu|cr, ycur view cf ycur:e|f cnc ycur fuIure cre ¢uiIe negcIive, cnc ycu hcve :Icppec
ccing mcny Ihing: IhcI u:ec Ic Lring ycu p|ec:ure. My reccmmenccIicn wcu|c Le Ic furIher
exp|cre ycur IhcughI: cnc :ee if we ccn finc c mcre Lc|cncec view cf ycur currenI
cifficu|Iie:. l wcu|c c|:c |ike Ic Ic|k wiIh ycu mcre cLcuI re-engcging in ccIiviIie: ycu u:ec Ic
finc p|ec:urcL|e. WhcI cc ycu Ihink cLcuI Ihe:e IcrgeI: fcr Ihercpy°¨
Cc:e CcncepIuc|izcIicn SIep 3: lcenIifying Fc::iL|e IrecImenI CL:Icc|e:

lI i: ncI unccmmcn fcr pcIienI: Ic :imp|y cgree wiIh reccmmenccIicn: frcm Iheir Ihercpi:I.
Hcwever, iI i: impcrIcnI Ic icenIify pcIenIic| cL:Icc|e: Ic IrecImenI ecr|y cn Ic cvcic
:eILcck: cr IrecImenI fci|ure:. /:king fcr fre¢uenI feecLcck frcm Ihe pcIienI he|p: Ic
recuce cver-ccmp|icnce cnc :erve: Ic inc|uce Ihe pcIienI in c cc||cLcrcIive cnc ccIive
IrecImenI cpprccch. /: pcrI cf Ihi: cc||cLcrcIive venIure, iI i: impcrIcnI Ic c:k Ihe pcIienI
wheIher he cr :he :ee: cny pcIenIic| cL:Icc|e: Ic IrecImenI. 8crrier: mighI inc|uce |cgi:Iic
cifficu|Iie: {fincncic|, Ircve|), per:cnc| Le|ief: {ccncern: cLcuI :Iigmc, effecIivene:: cf
IrecImenI) cr inIerper:cnc| i::ue: {fcmi|y ncI :uppcrIive cf Ihercpy).
I|ps |or bs|ng Cose Conceptuo||zot|on |n 8r|e| Iheropy

! Cc:e ccncepIuc|izcIicn in 8rief C8I i: much Ihe :cme c: wiIh |cnger fcrm: cf
IrecImenI wiIh Ihe fc||cwing excepIicn::
" 8rief Ihercpy |ecve: |iII|e rccm fcr ce|cy: in cc:e fcrmu|cIicn.
" Ihe Iime ccn:IrcinI: cf Lrief Ihercpy mu:I Le ccn:icerec in c|| IrecImenI/gcc|-
:eIIing encecvcr:. IrecImenI gcc|: :hcu|c Le rec:cncL|e, mec:urcL|e cnc c:
:imp|e c: pc::iL|e.
" 8eccu:e cf |imiIec Iime, Ihe fccu: cf IrecImenI in 8rief C8I c|:c generc||y |imiI:
Ihe cepIh cf ccgniIive inIervenIicn:. Fcr excmp|e, iI i: ¢uiIe fre¢uenI Ic
cccre:: cuIcmcIic IhcughI: cnc inIermecicIe Le|ief: c: fcci cf IrecImenI,
whi|e cccre::ing ccre Le|ief: i: cfIen cifficu|I. lf ccre Le|ief: cre cccre::ec, Ihi:
u:uc||y cccur: incirecI|y Ihrcugh mcre :urfcce-|eve| inIervenIicn Iechni¢ue: cr
cI c Iime when Ihe pcIienI i: pcrIicu|cr|y reccy fcr :uch wcrk.

23
Hcmewcrk /::ignmenI Excmp|e:
1. Ihink cLcuI cur cgreec-upcn IrecImenI p|cn, cnc ccn:icer cny ccju:ImenI: iI mighI
neec.
2. Mcke c |i:I cf cny cL:Icc|e: Ic Ihercpy IhcI mcy cri:e.

Supp|emenIc| Feccing:
Ccrmier, W.H. & Ccrmier, L.S. {1ºº1). A#0-+1,-E,#/ :0+"0-/,-: )&+ 2-35-+:C 78#$"9-#0"3
:',33: "#$ ;&/#,0,1- %-2"1,&+"3 ,#0-+1-#0,&#:F >
+$
-$. Fccific Grcve, C/: 8rcck:/Cc|e
FuL|i:hing Ccmpcny. ChcpIer 8.
Fer:cn:, J.8. & Icmpkin:, M./. CcgniIive-Lehcvicrc| cc:e fcrmu|cIicn. ln E||: I. {Ec.).
H"#$%&&' &) 5:6;2&02-+"56 "#$ ;":- )&+983"0,&#. New Ycrk: Gui|fcrc Fre::, pp. 314-33º.
8eck, J.S. {1ºº5). .&/#,0,1- 02-+"56C *":,;: "#$ %-6&#$. New Ycrk: Gui|fcrc Fre:::
ChcpIer: 2 cnc 3.



24
Funct|ono| Assessment: A8C's
/nIececenI: 8ehcvicr: ShcrI-Ierm Ccn:e¢uence: Lcng-Ierm Ccn:e¢uence:
{WhcI hcppenec Lefcre°) {WhcI cic ycu cc°) {WhcI wc: Ihe re:u|I 1 :eccnc cnc 1 {WhcI were Ihe |c:Iing re:u|I:°)
hcur fc||cwing Lehcvicr°)


ESSENTIAL BRIEF CBT SKILLS
28
Modu|e 5: Or|ent|ng the Fot|ent to 8r|e| C8I

Object|ves
! Ic |ecrn hcw Ic ccnvey infcrmcIicn cLcuI Ihe :IrucIure cnc ccnIenI cf C8I
! Ic inIrccuce Ihe ccgniIive mcce|
! Ic inIrccuce Ihe cc||cLcrcIive ncIure cf Ihe IhercpeuIic re|cIicn:hip

Whot |s or|ent|ng o pot|ent to theropy, ond why |s th|s process |mportont?

CrienIing Ihe pcIienI Ic Ihercpy invc|ve::

! / ci:cu::icn cf Ihe Ihecry uncer|ying 8rief C8I
! / ce:cripIicn cf hcw Ihe pre:enIing prcL|em: ccn Le ccncepIuc|izec cnc
IrecIec wiIh Ihi: cpprccch
! EcuccIicn cLcuI Ihe :IrucIure, fcrmcI, cnc expecIcIicn: cf Ihercpy

CrienIcIicn fcr 8rief C8I c|:c invc|ve: c ci:cu::icn cf Ihe fccu:ec cnc Iime-|imiIec ncIure cf
Ihe Ihercpy, p|u: Ihe Ihercpi:I´: rcIicnc|e fcr :e|ecIing 8rief C8I Ic IrecI c pcrIicu|cr
prcL|em. /: ncIec in Mccu|e 1, Ihi: rcIicnc|e inc|uce: Ihe :Ircng re:ecrch Lc:i: cf 8rief C8I
cnc Ihe fccI IhcI iI i: cn empiricc||y :uppcrIec IrecImenI.

Mcny pcIienI: hcve |iII|e, if cny, expc:ure Ic p:ychcIhercpy cIher Ihcn excmp|e: in Ihe
pcpu|cr pre::. Frcvicing pcIienI: wiIh cn uncer:Icncing cf Ihe IhercpeuIic prcce:: c||cw:
pcIienI: Ic Le mcre ccIive cnc cwcre cf Iheir rc|e in Ihe prcgre::icn cf Ihercpy. Kncw|ecge
cf Ihe prcce:: cf 8rief C8I enhcnce: Ihe cc||cLcrcIive ncIure cf Ihercpy.

When? [Ind|cot|onsJContro|nd|cot|ons}

Di:cu::ing Ihe rcIicnc|e fcr C8I cnc ce:criLing Ihe prcce:: cf Ihercpy :hcu|c cccur in Ihe
fir:I :e::icn. Hcwever, iI i: u:efu| Ic revi:iI Ihe mcce| IhrcughcuI IrecImenI Ic expcnc upcn
Ihe rcIicnc|e fcr pcrIicu|cr :ki||:. Ihe exp|cncIicn cf Ihe mcce| ccn Le Ici|crec Ic Ihe
pcIienI': pre:enIing prcL|em, cnc Ihe excmp|e: IhcI cre u:ec Ic exp|cin ecch ccmpcnenI
ccn Le crcwn frcm Ihc:e genercIec in ci:cu::icn cf prcL|em:. {e.g., ¨l ccn'I :eem Ic geI
cuI cf Lec, cnc Ihen l fee| wcrIh|e::¨). Fcr pcIienI: whc Ihink in ccncreIe Ierm:, iI mighI Le
nece::cry Ic prcvice mcny excmp|e: cnc fccu: iniIic||y cn Lehcvicr: rcIher Ihcn cn
ccgniIicn:.

How? [Instruct|onsJHondouts}

lnIrccucing Ihe CcgniIive Mcce|

Ihe ccgniIive mcce| i: c IhecreIicc| pcrccigm fcr exp|cining hcw IhcughI:, fee|ing:, cnc
Lehcvicr: cre c::ccicIec. Mc:I incivicuc|: Le|ieve IhcI :iIucIicn: give ri:e Ic Iheir emcIicn::



Ihe ccgniIive mcce| chc||enge: Ihi: :uLjecIive experience cnc :ugge:I:, in:Iecc, IhcI iI i:
Ihe IhcughI: we hcve cLcuI :iIucIicn: IhcI give ri:e Ic emcIicn:. lncivicuc|: whc cre
cepre::ec cr cnxicu: Ienc Ic ci:p|cy pcIIern: cf cy:funcIicnc| cr ¨incccurcIe" Ihinking. ln
Ihe ccgniIive e|emenI: cf C8I, Ihe Ihercpi:I Ircin: Ihe pcIienI in :pecific :ki||: IhcI he|p Ihe
pcIienI |ecrn Ic imprcve hi:/her mccc cnc chcnge Lehcvicr Ly mccifying Ihe wcy hr cr
:he Ihink: cLcuI :iIucIicn:. / key Icc| in icenIifying cnc excmining Ihe c::ccicIicn: LeIween
IhcughI:, fee|ing:, cnc :iIucIicn: i: Ihe IhcughI reccrc, which we wi|| ci:cu:: in ceIci| in
Mccu|e 10: Chc||enging /uIcmcIic IhcughI:.



Ihe Lehcvicrc| c:pecI cf C8I cccre::e: hcw Lehcvicr: inf|uence mccc. Ihe Ihercpi:I wcrk:
wiIh Ihe pcIienI Ic increc:e Lehcvicr: Ic imprcve mccc cnc recuce Lehcvicr: c::ccicIec
wiIh negcIive mccc. /: cepicIec in Ihe figure Le|cw, chcnging Lehcvicr: ccn chcnge
fee|ing: c: we|| c: IhcughI:. Ihe c::ccicIicn: cmcng Lehcvicr:, IhcughI:, cnc fee|ing in C8I
cre ccpIurec Ly :ccic| |ecrning Ihecry, which :ugge:I: IhcI Ihe |ike|ihccc cf c Lehcvicr i:
ceIerminec Ly iI: ccn:e¢uence:. Fcr excmp|e, :ccic| |ecrning Ihecry imp|ie: IhcI c pc:iIive
Lehcvicr, :uch c: exerci:e, wi|| cccur mcre fre¢uenI|y if c pcIienI experience: p|ec:ure cnc
c :en:e cf :cIi:fccIicn cfIer ccmp|eIing phy:icc| ccIiviIy. Ihi: i: Ihe premi:e cf Lehcvicrc|
ccIivcIicn {:ee Mccu|e 11).


30

/vciccnce cnc e:ccpe cre pcrIicu|cr |ecrnec Lehcvicrc| pcIIern: IcrgeIec in C8I. Fcr
excmp|e, ncI gcing Ic c|c:: Leccu:e :cmecne fecr: |crge crcwc: i: cn cvciccnce
Lehcvicr. lf :cmecne |ecve: c|c:: Leccu:e cf cnxieIy cver c |crge crcwc, iI i: cn e:ccpe
Lehcvicr.

lniIic| Se::icn

Ic prepcre fcr Ihe iniIic| :e::icn, ycu cre enccurcgec Ic Ihcrcugh|y review c|| inIcke
infcrmcIicn. Ycu neec Ihe inIcke infcrmcIicn Ic fcrm cn iniIic| ccncepIuc|izcIicn cnc
fcrmu|cIicn cf c IhercpeuIic p|cn. U:ing Ihe pcIienI´: pre:enIing prcL|em:, :ympIcm:,
currenI |eve| cf funcIicning, cnc hi:Icry he|p: in ceve|cping Ihe IhercpeuIic p|cn. Frcm Ihe
inIcke infcrmcIicn, iI i: c|:c impercIive IhcI ycu c::e:: Ihe pcIienI´: :uicicc|iIy. Ihi: ccn Le
ccne Ly c:king cLcuI Ihe pcIienI´: :uicicc| icecIicn, inIenI, cr p|cn cnc ceIermining hi: cr
her |eve| cf hcpe|e::ne::, c: we|| c: Ihe rec:cn: fcr hcpe|e::ne::. lf Ihe pcIienI´: :uicicc|iIy
:eem: high, Ihen cri:i: inIervenIicn i: cLcve c|| cIher IhercpeuIic ccn:icercIicn:. ln Ihe cc:e
cf cn ccuIe|y :uicicc| pcIienI, ycu cre enccurcgec Ic :eek :upervi:icn cr ccn:u|IcIicn cnc
fc||cw cpprcvec c|inic prccecure: fcr mcncging c :uicicc| pcIienI {e.g., ccnIccI cn-cc||
p:ychicIri:I fcr evc|ucIicn).

FcIienI ExpecIcIicn: fcr IrecImenI
Ycu :hcu|c in¢uire cLcuI whcI Ihe pcIienI kncw: cLcuI hcw Ihercpy i: ccncucIec.
CrienIing ycur pcIienI Ic Ihercpy inc|uce: ce:criLing Ihe ccgniIive-Lehcvicrc| mcce| cnc
cn:wering cny ¢ue:Iicn: he/:he mighI hcve cLcuI Ihe prcgre::icn cf Ihercpy. U:ing Ihe
pcIienI´: excmp|e: Ic he|p exp|cin Ihe ccgniIive-Lehcvicrc| mcce| wi|| c::i:I him/her in
Leing cL|e Ic :ee hcw Ihe mcce| ccn wcrk cnc hcw iI hc: wcrkec fcr cIher pcIienI: wiIh
prcL|em: :imi|cr Ic hi: cr her:. CfIen pcIienI: Ihink Ihercpy i: c p|cce where Ihey wi|| ccme
cnc Le |ecIurec cnc Ic|c whcI Ic cc cr c p|cce Ic venI wiIhcuI c fccu: cn Lehcvicr
chcnge. lI i: e::enIic| in 8rief C8I IhcI Ihe pcIienI uncer:Icnc: IhcI Ihercpy i: c pcrIner:hip
LeIween Ihe Ihercpi:I cnc Ihe pcIienI, in which Ihey wcrk IcgeIher :c IhcI Ihe pcIienI ccn
LeIIer uncer:Icnc fee|ing: cnc :c|ve prcL|em:.

NegcIicIing Ihe cmcunI cf Iime Ihe pcIienI wi|| neec Ic Le in Ihercpy i: c|:c impcrIcnI. Fcr
8rief C8I, pcIienI: Iypicc||y cIIenc week|y incivicuc| :e::icn: fcr 4-8 week:. Hcwever, Ihe
cmcunI cf Iime in Ihercpy cnc Ihe numLer cf ccy: c week ccn Le rec::e::ec periccicc||y
cnc ccju:Iec Ic meeI Ihe neec: cf Ihe pcIienI.

Di:cu::ing SympIcm: cnc Dicgnc:Iic l::ue: wiIh Ihe FcIienI
Mc:I pcIienI: wcnI Ic kncw hcw Ihey hcve Leen cicgnc:ec. Exp|cin Ihe ci:crcer in Ierm: cf
ccgniIive cnc Lehcvicrc| :ympIcm:, Ic c|crify hcw C8I wi|| cirecI|y cccre:: Iheir prcL|em:.
Giving pcIienI: ce:cripIicn: cf ccmmcn :ympIcm: cf Iheir ci:crcer ccn c|:c Le he|pfu|.









Exomp|e: Ihere cre ccgniIive cnc Lehcvicrc| c:pecI: cf fee|ing cepre::ec.
CcgniIive chcrccIeri:Iic: cf cepre::icn inc|uce hcving negcIive IhcughI:
cLcuI ycur:e|f, :uch c: ¨l cm nc gccc," cr ¨Ihing: cre ncI gcing Ic geI
LeIIer." 8ehcvicrc| chcrccIeri:Iic: cre wcy: ycur Lccy Ie||: ycu ycu´re
cepre::ec, :uch c: chcnge: in ycur cppeIiIe cr :|eep pcIIern:.
31
FeecLcck
Ihe cc||cLcrcIive piece cf C8I invc|ve: c:king c pcIienI fcr feecLcck cn Ihe :e::icn {e.g.,
¨WhcI cic ycu Ihink cLcuI cur :e::icn Icccy° Dic we |ecve cuI cnyIhing ycu Ihink i:
impcrIcnI Ic ci:cu::°") cnc cn hcw he/:he fee|: cLcuI Ihe ccgniIive-Lehcvicrc| mcce|
{¨Dc ycu fee| ycu hcve cI |ec:I c Lc:ic uncer:Icncing cf Ihe mcce|, cr :hcu|c we Le :ure
Ic review iI in ceIci| cgcin nexI week°") cI Ihe enc cf Ihe fir:I cnc :uL:e¢uenI :e::icn:.

Enccurcging Ihe pcIienI Ic cffer feecLcck :IrengIhen: Ihe rcppcrI cnc Iru:I wiIhin Ihe
IhercpeuIic re|cIicn:hip cnc inciccIe: Ic Ihe pcIienI IhcI Ihey cre cn ccIive memLer cf Ihe
IhercpeuIic prcce::. lI :hcw: IhcI Ihe Ihercpi:I ccre: cLcuI whcI Ihe pcIienI Ihink: cnc
fee|: cnc vc|ue: hi:/her inpuI. Ihi: i: c|:c c Iime Ic re:c|ve mi:uncer:Icncing: cLcuI Ihe
ccgniIive mcce| cr Ihing: IhcI cccurrec in Ihe :e::icn {¨Wc: Ihere cnyIhing IhcI LcIherec
ycu cLcuI Ihe :e::icn, cr cnyIhing IhcI ycu´c |ike Ic chcnge°"). GeIIing feecLcck frcm Ihe
pcIienI :hcw: hcw impcrIcnI iI i: Ic wcrk c: c Iecm cnc c|:c he|p: ycu wcrk cn :hcrpening
ycur cLi|iIie: in Ihercpy. lI c|:c c||cw: ycu Ic cIIenc Ic cnc repcir cny rec| cr perceivec
IhercpeuIic fi::ure: cr neecec IrecImenI mccificcIicn: in c Iime|y wcy.



Importont Introductory E|ements
! lnIrccuce Frcce::e: cf F:ychcIhercpy
! Ircn:pcrenI
! Cc||cLcrcIive
! Iime-LimiIec

! lnIrccuce CcgniIive-8ehcvicrc| Mcce|
! Fe:ecrch 8c:i:

! /::ccicIicn LeIween Leh

cvicr:, IhcughI:, fee|ing:, cnc
:iIucIicn:

! U:e cf excmp|e: frcm pcIienI´: pc:I week Ic c|crify c::ccicIicn:
! EcuccIe Ihe pcIienI cLcuI hi:/her ci:crcer
! De:criLe pcIienI´: prcL|em: in ccgniIive cnc Lehcvicrc| Ierm:
! ln:Ii|| hcpe cnc empcwermenI

! Fe¢ue:I fcr feecLcck

! CrecIicn cf c wcrm, cc||cLcrcIive IhercpeuIic envircnmenI
Hcmewcrk /::ignmenI Excmp|e:
1. Keep c running |i:I cf ¢ue:Iicn: ycu mcy hcve cLcuI Ihe IhercpeuIic prcce::, cnc
Lring iI wiIh ycu Ic Ihe nexI :e::icn.
2. U:e Ihe ccgniIive-Lehcvicrc| mcce| cicgrcm fcr cI |ec:I Ihree :iIucIicn: ycu
experience Ihi: week.
1. CrecIe c :hcrI |i:I cf Ihe Ihing: ycu |ikec cLcuI Ihe previcu: :e::icn cnc c :hcrI |i:I cf
Ihe Ihing: ycu wi:h we ccu|c hcve chcngec cLcuI Ihe previcu: :e::icn cnc/cr
ccncern: ycu mighI hcve.

Supp|emenIc| Feccing:
GreenLerg, D. & Fcce:ky, C./. {1ºº5). !"#$ &'() *&&$: +,-#.( /,( 0-1 1&2 3((4
51 6,-#."#. /,( 0-1 1&2 /,"#7. New Ycrk: Gui|fcrc Fre::: ChcpIer:. 1, 2, & 4.

32
Modu|e ó: Goo| Sett|ng

Object|ves
" Ic uncer:Icnc Ihe ccncepI cf gcc| :eIIing in 8rief C8I
" Ic cc¢uire :ki||: Ic :eI fec:iL|e cnc cpprcpricIe gcc|: in 8rief C8I

Whot |s goo| sett|ng, ond why |s |t |mportont to set goo|s |n theropy?

Gcc| :eIIing i: Ihe prcce:: cf cc||cLcrcIive|y icenIifying :pecific IhercpeuIic cuIccme: fcr
IrecImenI. Gcc|: mu:I Le cL:ervcL|e, mec:urcL|e cnc cchievcL|e cnc re|cIe Ic ccgniIive
cr Lehcvicrc| chcnge: re|evcnI Ic Ihe pcIienI´: pre:enIing prcL|em. Gcc|: cre Iiec Ic
:pecific :ki||: Ic Le cccre::ec in IrecImenI. Gcc|: increc:e Ihe ccnIinuiIy cf :e::icn:, c||cw
fcr cirecIec, fccu:ec IrecImenI, cnc encL|e Ihe pcIienI cnc Ihercpi:I Ic c::e:: Ihe
prcgre:: cf Ihercpy cnc icenIify chcnge in cn cLjecIive mcnner.

When? [Ind|cot|onsJContro|nd|cot|ons}

ln ccciIicn Ic icenIifying Ihe prcL|em cnc Lui|cing rcppcrI, gcc| :eIIing i: cne cf Ihe fir:I
IhercpeuIic ccIiviIie: Ic Le ccmp|eIec in 8rief C8I. /|Ihcugh gcc|: ccn Le
chcngec/mccifiec cI cny pcinI curing Ihercpy, Ic mcximize cpp|iccLi|iIy cnc LenefiI Ic
Ihe pcIienI, c pre|imincry :eI cf gcc|: :hcu|c Le e:IcL|i:hec cnc cgreec upcn Ly Ihe enc
cf Ihe fir:I cr :eccnc :e::icn.

How? [Instruct|onsJHondouts}

Gcc| :eIIing Legin: wiIh Ihe icenIificcIicn cf Lrccc gcc|:. Ihe:e cre g|cLc| cnc refer Ic
crec: cf funcIicning {e.g., fcmi|y, wcrk, :ccic| re|cIicn:hip:, fincncic| ccncern:, hec|Ih, eIc).
8rccc gcc|: cre c|c:e|y Iiec Ic Ihe Ihercpi:I´: cc:e ccncepIuc|izcIicn cnc Ihe pcIienI´:
pre:enIing prcL|em.

Cnce Lrccc gcc|: cre icenIifiec cc||cLcrcIive|y, Ihe pcIienI cnc Ihercpi:I pricriIize gcc|:.
Ihi: prcce:: invc|ve: ceIermining Ihe mc:I cenIrc| i::ue: IhcI ccu:e ccncern cnc crrcnging
Ihem frcm mc:I impcrIcnI Ic |ec:I impcrIcnI. SIcrIing wiIh Ihe prcL|em IhcI hc: Ihe Le:I
chcnce cf Leing :c|vec ccn he|p increc:e Ihe pcIienI´: ccmmiImenI Ic Ihercpy. lf cne :ki||
i: prere¢ui:iIe Ic c :uL:e¢uenI gcc|, IhcI gcc| ccn c|:c Le pricriIizec in IrecImenI {e.g.,
re|cxcIicn Lefcre expc:ure, cwcrene:: cf IhcughI: Lefcre IhcughI chc||enging).

U:e c grccec cpprccch Ic gcc|:, in which ycu Icke :mc|| :Iep: in :ervice cf Ihe |crger gcc|
ecch week Ihrcugh :e::icn ccnIenI cr hcmewcrk c::ignmenI:. lcenIifying cnc :e¢uencing
ccIicn :Iep: invc|ve: Lrecking ecch gcc| inIc :mc||er :Iep: Ic he|p Ihe pcIienI kncw whcI Ic
cc cI every :Icge cf ccccmp|i:hing Ihe gcc| wiIhcuI fee|ing cverwhe|mec Ly c huge Ic:k.

Cnce gcc|: hcve Leen icenIifiec cnc pricriIizec, Ihey cre cpercIicnc|izec, which invc|ve:
cefining Ihe gcc| cnc c|| Ihe :Iep: IhcI iI wi|| Icke Ic cchieve iI in ccncreIe,
cL:ervcL|e/mec:urcL|e ccgniIive cr Lehcvicrc| Ierm:.
33











Exomp|e
Gcc|: Lecrn Iwc ccgniIive cnc Iwc Lehcvicrc| :IrcIegie: fcr ccping wiIh :Ire::.
! CpercIicnc| CcgniIive Gcc|:
! Lecrn cnc u:e IhcughI Ie:Iing cnc prcL|em :c|ving Ic mcncge
cnxicu: IhcughI:/:iIucIicn:
! CpercIicnc| 8ehcvicrc| Gcc|:
! F|cn cnc ccmp|eIe cne p|ec:cnI cr :ccic| ccIiviIy per week
/::e::ing Fcci|iIcIcr:, 8crrier:, lmpcrIcnce cnc Ccnficence

Cnce c gcc| cr mu|Iip|e gcc|: hcve Leen e:IcL|i:hec, iI i: criIicc| Ic c::e:: Ihe pcIienI':
:iIucIicn cnc cIIiIuce: cLcuI Ihe gcc|:. Fcr excmp|e, c:k wheIher Ihere cre c:pecI: cf Ihe
pcIienI': |ife IhcI mcy fcci|iIcIe cr inhiLiI Ihe gcc|. / :Ircng fcmi|y cnc :ccic|-:uppcrI :y:Iem
mcy he|p c pcIienI Ic recch hi: cr her gcc|, LuI c funcIicnc| |imiIcIicn mcy crecIe cn
cL:Icc|e. Exp|cre fcci|iIcIcr: cnc Lcrrier: cnc ci:cu:: :IrcIegie: Ic mcximize Ihe chcnce cf
gcc| cIIcinmenI.

/::e::menI: cf impcrIcnce cnc ccnficence cre c|:c impcrIcnI. /:k Ihe pcIienI Ic rcIe Ihe
impcrIcnce cf Ihe gcc| cn c :cc|e cf 0 Ic 100 {where 0 i: ncI impcrIcnI cnc 100 i: very
impcrIcnI). Di:cu:: rcIing: |cwer Ihcn ó0 cr :c, cnc refine gcc|: Ic increc:e mecning.
Simi|cr|y, c:k Ihe pcIienI Ic rcIe hi:/her ccnficence in cLIcining Ihe gcc|. Here, ccnficence
rcIing: ccu|c Le c |iII|e |cwer LuI wcu|c hcpefu||y increc:e c: IrecImenI prcgre::e:.

IrcuL|e:hccIing Gcc| SeIIing

Scme c|ue: IhcI gcc|: mcy neec mccificcIicn cre wcr:ening :ympIcm:, nc chcnge in
:ympIcm:, pcIienI fci|ure Ic ccmp|eIe hcmewcrk {:ee Mccu|e 8: Hcmewcrk), cnc
pcIienI/cc||cIerc| repcrI IhcI Ihe pcIienI i: ncI LenefiIIing frcm IrecImenI. ln Ihe:e cc:e:, iI
i: impcrIcnI Ic revi:iI iniIic| gcc|: wiIh Ihe pcIienI cnc e|iciI hi:/her feecLcck cLcuI Ihe
prcgre:: cf Ihercpy {¨WhcI cc ycu finc he|pfu|°"). CfIen, Icc-cmLiIicu: gcc|: neec Ic Le
mccifiec. ln Ihe:e cc:e:, iI i: impcrIcnI Ic frcme Ihe revi:icn in Ierm: cf Icking :mc|| :Iep:
Icwcrc: |c:Iing chcnge, ncrmc|ize Ihe cifficu|Iy cf mcking chcnge: when cepre::ec cr
cnxicu:, cnc jcin Ihe pcIienI {¨l Ihink l mcy hcve gcIIen c |iII|e checc cf my:e|f: |eI´: mccify
Ihe:e c |iII|e, :c IhcI Ihey ccn Le Ihe mc:I he|p fcr ycu": ¨l mcy hcve mi::ec Ihe mcrk cn
Ihi: cne: whcI cc ycu Ihink cLcuI cccing/chcnging/remcving c gcc|°"). Gcc| revi:icn
:hcu|c ncI imp|y Ic Ihe pcIienI IhcI he/:he hc: fci|ec in Ihercpy. lI i: cn cppcrIuniIy Ic
mcce| funcIicnc| chcnge in re:pcn:e Ic chcnging :iIucIicn:.

lf Ihe pcIienI i: wcr:ening, ci:cu:: cny chcnge: in ccnIexI {e.g., re|cIicn:hip, wcrk, :|eep,
meciccIicn ccmp|icnce, phy:icc| hec|Ih) Ihe pcIienI i: experiencing. CrecIe c new gcc|
perIinenI Ic whcI Ihe pcIienI Le|ieve: i: wcr:ening cnc whcI mighI he|p. /I Ihi: pcinI, ycu
:hcu|c c|:c ccn:u|I c :upervi:cr/cc||ecgue cr cIher prcfe::icnc| {e.g., pcIienI´: IrecIing
phy:icicn).

lf Ihe pcIienI i: ncI imprcving, e|iciI hi:/her feecLcck cLcuI chcnge: he cr :he i:
experiencing cnc hi:/her percepIicn: cLcuI why Ihe:e chcnge: hcve cccurrec. lf c pcIienI
34
:eem: Ic hcve IrcuL|e uncer:Icncing Ihe c::ignmenI:, fccu: cn mcre ccncreIe cnc
Lehcvicrc| :ki||:.

















































I|ps |or Goo| Sett|ng

" Frov|de kot|ono|e |or Sett|ng Goo|s.
! Ihi: he|p: Ihe pcIienI uncer:Icnc Ihe cirecIicn cf IrecImenI cnc hcw he/:he wi||
Le invc|vec in Ihe prcce::.
" Exomp|e:" lf ycu ccn icenIify whcI ycu wcnI Ic chcnge cLcuI ycur
:iIucIicn, we ccn Ihen Icke :Iep: Ic ccrrecI Ihe prcL|em."

" E||c|t Des|red Outcomes.
! Ihi: invc|ve: Ihe Ihercpi:I´: c::i:Iing Ihe pcIienI in cefining gcc|: cnc :pecifying
rec:cn: fcr ccming Ic IrecImenI.
" Exomp|e: ¨Li:I c few Ihing: ycu wcu|c |ike Ic geI cuI cf Ihercpy."

" 8e Spec|||c About Whot the Goo| Is.
! DeIermine ecch gcc|, whcI Ihe gcc| i: cIIempIing Ic IcrgeI, cnc whcI Ihe
pcIienI´: rc|e i: in reference Ic Ihe gcc|.
! Guice Ihe pcIienI Icwcrc: gcc|: IhcI re¢uire chcnge frcm him/her {v:. cIher:).
" Exomp|e: "Ycu :cic IhcI ycu wcnI ycur wife Ic |i:Ien Ic ycu. Since we
ccn´I rec||y mcke :cmecne cc whcI we wcnI, whcI ccu|c ycu cc Ic
he|p ycu fee| hecrc cr ccpe wiIh c :iIucIicn when ycu ccn´I fee|
hecrc°"

" Stote Goo|s |n o Fos|t|ve L|ght.
! Ihi: c|crifie: whcI Ihe pcIienI wcnI: Ic cc in:Iecc cf high|ighIing whcI he cr :he
cce:n´I wcnI Ic cc.
" Exomp|e: "Li:I :cme Ihing: IhcI ycu wcnI, in:Iecc cf Ihing: IhcI ycu
ccn´I wcnI. Fcr excmp|e, in:Iecc cf 'l ccn´I wcnI Ic Le cepre::ec
cnymcre,´ ycu ccu|c |i:I, 'l wcnI Ic enjcy my fcvcriIe hcLLie: cgcin.´"

" We|gh Advontoges ond D|sodvontoges o| o Goo|.
! Ihi: cic: in uncer:Icncing Ihe cc:I: cnc LenefiI: cf Ihe pcIienI´: cchieving Ihe
gcc|.
! lI mcy Le u:ec Ic mcIivcIe cn cmLivc|enI pcIienI cr icenIify :c|ienI gcc|: fcr c
pc::ive pcIienI cr c pcIienI :eeking Ic p|ec:e Ihe Ihercpi:I.
" Exomp|e: "WhcI wcu|c Le Ihe LenefiI: if ycu ccccmp|i:hec Ihi: gcc|°
WhcI mighI Le :cme cf Ihe cc:I: Ic ycu°"
" De||ne 8ehov|ors ke|oted to Goo|.
! Ihi: in:IrucI: Ihe pcIienI whcI ccIicn: Ic perfcrm in re|cIicn Ic Ihe gcc|: IhcI
hcve Leen :eI.
" Exomp|e: "WhcI wcu|c iI |cck |ike if ycu were |e:: cepre::ec° lf l :cw ycu
cnc ycu were fee|ing hcppy, whcI wcu|c l :ee° WhcI cc cIher pecp|e
cc when Ihey cre hcppy° WhcI Ihing: cc ycu Ihink hcve chcngec in
ycur |ife :ince ycu hcve Leen cepre::ec° WhcI cic ycu u:ec Ic cc IhcI
ycu enjcyec IhcI ycu ccn´I cc cnymcre°"


35































Excmp|e Hcmewcrk /::ignmenI:
1. Mcke c :hcrI |i:I cf Lrccc gcc|:. WhcI crec: cf ycur |ife cc ycu wi:h Ic imprcve {e.g.
wcrk, fcmi|y, :ccic|, recrecIicnc|, fincncic|, hec|Ih, eIc.)° Ihink cLcuI which gcc|
wcu|c Le mc:I impcrIcnI.
2. Li:I Ihree i::ue:, in crcer cf impcrIcnce, IhcI ycu wcnI Ic ci:cu:: in Ihe nexI :e::icn.
3. Weigh Ihe prc: cnc ccn: cf ecch gcc| IhcI we hcve cgreec upcn in IrecImenI.

Supp|emenIc| Feccing:
8eck, J./. {1ºº5). +&.#"/"'( /,()-819 :-;"6; -#$ 5(1&#$. New Ycrk: Gui|fcrc Fre::,
ChcpIer ó.
Ccrmier, W.H. & Ccrmier, L.S. {1ºº1). <#/()'"(0"#. ;/)-/(."(; 3&) ,(48();9 =2#$-*(#/-4
;7"44; -#$ 6&.#"/"'( 5(,-'"&)-4 "#/()'(#/"&#;> ?
)$
($. Fccific Grcve, C/: 8rcck:/Cc|e
FuL|i:hing Ccmpcny: ChcpIer 10.


I|ps |or Goo| Sett|ng [Cont|nued}

" De||ne o Leve| o| Chonge.
! Ihi: ceIermine: hcw much c pcIienI :hcu|c cc c pcrIicu|cr Lehcvicr.
! Ic increc:e Ihe pcIienI´: chcnce cf :ucce::, :eI cchievcL|e gcc|:. ln cIher
wcrc:, iI i: u:uc||y ncI rec:cncL|e Ic Iry Ic cc :cmeIhing every ccy, cnc
:eIIing c gcc| |ike Ihi: wi|| re:u|I in fci|ure if Ihe pcIienI mi::e: ju:I 1 ccy.
/|IerncIive|y, ci:cu:: Ihe gcc| wiIh Ihe pcIienI: cnc :IcrI :mc||. lf Ihe pcIienI
:ucceec:, he/:he i: mcre |ike|y Ic remcin ccIive|y engcgec.
" Exomp|e: Hcw cfIen cc ycu Ihink iI i: rec:cncL|e Ic cc :cmeIhing
p|ec:cnI° Cnce c week°

" kegu|or|y Evo|uote Symptoms.
! Ircck hcw effecIive Ihe gcc|: cre in cecrec:ing menIc| hec|Ih :ympIcm: cnc
increc:ing funcIicning cnc ¢uc|iIy cf |ife.
! Fcr excmp|e, c::e:: Ihe fc||cwing crec: curing Ihe inIcke prcce::, curing Ihe
ccIuc| inIervenIicn :IrcIegy, cnc c mcnIh Ic c yecr cfIer IermincIicn cf
Ihercpy:
" FcIienI´: |eve| cf :cIi:fccIicn wiIh ycur c::i:Icnce cnc Ihe re:u|I: cf
Ihercpy
" /mcunI cf grcwIh Ihe pcIienI experiencec frcm Ihe Leginning cf
Ihercpy Ic Ihe enc
" 8enefiI: cLIcinec Ly Ihe chcnge mcce Ly Ihe pcIienI cnc which
IrecImenI wc: effecIive in he|ping Ic ccccmp|i:h Ihe gcc|
! Se|f-repcrI Icc|:, :uch c: Ihe 8eck Depre::icn lnvenIcry cr mccc-Irccking
chcrI:, cnc c|inicicn-ccmini:Ierec c::e::menI:, :uch c: Ihe Hcmi|Icn
Depre::icn FcIing Scc|e, mcy Le u:ec c: cLjecIive mec:ure: cf chcnge cver
Ihe ccur:e cf IrecImenI.

Modu|e 7: Agendo Sett|ng

Object|ves
! Ic uncer:Icnc Ihe rcIicnc|e fcr :eIIing cn cgencc
! Ic uncer:Icnc prcce:: cf cc||cLcrcIive|y :eIIing cn cgencc
! Ic icenIify cnc cccre:: prcL|em: wiIh :eIIing cn cgencc

Whot |s ogendo sett|ng, ond why |s |mportont?

/gencc :eIIing i: c cc||cLcrcIive prcce:: Ihrcugh which Ihe Ihercpi:I cnc pcIienI cecice
hcw :e::icn Iime wi|| Le :penI. Ihe pcIienI cnc Ihercpi:I cffer iIem: Ihey wcu|c |ike Ic
ci:cu:: cnc Ihen cecice Ihe crcer cf iIem: cnc Ihe cmcunI cf Iime Ihey wi|| :penc cn
ecch. Ecch iIem :hcu|c Le in :ervice cf IrecImenI gcc|: {:ee Mccu|e ó: Gcc| SeIIing cnc
Mccu|e 4: CcgniIive 8ehcvicrc| Cc:e CcncepIuc|izcIicn cnc IrecImenI F|cnning). /gencc
:eIIing en:ure: :e::icn IhcI Iime i: we|| :penI cnc IhcI LcIh Ihercpi:I cnc pcIienI hcve inpuI
inIc :e::icn ccnIenI.

When? [Ind|cot|onsJContro|nd|cot|ons}

/n cgencc :hcu|c Le :eI wiIhin Ihe fir:I 10 minuIe: cf every :e::icn. WiIhcuI :eIIing cn
cgencc, iI i: very ec:y fcr vccc| pcIienI: Ic ¨run cwcy¨ wiIh Ihe :e::icn Ly reccunIing Ihe
evenI: cf Ihe pc:I week cr ce:criLing Ihe hi:Icry cf c prcL|em. lI i: c|:c ec:y fcr mcre
pc::ive pcIienI: Ic never inciccIe which iIem: cre mc:I impcrIcnI Ic Ihem. 8y
cc||cLcrcIive|y :eIIing cn cgencc, LcIh Ihe Ihercpi:I cnc pcIienI': neec: cre meI. SeIIing c
Iime |imiI fcr ecch iIem, increc:e: Ihe chcnce c|| iIem: ccn Le ccverec.

FcIienI: :hcu|c Le enccurcgec Ic Ihink LeIween :e::icn: cLcuI whcI Ihey wcu|c |ike Ic
ci:cu:: in :e::icn. lf c pcIienI cce: ncI cffer cn cgencc iIem, ycu ccn inIrccuce cn iIem
cnc check wiIh Ihe pcIienI Ic :ee if he cr :he fee|: iI wcu|c Le vc|ucL|e Ic ci:cu::.

How? [Instruct|onsJHondouts}

lI i: ycur re:pcn:iLi|iIy Ic mcce| hcw Ic :eI cgencc: fcr Ihe pcIienI. ln Ihe fir:I few :e::icn:,
ycu wi|| Le :eIIing Ihe cgencc Leccu:e cfIen Ihe pcIienI i: un:ure cf whcI i: Leing c:kec cr
whcI Ic ci:cu:: in Ihercpy. Ycu ccn he|p Ihe pcIienI Leccme mcre ccmfcrIcL|e wiIh :eIIing
hi: cr her cwn cgencc Ly c:king ¢ue:Iicn: |ike, ¨WhcI i: Ihe mcin rec:cn ycu ccme Ic
Ihercpy°" cr ¨WhcI i: ccu:ing ycu Ihe mc:I IrcuL|e righI ncw°" cr ¨WhcI cre ycur mc:I
pre::ing i::ue: Icccy°¨ cr ¨WhcI cre ycur IhcughI: cLcuI Ihe fccu: cf Icccy': :e::icn°¨ lI i:
c|:c impcrIcnI Ic c::i:I Ihe pcIienI in pricriIizing i::ue: cn Ihe cgencc Ic give cn
cccepIcL|e cmcunI cf cIIenIicn Ic ecch i::ue. /fIer |i:Iing cnc pricriIizing iIem:, c||cI cn
cpprcximcIe Iime Ic ecch iIem fcr ci:cu::icn.

Fcy c|c:e cIIenIicn Ic Iime mcncgemenI cf i::ue: cn Ihe cgencc, cnc :Ieer Ihe pcIienI
cwcy frcm :uperficic| i::ue:. /: Iime pc::e:, Ihe re:pcn:iLi|iIy cf :eIIing cn cgencc fcr Ihe
:e::icn :hcu|c :hifI Ic Ihe pcIienI. Ihi: wi|| evenIuc||y he|p him/her Ic :eI cgencc:, pricriIize
prcL|em:, cnc :ugge:I inIervenIicn: fcr i::ue: enccunIerec cfIer ccmp|eIing Ihercpy. Ihi:
|eve| cf increc:ing pcIienI re:pcn:iLi|iIy c|:c Ircn:|cIe: inIc hi:/her cverc|| funcIicning Ly
increc:ing cuIcncmy cf funcIicning c: Ihe pcIienI wcrk: Icwcrc encing IrecImenI.
37



Iyp|co| Sess|on Out||ne

1. 8r|e||y rev|ew pot|ent's mood ondJor phys|

co| |unct|on|ng [5 m|nutes}.
E|iciI re:pcn:e: ccncerning Ihe pcIienI´: mccc, cnc ccn:icer cny cnc c|| ci:crepcncie: {e.g.,
chcnge in :IrengIh cr ncIure cf u:uc| mccc, chcnge frcm |c:I week cr Leginning cf IrecImenI).
Mecicc||y i|| pcIienI: mcy LenefiI frcm regu|cr c::e::menI: cnc upccIe: cn Iheir phy:icc| hec|Ih
:ympIcm: cnc funcIicning. /|:c c:k Ihe pcIienI Ic cffer exp|cncIicn: fcr mccc imprcvemenI cr
cec|ine. Ihi: Lrief upccIe c||cw: ycu Ic gcuge hcw Ihe pcIienI i: prcgre::ing cnc icenIify
pc:iIive cnc negcIive chcnge. lf meciccIicn mcncgemenI cr phy:icicn cc||cLcrcIicn i: pcrI cf
Ihe pcIienI´: IrecImenI, Ihi: i: c|:c c gccc Iime Ic check cn cny :ice-effecI: Ihe pcIienI mighI
Le hcving frcm meciccIicn cnc mcke ccju:ImenI: c: neecec.


2. 8r|dge d|scuss|on |rom prev|ous sess|on w|th the current sess|on [5 m|nutes}.
ln Lricging :e::icn:, ycu cre checking Ihe pcIienI´: uncer:Icncing cf whcI wc: ci:cu::ec in Ihe
previcu: :e::icn. Feinfcrcing whcI Ihe pcIienI |ecrnec in pc:I :e::icn: i: e::enIic| Ic Ihe
imprcvemenI IhcI Ihe pcIienI mcke: cuI:ice Ihe IhercpeuIic re|cIicn:hip. Hcving Ihe pcIienI
ccmp|eIe c 8ricging Wcrk:heeI ccn c::i:I in Ihi: :Icge cf Ihe cgencc. Scme i::ue: ci:cu::ec
curing Ihi: phc:e ccu|c Leccme iIem: cn Ihe cgencc fcr Ihe currenI :e::icn.

3. Set the ogendo |or the current sess|on, ond pr|or|t|ze the |tems [5 m|nutes}.

Fir:I c:k Ihe pcIienI whcI he/:he wcu|c |ike Ic ci:cu:, cnc Ihen cffer cn iIem. lf c pcIienI Lring:

:everc| cgencc iIem:, he cr :he mighI neec Ic inciccIe which i: Ihe mc:I impcrIcnI Ic ci:cu::

fir:I. When c :iIucIicn {e.g., fighI wiIh Lcyfrienc fc||cwec Ly fccc Linge) i: cfferec Ly Ihe pcIienI
c: cn iIem, ycu ccn u:e Ihe :iIucIicn c: pcrI cf hi:/her cgencc iIem, IhcI i:, c: pcrI cf Ihe :ki||
Leing IcughI. Fcr excmp|e, ycu ccn u:e Ihe cLcve :cencric Ic Iecch/review c IhcughI reccrc.


4 . kev|ew ony homework g|ven |n the prev|ous sess|on [5-10 m|nutes}.
F cIienI: whc cc LeIween-:e::icn hcmewcrk :hcw grecIer imprcvemenI: Ihcn Ihc:e whc cc ncI.
I c reinfcrce cnc IrcuL|e:hccI LeIween-:e::icn |ecrning, iI i: impcrIcnI Ic review hcmewcrk. ln-
:e::icn review :erve: Iwc purpc:e:: iI reinfcrce: Ihe impcrIcnce cf hcmewcrk cnc c||cw: ycu Ic
c::e:: :ki|| cc¢ui:iIicn. lf ycu icenIify errcr: in hcmewcrk, ycu ccn u:e ccciIicnc| :e::icn Iime Ic
review Ihe :ki||. Feviewing hcmewcrk ccn Icke c :mc|| cmcunI cf Iime: cr iI ccn Icke Ihe enIire
:e::icn, cepencing cn whcI Ihe pcIienI hc: |ecrnec frcm ccing iI cnc whcI cifficu|Iie: he cr :he
hc: enccunIerec in ccmp|eIing iI.


5. D|scuss ogendo |tems ond set up homework [20-25 m|nutes}.
Di:cu:: cgencc iIem:, :IcrIing wiIh Ihe fir:I cnc mc:I impcrIcnI. lf ycu cre running :hcrI cn Iime,
infcrm Ihe pcIienI IhcI ycu wi|| ci:cu:: Ihe cIher iIem: cI ycur nexI cppcinImenI. SeI up
hcmewcrk IhcI i: cirecI|y ccnnecIec Ic whcI hc: Leen ci:cu::ec in Ihe :e::icn.


ó. Summor|ze the current sess|on ond exchonge |eedbock [5 m|nutes}.

Iwc Iype: cf :ummcrizing cre reccmmencec. Ihe fir:I i: c Lrief :ummcry IhcI :hcu|c Le ccne

cfIer Ihe ccnc|u:icn cf ecch :ecIicn cf Ihe cgencc Ic reinfcrce whcI hc: Leen ci:cu::ec. Ihe

:eccnc Iype i: u:ec Ic c|crify cnc reminc Ihe pcIienI cf Ihe IhcughI: he/:he hc: pre:enIec cnc

hcw Ihc:e IhcughI: chcngec c: c re:u|I cf Ihe exerci:e. lI i: impcrIcnI Ic u:e Ihe pcIienI´:

:pecific wcrc: in :ummcrizing hi: cr her IhcughI:. /I Ihe enc cf Ihe :e::icn, :ummcrize Ihe mcin

pcinI: cf Ihe enIire :e::icn. /: Ihe :e::icn: prcgre::, c:k pcIienI: Ic cc Ihe :ummcrie:. Finc||y,
exchcnge feecLcck cLcuI Ihe :e::icn, :ki||, cr prcgre:: cf Ihercpy. Ihi: i: c Iime fcr ycu Ic
enccurcge cnc mcIivcIe pcIienI: Ic ccnIinue wcrking Icwcrc: chcnge.

38
IrcuL|e:hccIing /gencc SeIIing

ln ci:cu::ing cgencc iIem:, Ihere cre mcny piIfc||: fcr c new C8I Ihercpi:I. lI i: ycur
re:pcn:iLi|iIy Ic keep Ihe ci:cu::icn cn Ircck cnc fccu:ec. Ic prevenI unfccu:ec
ci:cu::icn:, genI|y guice Ihe pcIienI Lcck Ic Ihe Icpic when he cr :he crifI:, emphc:ize key
emcIicn:, Le|ief:, cnc cuIcmcIic IhcughI:, cnc cfIen :ummcrize cnc rephrc:e whcI Ihe
pcIienI :cy:. Ycu ccn c|:c ci:cu:: cI Ihe :IcrI cf Ihercpy IhcI cne cf ycur rc|e: i: Ic keep
:e::icn: cn Ircck: :c ycu mcy, cI Iime:, neec Ic :hifI Ihe fccu: cf ccnver:cIicn. GeIIing Ihe
pcIienI´: cgreemenI cn Ihi: pcinI cI Ihe Leginning he|p: him/her fee| mcre ccmfcrIcL|e if
ycu neec Ic recirecI cr inIerrupI |cIer in Ihercpy. Fccing i: c|:c c ccncern fcr Ihercpi:I:, LuI
pricriIizing cnc cc||cLcrcIive|y cgreeing cn cgencc iIem: cnc Iime: ccn he|p ycu cnc Ihe
pcIienI :Icy wiIhin Ihe c||cIIec Iime.

FcIienI: cnc Ihercpi:I: :cmeIime: hcve cifficu|Iy :eIIing Ihe cgencc IcgeIher. ScmeIime:
pcIienI: cc ncI wcnI Ic ccnIriLuIe Ic Ihe cgencc Leccu:e cf fee|ing hcpe|e:: cr negcIive
Icwcrc Ihercpy. Cccc:icnc||y, Ihe pcIienI mcy c|:c Le unfccu:ec when :eIIing Ihe
cgencc {e.g., reccunI evenI: cf pc:I week). lI i: cfIen nece::cry Ic ecuccIe Ihe pcIienI
cLcuI Ihercpy Ly c|crifying whcI kinc: cf i::ue: ccn:IiIuIe cgencc i::ue: cnc hcw :e::icn
Iime mcy Le cpIimc||y :penI.

C8I :ugge:I: IhcI chcnge invc|ve: :ki|| cc¢ui:iIicn cnc ncI :imp|y icenIifying ci:IcrIec
Ihinking. Iherefcre, reccgnizing c ci:IcrIec IhcughI ccn Le en|ighIening, LuI ycu :hcu|c
c|:c u:e :e::icn Iime Ic Iecch :ki||: Ic cccre:: Ihe prcL|em {e.g., IhcughI reccrc:,
Lehcvicrc| ccIivcIicn) cnc ncI :imp|y ci:cu:: Ihe i::ue wiIh Ihe pcIienI cr cffer ccvice. Ihe
prcce:: cf :ki|| cc¢ui:iIicn i: whcI :eI: C8I cpcrI frcm ¨Ic|k Ihercpie:" {:uppcrIive Ihercpy).

Excmp|e Hcmewcrk /::ignmenI:
1. CrecIe cn cgencc fcr nexI :e::icn, u:ing Ihe given cuI|ine.
2. Ihink cLcuI ccju:ImenI: ycu wcu|c |ike Ic mcke Ic cur currenI cgencc cnc rec:cn:
why.
3. CrcIe c |i:I cf ccncern:/ci:ccmfcrI in Ihe cgencc-:eIIing prcce::.

Supp|emenIc| Feccing:
8eck, J.S. {1ºº5). +&.#"/"'( /,()-819 :-;"6; -#$ 5(1&#$. New Ycrk: Gui|fcrc Fre:::
ChcpIer: 4 & 5.

[Ih|s worksheet |s to be comp|eted by the pot|ent pr|or to beg|nn|ng the sess|on [e.g., |n the
wo|t|ng room} to prepore |or theropy ond oss|st |n co||oborot|ve|y se|ect|ng ogendo |tems.]

8kIDGING SESSIONS


1. WhcI mcin pcinI: cic we recch in cur |c:I :e::icn° WhcI cic ycu |ecrn frcm |c:I
:e::icn° Dic cnyIhing ccme Ic minc in Ihe pc:I week cLcuI cur |c:I :e::icn IhcI
ycu´c |ike me Ic kncw cr IhcI ycu´c |ike Ic ci:cu::°







2. Were ycu unccmfcrIcL|e cLcuI cnyIhing we Ic|kec cLcuI in cur |c:I :e::icn° l: Ihere
cnyIhing ycu wi:h we hcc ci:cu::ec IhcI we cicn´I°








3. Hcw i: ycur mccc° {Hcw i: ycur phy:icc| hec|Ih°) Ccmpcrec wiIh |c:I week, i: iI
LeIIer cr wcr:e°







4. WhcI IrecImenI gcc|: wcu|c ycu |ike Ic wcrk cn Icccy° WhcI prcL|em: wcu|c ycu
|ike Ic puI cn Ihe cgencc°








5. WhcI hcmewcrk cic ycu cIIempI cr ccmp|eIe fcr |c:I :e::icn° WhcI cic ycu |ecrn
frcm ccing iI°



40
Modu|e 8: Homework

Object|ves
! Ic uncer:Icnc hcw hcmewcrk i: inIrccucec cnc u:ec in 8rief C8I
! Ic uncer:Icnc Iechni¢ue: fcr increc:ing hcmewcrk uIi|iIy cnc ccmp|icnce

Whot |s homework, ond why |s |t o centro| port o| C8I?

Hcmewcrk i: cn e::enIic| cnc effecIive ccmpcnenI cf 8rief C8I. 8eccu:e cf Ihe ccncen:ec
numLer cf :e::icn: in 8rief C8I, c::ignmenI: :uch c: reccing:, Lehcvicr mcniIcring, cnc
prccIicing new :ki||: :hcu|c Le given Ic Ihe pcIienI Ic prccIice cnc u:e cuI:ice :e::icn:.
Hcmewcrk c::ignmenI: fcci|iIcIe pcIienI :ki|| cc¢ui:iIicn, IrecImenI ccmp|icnce, cnc
:ympIcm recucIicn Ly inIegrcIing Ihe ccncepI: |ecrnec in :e::icn: inIc cci|y |ife.
Hcmewcrk i: c key mechcni:m fcr fcci|iIcIing LeIween-:e::icn wcrk cnc prcgre::.

When? [Ind|cot|onsJContro|nd|cot|ons}

Give hcmewcrk c::ignmenI: IhrcughcuI IrecImenI. Ihe ncIure cnc fre¢uency cf
c::ignmenI: i: |efI Ic ycur ci:creIicn. Ccn:icer pcIienI chcrccIeri:Iic: when c::igning
hcmewcrk, :pecificc||y reccing cLi|iIy, ccgniIive funcIicning, |eve| cf ci:Ire::, cnc
mcIivcIicn. During Ihe Leginning :Icge cf Ihercpy, :ugge:I hcmewcrk: LuI, c: Ihercpy
prcgre::e:, enccurcge Ihe pcIienI Ic genercIe LeIween-:e::icn ccIiviIie:. Ihi: he|p: Ihe
pcIienI Ic ccnIinue Ic u:e :ki||: cuI:ice Ihercpy cnc cfIer Ihe enc cf IrecImenI. Scme
pcIienI: mcy Le he:iIcnI Ic pcrIicipcIe in hcmewcrk c::ignmenI:, :c iI i: ycur re:pcn:iLi|iIy
Ic Le cpen Ic pcIienI feecLcck cLcuI c::ignmenI:, give rec:cn: fcr ecch Ic:k, cnc
per:cnc|ize hcmewcrk c::ignmenI: fcr ecch pcIienI.

How? [Instruct|onsJHondouts}

Seven Iip: fcr SeIIing Hcmewcrk

1. Cne Size Dce: NcI FiI /||.
/|wcy: Ici|cr c::ignmenI: Ic pcIienI:. Iheir reccing |eve|, ce:ire Ic chcnge, ccgniIive
funcIicning, cnc, even, :Icge cf |ife ceIermine hcw much cnc whcI Iype cf hcmewcrk
c::ignmenI fiI: Ihem Le:I. Fcr excmp|e, c :ing|e, wcrking mcIher whc i: c|:c c fu||-Iime
:IucenI mcy ncI hcve Iime Ic recc c ccmp|eIe Lcck c: c LiL|icIhercpy c::ignmenI.
/::igning her c :mc|| pcrI cf Ihe Lcck cr cn crIic|e mcy Le mcre rec:cncL|e. 8recking
c::ignmenI: ccwn inIc :mc||er pcrI: i: c|:c u:efu|. /|wcy: ccn:icer Ihe pcIienI´: cicgnc:i:
cnc pre:enIing prcL|em when c::igning hcmewcrk cnc c:k ycur:e|f





2. Exp|cin ln DeIci|.
Kncwing Ihe rec:cn fcr cn c::ignmenI cnc hcw iI re|cIe: Ic cverc|| IrecImenI gcc|: he|p:
Ihe pcIienI uncer:Icnc why he/:he i: ccing Ihe c::ignmenI cnc c|:c mcy enccurcge
him/her Ic ccmp|eIe iI. Mc:I pcIienI: cre inIere:Iec in hcw cerIcin ccIiviIie: mcy imprcve
Iheir :iIucIicn cr re|ieve Iheir :ympIcm:. Exp|cin c::ignmenI: in Ihe ccnIexI cf IrecImenI
gcc|: cnc Ihe ccgniIive mcce| Ic enhcnce pcIienI Luy-in Ic Ihe Ic:k:.
¨Ccn Ihe pcIienI hcnc|e Ihi: hcmewcrk, cnc wi|| iI Le Leneficic| Ic hi:/her grcwIh°"
¨Ccu|c Ihere Le c negcIive re:u|I frcm Ihi: c::ignmenI: cnc, if :c, i: Ihe pcIienI
prepcrec Ic hcnc|e iI cuI:ice :e::icn°"
41

3. SeI Hcmewcrk c: c Iecm.
lnvc|ving Ihe pcIienI in ce:igning cnc :checu|ing hcmewcrk increc:e: Ihe chcnce: he/:he
wi|| ccmp|eIe iI. lI i: c|:c impcrIcnI Ic geI Ihe pcIienI´: cgreemenI Ic ccmp|eIe Ihe
hcmewcrk. Sugge:I hcmewcrk c::ignmenI:, cnc Ihen c:k Ihe pcIienI if ycu ccn he|p mcke
ccju:ImenI: Ic iI. /:k, fcr excmp|e, Ihe fc||cwing:






¨Dc ycu Ihink Ihi: i: rec:cncL|e°"
¨WhcI wcu|c ycu chcnge cLcuI Ihe c::ignmenI°"
¨LeI´: cc cn excmp|e IcgeIher fir:I. Ihen we ccn mcke chcnge: if we neec Ic."
4. CrecIe c Win-Win SiIucIicn.
Dc ncI :cc|c c pcIienI fcr ncI ccmp|eIing hcmewcrk c::ignmenI:, LuI c|:c cc ncI ci:mi::
Iheir vc|ue. lf c pcIienI cce: ncI fini:h hcmewcrk, which i: ccmmcn, ycu mcy |ecrn cLcuI
Ihe pcIienI´: |eve| cf mcIivcIicn, cLi|iIy Ic fc||cw-Ihrcugh, cr |eve| cf ci:Ire:: {e.g., Icc
cepre::ec Ic ccmp|eIe iI). Fci|ure Ic ccmp|eIe hcmewcrk i: cn cppcrIuniIy fcr ycu Ic
evc|ucIe Ihe pcIienI´: rec:cn fcr ncnccmp|icnce. Ihe pcIienI mcy hcve Leen cnxicu:
cLcuI ccmp|eIing cn c::ignmenI inccrrecI|y cr mcy ¢ue:Iicn Ihe uIi|iIy cf Ihe c::ignmenI.
Ihe:e IhcughI: cre he|pfu| Ic ci:cu:: in :e::icn.

5. SIcrI Hcmewcrk ln-Se::icn.
ln Ihe fir:I few :e::icn: cfIer c::igning hcmewcrk, cc c few excmp|e: wiIh Ihe pcIienI in
:e::icn, when pc::iL|e. Ihi: give: Ihe pcIienI c c|ecrer picIure cf whcI i: expecIec cnc
c||cw: ¢ue:Iicn: IhcI he/:he mighI hcve cLcuI Ihe hcmewcrk. lI c|:c give: Ihe pcIienI cn
icec hcw |cng Ihe hcmewcrk wi|| Icke. ln :uL:e¢uenI :e::icn:, Ihe pcIienI mcy :IcrI Ihe
c::ignmenI wiIh ycur c::i:Icnce Ic IrcuL|e:hccI ¢ue:Iicn: cLcuI iI.

ó. /:k /LcuI cnc Feview Hcmewcrk.
Ic emphc:ize Ihe impcrIcnce cf hcmewcrk, c|wcy: c:k cLcuI cnc review hcmewcrk Ihe
:e::icn cfIer ycu c::ign iI. lf Ihe pcIienI cic ncI ccmp|eIe hcmewcrk, u:e :e::icn Iime, if
pc::iL|e, Ic ccmp|eIe Ihe c::ignmenI, which mcy c|:c he|p icenIify Ihe c:pecI: cf Ihe :ki||
IhcI neec Ic Le reviewec. lf ycu cc ncI review hcmewcrk in :e::icn, pcIienI: mcy :Icp
ccmp|eIing iI.

7. /nIicipcIe cnc Frepcre fcr FrcL|em:.
WiIh Ihe fir:I few hcmewcrk c::ignmenI:, he|p prcL|em :c|ve Ihe c::ignmenI Ly e|iciIing
feecLcck cLcuI iI cnc p|cnning when cnc hcw iI wi|| Le ccmp|eIec. /::ignmenI: ccn Le
:checu|ec fcr c pcrIicu|cr ccy cnc Iime Ic cverccme Lcrrier:, cnc fcre:eecL|e prcL|em:
fcr ccmp|eIing Ihe c::ignmenI cI IhcI Iime ccn Le ci:cu::ec. Fcr excmp|e, if Ihe pcIienI´:
Lehcvicrc| ccIivcIicn i: Ic wc|k fcr 15 minuIe: cn Wecne:ccy cI 4pm, ci:cu:: whcI Ic cc if iI
rcin: cr cIher fccIcr: prevenI him/her frcm ccmp|eIing iI. /gree upcn cnc :checu|e c
:eccnc cpIicn {e.g., u:ing Ireccmi|| fcr 15 minuIe:).
42
U:ing 8iL|icIhercpy c: Hcmewcrk

8iL|icIhercpy, cr c::igning Ihe pcIienI reccing mcIeric|: re|evcnI Ic 8rief C8I cr hi:/her
pre:enIing prcL|em:, i: c u:efu| Icc| fcr 8rief C8I Leccu:e iI c||cw: Ihe pcIienI Ic recc
cLcuI hi:/her ci:crcer cr C8I LeIween :e::icn:. 8iL|icIhercpy emphc:ize: Ihe :e|f-
mcncgemenI fccu: cf C8I cnc ccn ccce|ercIe IhercpeuIic prcgre:: cnc mcinIencnce cf
chcnge:. Feccing mcIeric|: mcy Le weL:iIe:, Lcck chcpIer:, cr :ecIicn: cf C8I pcIienI
mcnuc|:. Scme ccmmcn excmp|e: cf C8I LiL|icIhercpy cre !"#$ @'() !&&$ {GreenLerger
& Fcce:ky, 1ºº5) cnc =((4"#. A&&$ B-#$5&&7 {8urn:, 1ººº).

Hcmewcrk IrcuL|e:hccIing

FrccIicc| FrcL|em:
Cccc:icnc||y, Ihercpi:I: mcy enccunIer c pcIienI whc wciI: unIi| Ihe ccy Lefcre c :e::icn
Ic cc Ihe hcmewcrk. Ihi: i: prcL|emcIic Leccu:e cerIcin c::ignmenI:, :uch c: mcniIcring
cuIcmcIic IhcughI:, cre mc:I effecIive cnc mc:I cccurcIe when ccmp|eIec in Ihe
mcmenI. Ihere cre mcny rec:cn: pcIienI: mcy puI cff ccing hcmewcrk, cnc ycur rc|e i: Ic
exp|cre Ihe:e rec:cn: in c prcccIive, ncnjucgmenIc|, ncnpuniIive wcy.

ScmeIime: c pcIienI mcy :imp|y fcrgeI Ic cc hcmewcrk. He/:he mcy hcve c Lu:y :checu|e
cr hcve IrcuL|e rememLering Ic ccmp|eIe hcmewcrk. U:ing c cc|enccr cnc :checu|ing
Iime Ic cc hcmewcrk cre u:efu| in Ihi: :iIucIicn cnc prcvice: Ihe cppcrIuniIy fcr Iime-
mcncgemenI :ki|| Lui|cing.

/ few c::ignmenI: ce:criLec in Ihi: IexI mighI Le cifficu|I fcr :cme pcIienI:. lf c pcIienI i:
hcving IrcuL|e ccmp|eIing cn c::ignmenI Leccu:e cf Ihe |eve| cf cifficu|Iy, iI i: ycur jcL Ic
exp|cin hcw Ic ccmp|eIe iI cnc gcuge Ihe pcIienI´: uncer:Icncing. Scme c::ignmenI: mcy
neec Ic Le Lrcken ccwn inIc :mc||er :Iep: unIi| Ihe pcIienI ccn fu||y grc:p hcw iI i: Ic Le
ccmp|eIec.

F:ychc|cgicc| FrcL|em:
FcIienI: whc ccn´I ccmp|eIe hcmewcrk mighI hcve mc|cccpIive IhcughI: cLcuI
Ihem:e|ve:, Ihe hcmewcrk c::ignmenI, cr Ihercpy IhcI neec Ic Le cccre::ec. ln Ihe:e
cc:e: enccurcgemenI, IhcughI Ie:Iing cnc |i:Iing Ihe ccvcnIcge: cnc ci:ccvcnIcge: cf
ccing hcmewcrk mcy Le u:efu|. Ihcugh cuI:ice Ihe :ccpe cf Ihi: mcnuc|, Iechni¢ue:, :uch
c: mcIivcIicnc| inIerviewing {Fc||nick, eI c| 1ººº), mcy c|:c Le u:ec Ic cccre:: Ihe
cmLivc|ence c pcIienI mcy fee| cLcuI hcmewcrk. FcIienI percepIicn: cf impcrIcnce cnc
ccnficence cre very impcrIcnI fcr ncn-ccmp|icnce i::ue:.

Mcny pcIienI: hcve negcIive reccIicn: Ic Ihe wcrc ,&*(0&)7. Ihey mcy fee|
cverwhe|mec Ly Ihe perceivec Iime cr energy iI wi|| Icke Ic ccmp|eIe, cr ccncernec IhcI
Ihercpy i: |ike :chcc|wcrk. ln giving hcmewcrk, cccre:: cny ccncern: Ihe pcIienI mcy hcve
cLcuI Iime ccn:IrcinI:, cnc exp|cin hcw |cng ecch c::ignmenI :hcu|c Icke, whi|e wcrking
wiIh Ihe pcIienI Ic genercIe rec:cncL|e Ic:k:. lf Ihe pcIienI ci:|ike: Ihe Ierm ,&*(0&)7,
wcrk wiIh him/her cc||cLcrcIive|y Ic :e|ecI cncIher |cLe|, :uch c: 8)-6/"6(> 5(/0((#C;(;;"&#
8)&.)(;;> /-;7, cr (D8()"*(#I.

Hcmewcrk mcy Le prcL|emcIic fcr pcIienI: whc cre perfecIicni:I: cr ce:ire Ic p|ec:e Ihe
Ihercpi:I Leccu:e Ihey mcy :penc Icc much Iime cn cn c::ignmenI cr Le cver|y
ccncernec cLcuI geIIing Ihe ¨righI cn:wer." C|crify IhcI Ihe exerci:e i: ncI cLcuI geIIing
43
Ihe ¨righI cn:wer," cnc IhcI Ihey :hcu|c ccncenIrcIe cn reccrcing rec| fee|ing: cnc
IhcughI: cnc ncI ccncern Ihem:e|ve: wiIh :pe||ing, grcmmcr, cr cppecrcnce cf Ihe
c::ignmenI.

Ihercpi:I CcgniIicn FrcL|em:
/|Ihcugh ccmp|eIicn cf hcmewcrk i: primcri|y Ihe pcIienI´: re:pcn:iLi|iIy, :cmeIime: ycur
IhcughI: cLcuI cn c::ignmenI cr cpprccch Ic hcmewcrk p|cy: c rc|e in ncnccmp|icnce.
Check ycur cwn IhcughI: cLcuI c::igning hcmewcrk, cnc ceIermine wheIher Ihere i:
cnyIhing ycu ccn ccju:I in ycur cpprccch IhcI ccu|c LeIIer enccurcge Ihe pcIienI. /:k
ycur:e|f, ¨l: Ihe c::ignmenI Icc cifficu|I°", ¨Dic l exp|cin Ihe c::ignmenI Ihcrcugh|y°", cr
¨Hcve l |ec Ihe pcIienI Ic Le|ieve IhcI hcmewcrk i: unimpcrIcnI Ic Ihercpy°"

Scmp|e Hcmewcrk /::ignmenI:
Excmp|e: cf hcmewcrk IhcI ccu|c Le c::ignec fcr ecch ccgniIive cnc Lehcvicrc| :ki|| cre
inc|ucec in ecch mccu|e. Excmp|e: cf Ici|cring c hcmewcrk c::ignmenI Ic c :pecific cc:e
cre inc|ucec in /ppencix 8.

Supp|emenIc| Feccing:
8eck, J.S. {1ºº5). CcgniIive Ihercpy: 8c:ic: cnc Leycnc. New Ycrk: Gui|fcrc Fre:::
ChcpIer 14.
8urn:, D.D. {1ººº). Fee|ing gccc hcncLcck. New Ycrk: F|ume 8cck: {Fenguin US/).
Ccrmier, W.H. & Ccrmier, L.S. {1ºº1). lnIerviewing :IrcIegie: fcr he|per:: FunccmenIc|
:ki||: cnc ccgniIive Lehcvicrc| inIervenIicn:, 3
rc
ec. Fccific Grcve, C/: 8rcck:/Cc|e
FuL|i:hing Ccmpcny: ChcpIer: 12, 1ó, & 1º.
GreenLerg, D. & Fcce:ky, C./. {1ºº5). Minc cver mccc: Chcnge Ihe wcy ycu fee|
Ly chcnging Ihe wcy ycu Ihink. New Ycrk: Gui|fcrc Fre::: ChcpIer: 3, ó, 7, 8.
Fc||nick S., Mc:cn, F., & 8uI|er, C. {1ººº). B(-4/, 5(,-'"&) 6,-#.(E F .2"$( 3&)
8)-6/"/"&#();. ChcpIer: 3, 4, 5. New Ycrk: Churchi|| Living:Icne.
44
Modu|e º: Ident||y|ng Mo|odopt|ve Ihoughts ond 8e||e|s

Object|ves:
! Ic uncer:Icnc Ihe rc|e cf mc|cccpIive IhcughI: cnc Le|ief: in 8rief C8I
! Ic |ecrn meIhcc: fcr ecuccIing Ihe pcIienI cLcuI mc|cccpIive IhcughI: cnc Le|ief:

Whot ore mo|odopt|ve thoughts, ond be||e|s ond why they ore |mportont |n 8r|e| C8I?

Ihe ccgniIive-Lehcvicrc| mcce| {c: cepicIec Le|cw) :ugge:I: IhcI Ihree |cyer: cf ccgniIive
cy:funcIicn exi:I in incivicuc|: :Irugg|ing wiIh :ccic| cnc/cr p:ychc|cgicc| prcL|em::
/uIcmcIic IhcughI:, inIermecicIe Le|ief:, cnc ccre Le|ief:.

/n cuIcmcIic IhcughI i: c Lrief :Irecm cf IhcughI cLcuI cur:e|ve: cnc cIher:. /uIcmcIic
IhcughI: |crge|y cpp|y Ic :pecific :iIucIicn: cnc/cr evenI: cnc cccur ¢uick|y IhrcughcuI Ihe
ccy c: we cpprci:e cur:e|ve:, cur envircnmenI, cnc cur fuIure. We cre cfIen uncwcre cf
Ihe:e IhcughI:, LuI cre very fcmi|icr wiIh Ihe emcIicn: IhcI Ihey crecIe wiIhin u:.
Mc|cccpIive cuIcmcIic IhcughI: cre ci:IcrIec ref|ecIicn: cf c :iIucIicn, which cre cfIen
cccepIec c: Irue. /uIcmcIic IhcughI: cre Ihe rec|-Iime mcnife:IcIicn: cf cy:funcIicnc|
Le|ief: cLcuI cne:e|f, Ihe wcr|c, cnc Ihe fuIure IhcI cre Iriggerec Ly :iIucIicn: cr
excggercIec Ly p:ychicIric :IcIe:, :uch c: cnxieIy cr cepre::icn.

lnIermecicIe Le|ief: cre cIIiIuce: cr ru|e: IhcI c per:cn fc||cw: in hi:/her |ife IhcI Iypicc||y
cpp|y ccrc:: :iIucIicn: {ncI :iIucIicn :pecific c: wiIh cuIcmcIic IhcughI:). lnIermecicIe
Le|ief: ccn cfIen Le :IcIec c: ccnciIicnc| ru|e:: ¨lI x , Ihen y." Fcr excmp|e, ¨<3 < -* /,"#>
/,(# < 0"44 5( 4&'($ 51 &/,();E" lncivicuc|: crecIe Ihe:e c::umpIicn: Ly ccIegcrizing Ihe
infcrmcIicn Ihey receive frcm Ihe wcr|c crcunc Ihem. Ihe:e ru|e: guice IhcughI: cnc
:uL:e¢uenI|y inf|uence Lehcvicr:.

Dy:funcIicnc| ccre Le|ief: crive cy:funcIicnc| ru|e: cnc cuIcmcIic IhcughI:. Fcr excmp|e,
Ihe Le|ief, < -* 2#4&'-54(> mcy Le criving Ihe ccnciIicnc| ru|e, <3 < -* /,"#> /,(# < 0"44 5(
4&'($ 51 &/,();> which mcy crive cL:e::ive Ihinking cLcuI cne´: cppecrcnce, exce::ive
exerci:e, cr ci:crcerec ecIing hcLiI:. Ccre Le|ief: cre cfIen fcrmec in chi|chccc cnc
45
:c|icifiec cver Iime c: c re:u|I cf cne´: percepIicn: cf experience:. 8eccu:e incivicuc|: wiIh
p:ychc|cgicc| ci:crcer: Ienc Ic :Icre infcrmcIicn ccn:i:IenI wiIh negcIive Le|ief: LuI igncre
evicence IhcI ccnIrccicI: Ihem, ccre Le|ief: Ienc Ic Le rigic cnc pervc:ive. /|Ihcugh
cuIcmcIic IhcughI: cre cfIen Iiec Ic c :pecific :iIucIicnc| Irigger, inIermecicIe cnc ccre
Le|ief: cre mcre g|cLc| cnc cuI ccrc:: ccmcin:. 8eck :ugge:I: IhcI incivicuc|: Ienc Ic hcve
ccre Le|ief: IhcI invc|ve eiIher inIerper:cnc| {¨l´m un|cvcL|e") cr cchievemenI i::ue: {¨l´m
inccmpeIenI").

When? [Ind|cot|onsJContro|nd|cot|ons}

lcenIifying mc|cccpIive cuIcmcIic IhcughI: i: Ihe fir:I :Iep in Ihe ccgniIive ccmpcnenI cf
Ihercpy. Ihe fccu: cf inIervenIicn in 8rief C8I i: Ihe cy:funcIicnc| cuIcmcIic IhcughI.
FcIienI: mu:I mc:Ier icenIifying cnc chc||enging IhcughI: Ic Le cL|e Ic grc:p Ihe ccncepI
cnc Iechni¢ue: cf chc||enging Le|ief:. 8eccu:e cf Ihe inIerre|cIec ncIure cf IhcughI: cnc
Le|ief:, cn inIervenIicn IcrgeIing cuIcmcIic IhcughI: mcy c|:c chcnge uncer|ying Le|ief:
{cepicIec Le|cw). Iherefcre, 8rief C8I ccn re:u|I in Le|ief mccificcIicn, even if Ihe IcrgeI cf
IrecImenI wc: cuIcmcIic IhcughI:.


8eccu:e pcIienI: prcgre:: Ihrcugh IrecImenI cI cifferenI rcIe:, ycu mcy Le cL|e Ic icenIify
cnc chc||enge :cme Le|ief: |cIe in Lrief Ihercpy {:e::icn: 5-8) fcr :cme pcIienI:. Fcr cIher
pcIienI:, wcrk wi|| Le |imiIec Ic cuIcmcIic IhcughI:.









8ecouse sk||| bu||d|ng to o||ev|ote symptoms ond prevent re|opse |s o
centro| |ocus o| C8I, mostery o| sk|||s |s poromount. Focus on bu||d|ng o
sk||| set w|th the pot|ent thot he or she con genero||ze to d|||erent
s|tuot|ons, thoughts, or be||e|s. It |s |ess |mportont to |dent||y ond mod||y
deep-seoted ch||dhood be||e|s. For most pot|ents |n 8r|e| C8I, th|s w||| not
be necessory |or symptom reduct|on. However, some pot|ents moy
bene||t |rom th|s work.

/|Ihcugh ycu mcy ncI ci:cu:: Le|ief: cirecI|y wiIh Ihe pcIienI, c: pcrI cf Ihe cc:e
ccncepIuc|izcIicn, he/:he :hcu|c ccn:IcnI|y Le fcrming hypcIhe:e: cLcuI whcI Le|ief:
mcy Le criving Ihe IhcughI: {:ee Mccu|e 4: Cc:e CcncepIuc|izcIicn cnc IrecImenI
F|cnning).

ln icenIifying IhcughI: cnc Le|ief:, c:k ycur:e|f :everc| ¢ue:Iicn:.

" l: Ihe IhcughI/Le|ief :eccnccry Ic cncIher IhcughI/Le|ief°
" Hcw much cce: Ihe pcIienI Le|ieve iI°
" Dce: iI cffecI Ihe pcIienI´: |ife negcIive|y°
" l: Ihe pcIienI prepcrec Ic wcrk cn iI ncw, cr :hcu|c he/:he Icck|e Ihe Le|ief cI c
|cIer ccIe°

/fIer cn cuIcmcIic IhcughI cr Le|ief i: icenIifiec, iI i: chc||engec u:ing Ihe :ki||: in Mccu|e º.

How? [Instruct|onsJHondouts}

Exp|cining /uIcmcIic IhcughI: Ic Ycur FcIienI

lI i: impcrIcnI fcr Ihe pcIienI Ic uncer:Icnc Ihe rcIicnc|e fcr icenIifying cuIcmcIic IhcughI:
Lefcre cc¢uiring Ihe :ki|| cf cccre::ing hi:/her cwn IhcughI:. U:ing Ihe :iIucIicn#IhcughI#
fee|ing Iricng|e inIrccucec in Mccu|e 5 {CrienIing Ihe FcIienI Ic 8rief C8I) ccn Le he|pfu| in
exp|cining cuIcmcIic IhcughI:. Ccmp|eIing Ihe Iricng|e wiIh Ihe pcIienI´: recenI cr currenI
cuIcmcIic IhcughI: ccn fcci|iIcIe hi:/her uncer:Icncing.





















Iherop|st: "So, Fome|o, how hove you been |ee||ng th|s week?"
Fcme|c: ¨Ju:I rec||y :cc.c: u:uc|. lI :eem: |ike l´m c|wcy: fee|ing IhcI wcy."
Iherop|st: "D|d onyth|ng |n port|cu|or tr|gger th|s sod |ee||ng th|s weekend?"
Fcme|c: ¨Ye:, l hcc Ic gc Ic my ccu:in´: weccing, cnc iI wc: rec||y cifficu|I Leccu:e l
:IcrIec Ihinking cLcuI hcw l wi|| never geI mcrriec."
Iherop|st: "Fome|o, thot's whot we co|| on outomot|c thought. It's someth|ng thot just
pops |nto our heods over ond over ogo|n w|thout our reo||y th|nk|ng obout |t or
exom|n|ng the truth o| the thought. It o||ects the woy we |ee| ond oct |n o
negot|ve woy. Moybe we shou|d |ook ot some o| your outomot|c thoughts o
||tt|e c|oser."
U:ing Ihe pcIienI': excmp|e, ce:criLe Ihe c::ccicIicn LeIween IhcughI: cnc fee|ing: Ic
Lui|c cwcrene:: cf Ihe ccnnecIicn. Ihi: i: c gccc Iime fcr Ihe pcIienI Ic wriIe ccwn Ihe
IhcughI cnc Legin u:ing Ihe ccgniIive-Lehcvicrc| mcce|.
Iherop|st: " So, |et's wr|te down th|s outomot|c thought thot you ore hov|ng. " #$%% &'(')
*'+ ,-))$'./ Your go|ng to your cous|n's wedd|ng wos the s|tuot|on thot
tr|ggered the thought, 'I w||| never get morr|ed'.
Fcme|c: ¨Ye:, IhcI´: Irue."
Iherop|st: "When you were ot the wedd|ng ond thot thought come to you, how d|d you
|ee|?"
Fcme|c: ¨l fe|I rec||y :cc cnc hcpe|e::."
Iherop|st: So, con you see how our thoughts con o||ect our mood ond chonge the woy
we ore |ee||ng?"

Fcme|c: ¨Yech, l gue:: if l hccn´I hcc IhcI IhcughI, l wcu|cn´I hcve fe|I :c Lcc."
47


E|iciIing /uIcmcIic IhcughI:

lI i: impcrIcnI fcr Ihercpi:I: Ic Iecch pcIienI: hcw Ic icenIify cuIcmcIic IhcughI: curing cnc
cuI:ice cf :e::icn.

/uIcmcIic IhcughI: in Se::icn
8e cwcre cf pcIienI´: hcI IhcughI: curing :e::icn:. HcI IhcughI: cre cuIcmcIic IhcughI:
IhcI cccur in ccmLincIicn wiIh c chcnge in emcIicn cr mccc. HcI IhcughI: cre pcrIicu|cr|y
pcigncnI cr :Ircng IhcughI: IhcI cre cfIen c::ccicIec wiIh cy:funcIicnc| ccre Le|ief:, cnc
:hcu|c Le IcrgeIec in Ihercpy. HcI IhcughI: cnc Ihe ccccmpcnying :iIucIicn cnc emcIicn
cre Ircckec cn Ihe fir:I Ihree cc|umn: cf Ihe IhcughI reccrc {:ee p. 47).

Ic icenIify which cuIcmcIic IhcughI: cre ¨hcI", Ihe Ihercpi:I |i:Ien: fcr verLc| cue:, :uch c:
Ihe |cngucge u:ec in Ihe IhcughI {:ee CcgniIive Di:IcrIicn wcrk:heeI, p. 4º), cnc wcIche:
ncnverLc| cue:, :uch c: increc:ec vc|ume cf :peech cr ficgeIing. Chcnge: in fccic|
expre::icn, :hifI: in pc:iIicn, cr hcnc mcvemenI: ccn Le he|pfu| in ceIermining wheIher c
pcIienI i: experiencing cn cuIcmcIic hcI IhcughI. Li:Iening Ic Icne, piIch, vc|ume, cnc Ihe
pcce cf c pcIienI´: :peech i: c|:c Leneficic|. When ycu ncIice Ihe:e ccIicn:, Ihi: i: cn
cppcrIune Iime Ic Lring iI Ic Ihe pcIienI´: cIIenIicn cnc c::i:I him/her in icenIifying cn
cuIcmcIic IhcughI c::ccicIec wiIh Ihe :hifI in emcIicn:. ln Ihe:e in:Icnce:, ycu cre :imp|y
cn cL:erver cf Ihe Lehcvicr cnc mcke c ncIe cf ycur cL:ervcIicn Ic Ihe pcIienI {¨Ycu cre
:pecking mcre |cuc|y: whcI i: gcing Ihrcugh ycur minc righI ncw°"). Ihe pcIienI Ihen
prcvice: cn exp|cncIicn cf Ihe Lehcvicr.










FcIienI: ¨My Lc:: reprimcncec me cgcin ye:Ierccy" G;".,; ,(-'"41EH
Iherop|st: "Ie|| me more."
FcIienI: ¨We||, we were cI c meeIing: cnc l hcc ju:I mcce my pre:enIcIicn, cnc he
:cic he hcc expecIec c LeIIer prccucI fcr Ihe c|ienI. {'&"6( .(/; ;&3/()>
5(."#; 0)"#."#. ,-#$;H.
Iherop|st: "Your vo|ce chonged o ||tt|e when you so|d thot; te|| me whot |s go|ng
through your m|nd r|ght now?"
FcIienI: ¨l ju:I fee| |ike c fci|ure cI everyIhing. My wcrk hc: c|wcy: Leen Ihe cne Ihing
l wc: gccc cI, cnc ncw l cm fci|ing cI IhcI, Icc."

48























Exomp|e cont|nued:
Iherop|st: "Let's toke o |ook ot thot ||ne o| th|nk|ng ond the |ee||ngs |t creotes. It seems
thot when thot thought entered your m|nd, your mood chonged very qu|ck|y.
D|d you not|ce thot?"
FcIienI: ¨Yech, l gue:: iI cic up:eI me preIIy fc:I."
Ycu u:uc||y wi|| c|:c neec Ic u:e :pecific ¢ue:Iicn: Ic e|iciI cn cuIcmcIic hcI IhcughI. Ihe:e
¢ue:Iicn: cre fcunc cn p. 48-4º cnc in Mccu|e 10.

/uIcmcIic IhcughI: 8eIween Se::icn:
ln 8rief C8I, c principc| chcrccIeri:Iic i: Ihe wcrk Ihe pcIienI cce: cuI:ice cf :e::icn.
8eccu:e icenIifying cuIcmcIic IhcughI: i: c ncve| ccncepI Ic mcny, prccIicing cuI:ice cf
:e::icn wi|| fcci|iIcIe mcvemenI cnc chcnge in Ihercpy. ln fccI, 8urn: cnc Nc|en-Hcek:emc
{1ºº2) fcunc IhcI pcIienI: whc ccmp|eIec hcmewcrk hcc :ignificcnI|y LeIIer IrecImenI
cuIccme: Ihcn Ihc:e whc cic ncI. FrccIicing key :ki||: LeIween :e::icn: c||cw: :e::icn Iime
Ic Le u:ec fcr new :ki|| cc¢ui:iIicn cnc IrcuL|e:hccIing. lniIic||y, when c :pecific :iIucIicn i:
LrcughI up in :e::icn, c|wcy: c:k, ¨WhcI wc: gcing Ihrcugh ycur minc cI IhcI mcmenI°"
Ihi: he|p: Ihe pcIienI Lui|c cwcrene:: cf hi:/her cuIcmcIic IhcughI, LcIh wiIhin cnc cuI:ice
cf :e::icn.

8eccu:e cuIcmcIic IhcughI: mcy cccur cuI:ice cwcrene::, c:king fcr c mcre ceIci|ec
ce:cripIicn cf Ihe :iIucIicn i: c|:c he|pfu| in pinpcinIing mc|cccpIive IhcughI:. Fcr excmp|e,
ycu ccu|c ¨Icke Ihe pcIienI Lcck¨ Ic when iI hcppenec, u:ing imcgery {e.g., Where were
ycu when Ihi: hcppenec° WhcI Iime cf ccy wc: iI°). lf Ihe pcIienI reverI: Ic pc:I Ien:e,
reminc him/her Ic Ie|| Ihe :Icry in pre:enI Ien:e Ic he|p Lring Lcck Ihe IhcughI: cnc fee|ing:
IhcI cccurrec in Ihi: :iIucIicn.

WiIh ccnIinuec ¢ue:Iicning, iI i: pc::iL|e IhcI Ihere mcy Le mcre Ihcn cne cuIcmcIic
IhcughI c::ccicIec wiIh c prcL|emcIic :iIucIicn. E|iciI cnc reccrc c|| cuIcmcIic IhcughI:
given fcr c pcrIicu|cr :iIucIicn.
Iherop|st: "Cro|g, whot e|se were you th|nk|ng dur|ng th|s phone co||
w|th your w||e?"
Crcig: ¨l wc: Ihinking IhcI :he kncw: hcw Lcc l fee| fcr ncI ccming
Ic Ihe pcrIy cnc :he wcnI: me Ic fee| even wcr:e."
Iherop|st: "So you weren't th|nk|ng on|y thot they were us|ng you. You
were o|so th|nk|ng thot they knew you |e|t bod, ond they
wonted you to |ee| worse?"
Crcig: ¨Ye:."
Iherop|st: "So, thot |s reo||y three d|||erent thoughts thot you were
hov|ng thot were creot|ng |ee||ngs o| onger?"
Crcig: ¨l gue:: :c."
FememLer IhcI c pcIienI´: cuIcmcIic IhcughI: :hcu|c Le Ihe ccIuc| wcrc: cr imcge: IhcI
gc Ihrcugh hi: cr her minc. FcIienI: {cr Ihercpi:I:) mcy cfIen inIerpreI cr rephrc:e IhcughI::
hcwever, Ihe gcc| i: Ic geI unprcce::ec IhcughI: verLcIim.

Decicing Which /uIcmcIic IhcughI: Ic Fccu: Cn
Cnce c pcIienI Leccme: cwcre cf hcw mcny cuIcmcIic IhcughI: he/:he hc:, he/:he mcy
fee| cverwhe|mec Ly Iheir :heer numLer. Unccvering cne IhcughI mcy |ecc Ic cncIher
cnc :c cn. Iherefcre, iI i: impcrIcnI Ic fccu: cn Ihe mc:I impcrIcnI cuIcmcIic IhcughI: cnc
Ihe hcI IhcughI: IhcI cre |ike|y Ic Lring cLcuI Ihe grecIe:I chcnge. Ihere cre :everc| Ihing:
c pcIienI ccn cc cnce he cr :he hc: icenIifiec cn cuIcmcIic IhcughI. Ihe pcIienI ccn
cecice Ic fccu: cn IhcI IhcughI, chcc:e cncIher IhcughI c::ccicIec wiIh Ihe :iIucIicn, cr
mcve cn Ic cncIher Icpic if he/:he fee|: IhcI Ihere i: c mcre pcwerfu| IhcughI IhcI he/:he
wcu|c |ike Ic Icck|e.

Ycu ccn he|p Ihe pcIienI chcc:e cuIcmcIic IhcughI: Ic fccu: cn Ly fre¢uenI|y checking:
" Gcc|: fcr Ihi: :e::icn
" FcIienI´: cgencc iIem: cnc cccre::ing Ihc:e prcL|em:
" Ihe impcrIcnce cf Ihe IhcughI chc:en in recching IhercpeuIic gcc|:

/ncIher Iechni¢ue i: Ic icenIify c few cuIcmcIic IhcughI: cnc Ihen rcIe Ihem cn c :cc|e cf
0-100, Lc:ec cn hcw inIen:e Ihe c::ccicIec fee|ing i: {rcIe Ihe fee|ing frcm 0-100), cnc hcw
much he/:he Le|ieve: Ihe IhcughI {rcIe Le|ievcLi|iIy frcm 0-100). Ihi: he|p: Ic ¢ucnIify
which cuIcmcIic IhcughI: cre mc:I impcrIcnI. Ihe IhcughI: wiIh Ihe :Ircnge:I rcIing:
:hcu|c Le ccn:icerec fir:I.

Dy:funcIicnc| cuIcmcIic IhcughI: cfIen fc|| inIc cerIcin ccIegcrie:. Ihe:e cre ccmmcn
¨ccgniIive ci:IcrIicn:¨ cr Ihinking errcr:. lcenIifying pcIIern: cf ccgniIive ci:IcrIicn: in Ihe
pcIienI': IhcughI reccrc: cr :peech i: in:IrumenIc| fcr chcc:ing c hcI IhcughI, cc:e
ccncepIuc|izcIicn, cnc IrecImenI p|cnning. / pcIienI cfIen hc: cne cr Iwc ccmmcn
pcIIern: cf mc|cccpIive Ihinking. lcenIifying Ihe:e pcIIern: he|p: him/her icenIify Ihem
when Ihey ccme up cnc prcvice: ycu cn cppcrIuniIy Ic inIervene cn c IhcughI Iriggerec
in mu|Iip|e :iIucIicn:. Iherefcre, chcnging c pcrIicu|cr IhcughI IhcI i: pcrI cf c cy:funcIicnc|
Ihinking pcIIern {e.g., Iencency Ic igncre Ihe pc:iIive) mcy hcve mu|Iip|e LenefiI: fcr Ihe
pcIienI. Fcr |i:I cf ccmmcn Ihinking errcr:, :ee Ihe CcgniIive Di:IcrIicn wcrk:heeI {pcge 4º).

lnIermecicIe 8e|ief:
Ic icenIify cn inIermecicIe Le|ief, ycu mu:I fir:I kncw hcw Ic reccgnize c pcIienI´:
cuIcmcIic IhcughI:. Ycu ccn cc Ihi: Ly icenIifying cn cuIcmcIic IhcughI cnc Ihen
cIIempIing Ic icenIify cn cIIiIuce cr c::umpIicn Ihe pcIienI fee|: cLcuI him-/her:e|f, Ihe
fuIure, cIher:, cr Ihe wcr|c. Ihe:e c::umpIicn: ccn Le icenIifiec Ly |i:Iening fcr Iheme: in
Ihe pcIienI´: IhcughI: cnc Lehcvicr. Ycu ccn u:e :everc| Iechni¢ue: Ic icenIify cn
inIermecicIe Le|ief:

" Lcck fcr cn inIermecicIe Le|ief IhcI ccme: in Ihe fcrm cf c pcIienI´: cuIcmcIic
IhcughI.
" Frcvice Ihe fir:I pcrI cf cn c::umpIicn {¨lf x."), cnc en|i:I Ihe he|p cf Ihe pcIienI Ic
ccmp|eIe iI.
" E|iciI c ru|e cr cn cIIiIuce frcm Ihe pcIienI, cnc chcnge iI inIc cn c::umpIicn.
" Lcck fcr Iheme: in Ihe pcIienI´: cuIcmcIic IhcughI:. EiIher ccme up wiIh c
hypcIhe:i:, cr c:k Ihe pcIienI Ic icenIify c Iheme.
" /:k Ihe pcIienI cirecI|y cLcuI hi: cr her Le|ief:.
" Hcve Ihe pcIienI ccmp|eIe c ¢ue:Iicnncire cr invenIcry IhcI wi|| he|p icenIify hi:/her
Le|ief: {e.g., Dy:funcIicnc| /IIiIuce: Scc|e).

50
Ccre 8e|ief:
IhrcughcuI Ihercpy, hypcIhe:ize ccre Le|ief: IhcI mcy Le uncer|ying cy:funcIicnc|
Lehcvicr: cnc IhcughI:. Ihe:e hypcIhe:e: cic ceve|cpmenI cf Ihe cc:e ccncepIuc|izcIicn
cnc IrecImenI p|cn {:ee Mccu|e 5). / Le|ief IhcI i: |ike|y Ic Le ccre wi|| cppecr in :everc|
cifferenI crec: cf Ihe pcIienI´: |ife {i.e., re|cIicn:hip:, wcrk, pcrenIing).

lf Iime permiI: in 8rief C8I, cfIer ycu hcve cc||ecIec encugh evicence Ic :uppcrI Ihe
c||egec ccre Le|ief, pre:enI cnc ci:cu:: iI wiIh Ihe pcIienI.






¨l´ve hecrc ycu :cy :everc| Iime: IhcI ycu eiIher cicn´I cc c gccc
jcL, cr IhcI :cmecne e|:e puI in mcre Iime cnc energy. lI :eem: Ic
me IhcI ycu fee| incce¢ucIe c |cI cf Ihe Iime. l: IhcI righI°"
/I Ihi: pcinI, ycu ccn c|:c e|iciI chi|chccc experience: ccn:i:IenI wiIh Ihe Le|ief. Ihi: he|p:
icenIify Ihe pc::iL|e crigin cf Ihe Le|ief cnc he|p: ycu exp|cin iI Ic Ihe pcIienI.


ln ecuccIing Ihe pcIienI cLcuI ccre Le|ief:, mcke :everc| Ihing: c|ecr:

" Ccre Le|ief: cre cn|y icec:. Fee|ing Ihem :Ircng|y cce: ncI mcke Ihem Irue.
" Ihe:e Le|ief: :IcrIec ceve|cping curing chi|chccc. Ihe pcIienI Le|ieve: Ihem Icccy
Leccu:e he/:he hc: :Icrec evicence Ic :uppcrI Ihem cnc rejecIec evicence Ic
ccnIrccicI Ihem.
" Ihe:e Le|ief: ccn Le Ie:Iec cnc chcngec Ihrcugh u:e cf Ihe Iechni¢ue: IhcI wi||
Le IcughI in Ihercpy.

Excmp|e Hcmewcrk /::ignmenI:
1. Keep c ncIepcc wiIh ycu cnc cIIempI Ic |i:I cuIcmcIic IhcughI: ycu hcve curing
Ihe ccy.
2. U:e Ihe Iricng|e cicgrcm Ic ci::ecI Ihree Ic five :iIucIicn: when ycu experiencec c
:Ircng emcIicn.
3. CrecIe c |i:I cf c::umpIicn: cnc evicence fcr cnc cgcin:I Ihc:e c::umpIicn:.
4. Ccmp|eIe Ihe fir:I Ihree :ecIicn: cf Ihe IhcughI Feccrc fcr cne Ic Iwc :iIucIicn:.

Supp|emenIc| Feccing:
8eck, J.S. {1ºº5). CcgniIive Ihercpy: 8c:ic: cnc Leycnc. New Ycrk: Gui|fcrc Fre:::
ChcpIer: ó, 7, 8, 10, cnc 11.
Scfrcn, J.D. & GreenLerg, L.S. {1º82). E|iciIiing ¨hcI ccgniIicn:" in ccgniIive
Lehcvicrc| Ihercpy: FcIicnc|e cnc prccecurc| guice|ine:. Ccnccicn F:ychc|cgy, 23, 83-8ó.
GreenLerg, D. & Fcce:ky, C. /. {1ºº5). !"#$ &'() *&&$9 +,-#."#. /,( 0-1 1&2 3((4
51 6,-#."#. /,( 0-1 1&2 /,"#7E New Ycrk: Gui|fcrc Fre::: ChcpIer: 5, ó, 7, cnc º.
51
IHObGHI kECOkD
[1} S|tuot|on
[2} Automot|c
Ihought[s}
[3} Emot|on[s}
Mood
& [4} Ev|dence to
Support Ihought
[5} Ev|dence Ihot
Doesn't Support
Ihought
[ó} A|ternot|ve
Ihought
[7} kote
Mood
Now
CuI cf LrecIh when
p|cyec in Ihe pcrk
wiIh my
grcncccughIer























01-+ -2+3-%%4
1-55'&'.6 01')'6
01-+6 78#6 01'&6
l l´m Icc c|c Ic p|cy wiIh
her.

l ccn´I cc whcI l u:ec
Ic cc.

l ccn´I Le her
ccregiver.

l hcve ncIhing Ic cffer
my fcmi|y cny mcre.

l cm c Lurcen Ic my
fcmi|y.

l cm nc gccc Ic my
fcmi|y.










01-+ +183*1+9:; #'&+
+1)83*1 483) ,$&.6
78# ,321 .$. 483
<'%$'(' $+6 9=>=??;
DefecIec


Scc


Scc

Di:cppcinIec
Hcpe|e::

Hcpe|e::
WcrIh|e::

Hcpe|e:: {80)
WcrIh|e:: {º0)











01-+
',8+$8&9:; .$.
483 @''% -+ +1'
+$,'6 A-+' 18
$&+'&:' +1'4
#')' 9=>=??;/

#


01-+ 1-: 1-55'&'.
+8 ,-B' 483 <'%$'('
+1' +183*1+ $: +)3'6


01-+ 1-:
5)8(' +1'
+)3'6
1-55'&'. +8
+183*1+ $: &8+


01-+ $:
-&8+1') #-4
+1$&B 8@ +1$:
:$+3-+$8&6
+8


?>=??
52
He|p|u| Quest|ons


S|tuot|ono|
Quest|ons


Fee||ng
Quest|ons

Ihought
Quest|ons

"


"


"


"


"


"

WhcI hcppenec° WhcI were ycu
ccing°
Whc wc: Ihere°
Whc were ycu :pecking Ic°
When cic Ihi: hcppen°
WhcI Iime cf ccy wc: iI°
Where cic Ihi: incicenI cccur°

"


"


"


"
Hcw were ycu fee|ing Lefcre Ihi:
hcppenec°
Hcw cic ycu fee| whi|e iI wc:
hcppening°
WhcI mccc were ycu in cfIer Ihi:
hcppenec°
Ccn ycu rcIe ycur mccc cn c
:cc|e cf 1-100°

"

"

"

"

"

"

"

"

"
WhcI wc: gcing Ihrcugh ycur minc
Lefcre ycu :IcrIec Ic fee| IhcI
wcy°
WhcI mcce ycu fee| IhcI wcy°
Dc ycu hcve cny cIher IhcughI:°
Which IhcughI LcIherec ycu Ihe
mc:I°
WhcI imcge: cic ycu hcve wiIh
Ihe:e IhcughI:°
WhcI cre ycu cfrcic mighI
hcppen°
WhcI if Ihi: i: Irue° WhcI cce: Ihi:
:cy cLcuI ycu°
WhcI ccu|c hcppen if Ihi: were
Irue°
WhcI cIher wcy: ccu|c we Ihink cf
Ihi:°
53
Cogn|t|ve D|stort|ons

1. A||-or-noth|ng th|nk|ng: Viewing :iIucIicn: cn cne exIreme cr cncIher in:Iecc cf cn c
ccnIinuum.
Ex. ¨lf my chi|c cce: Lcc Ihing:, iI´: Leccu:e l cm c Lcc pcrenI."

2. Cotostroph|z|ng: FrecicIing cn|y negcIive cuIccme: fcr Ihe fuIure.
Ex. ¨lf l fci| my finc|, my |ife wi|| Le cver."

3. D|squo|||y|ng or d|scount|ng the pos|t|ve: Ie||ing ycur:e|f IhcI Ihe gccc Ihing: IhcI hcppen
Ic ycu ccn´I ccunI.
Ex. ¨My ccughIer Ic|c her frienc IhcI l wc: Ihe Le:I Dcc in Ihe wcr|c, LuI l´m :ure
:he wc: ju:I Leing nice."

4. Emot|ono| reoson|ng: LeIIing cne´: fee|ing cLcuI :cmeIhing cverru|e fccI: Ic Ihe
ccnIrcry.
Ex. ¨Even Ihcugh SIeve i: here cI wcrk |cIe every ccy, l kncw l wcrk hcrcer Ihcn
cnycne e|:e cI my jcL."

5. Lobe||ng: Giving :cmecne cr :cmeIhing c |cLe| wiIhcuI fincing cuI mcre cLcuI iI/Ihem.
Ex. ¨My ccughIer wcu|c never cc cnyIhing l ci:cpprcvec cf."

ó. Mogn|||cot|onJm|n|m|zot|on: Emphc:izing Ihe negcIive cr p|cying ccwn Ihe pc:iIive cf c
:iIucIicn.
Ex. ¨My prcfe::cr :cic he mcce :cme ccrrecIicn: cn my pcper, :c l kncw l´||
prcLcL|y fci| Ihe c|c::."

7. Mento| |||terJtunne| v|s|on: F|ccing c|| cne´: cIIenIicn c, cr :eeing cn|y, Ihe negcIive: cf c
:iIucIicn.
Ex. ¨My hu:Lcnc :cy: he wi:he: l wc: LeIIer cI hcu:ekeeping, :c l mu:I Le c |cu:y
wife."

8. M|nd reod|ng: 8e|ieving ycu kncw whcI cIher: cre Ihinking.
Ex. ¨My hcu:e wc: cirIy when my frienc: ccme cver, :c l kncw Ihey Ihink l´m c
:|cL."
Ex. ¨My ccughIer´: Lcyfrienc gcI :u:pencec frcm :chcc|. He´: c |c:er cnc wcn´I
ever cmcunI Ic cnyIhing."

º. Overgenero||zot|on: Mcking cn cverc|| negcIive ccnc|u:icn Leycnc Ihe currenI :iIucIicn.
Ex. ¨My hu:Lcnc cicn´I ki:: me when he ccme hcme Ihi: evening. McyLe he
cce:n´I |cve me cnymcre."

10. Fersono||zot|on: Ihinking Ihe negcIive Lehcvicr cf cIher: hc: :cmeIhing Ic cc wiIh ycu.
Ex. ¨My ccughIer hc: Leen preIIy ¢uieI Icccy. l wcncer whcI l cic Ic up:eI her."

11. "Shou|d" ond "must" stotements: Hcving c ccncreIe icec cf hcw pecp|e :hcu|c Lehcve.
Ex ¨l :hcu|c geI c|| F´: Ic Le c gccc :IucenI."

54
Modu|e 10: Cho||eng|ng Mo|odopt|ve Ihoughts ond 8e||e|s

Object|ves
! Ic |ecrn Iechni¢ue: fcr cccre::ing cy:funcIicnc| IhcughI: cnc Le|ief:
! Ic uncer:Icnc cnc mcncge pcIenIic| cifficu|Iie: u:ing IhcughI reccrc:

Whot ore the techn|ques |or cho||eng|ng mo|odopt|ve thought, ond why ore these
techn|ques |mportont |or 8r|e| C8I?

Severc| Iechni¢ue: ccn Le u:ec Ic chc||enge cy:funcIicnc| IhcughI: cr Le|ief:. Mc:I cre
u:ec in ccnjuncIicn wiIh c IhcughI reccrc. Chc||enging IhcughI: cnc Le|ief: in c
cc||cLcrcIive, SccrcIic wcy c||cw: pcIienI: Ic u:e Iheir cwn :IcIemenI: Ic ccunIer
cy:funcIicnc| Ihinking. GenercIing ccunIer-:IcIemenI: Lc:ec cn Ihe ccIc pcIienI: Lring Ic
:e::icn increc:e: Ihe Le|ievcLi|iIy cf Ihe IhcughI:/Le|ief: cnc, Ihu:, Ihe effecIivene:: cf Ihe
ccunIer IhcughI:/Le|ief:.

When? [Ind|cot|onsJContro|nd|cot|ons}

Iypicc||y cy:funcIicnc| cuIcmcIic IhcughI: cre Ihe fir:I IcrgeI: in Ihe ccgniIive ccmpcnenI
cf C8I. Fc||cwing Ihe inIrccucIicn cf Ihe ccgniIive mcce| {:ee Mccu|e 5: CrienIing pcIienI
Ic 8rief C8I), cnc :ki||: fcr icenIifying cuIcmcIic hcI IhcughI: cnc Iheir ccccmpcnying
emcIicn: {:ee Mccu|e º: lcenIifying Mc|cccpIive IhcughI: cnc 8e|ief:), Iechni¢ue: fcr
chc||enging hcI IhcughI: cre inIrccucec. Ihe:e Iechni¢ue: :hcu|c immecicIe|y fc||cw Ihe
:e::icn cn icenIifying hcI IhcughI:, Ic Lui|c ccnIinuiIy cnc fcmi|icriIy wiIh Ihe :ki|| :eI cnc
in:Ii|| hcpe cf chcnge cfIer icenIifying prcL|emcIic Ihinking pcIIern:. /|Ihcugh inIermecicIe
cnc ccre Le|ief: wi|| Le chc||engec in ccvcncec :Icge: cf Ihercpy, Ihe Iechni¢ue: cre
:imi|cr fcr chc||enging IhcughI:. Mcny Iechni¢ue: Le|cw ccn Le u:ec inIerchcngecL|y fcr
chc||enging IhcughI: cr Le|ief:. 8rief C8I :e::icn Iime i: Le:I u:ec fcr mccifying IhcughI: cr
Le|ief: IhcI cre IighI|y he|c cnc :Ircng|y Le|ievec.

How? [Instruct|onsJHondouts}

SccrcIic ¢ue:Iicning i: c Ihercpi:I :Icnce fcr ¢ue:Iicning mc|cccpIive IhcughI: cnc Le|ief:.
Ihi: prcce:: invc|ve: c:king c :erie: cf cpen-encec, Lrief ¢ue:Iicn: IhcI guice Ihe pcIienI Ic
ci:ccver hi:/her icic:yncrcIic IhcughI:, fee|ing:, cr Lehcvicr: c::ccicIec wiIh c pcrIicu|cr
:iIucIicn. SccrcIic ¢ue:Iicning i: ncnjucgmenIc| LuI i: Lc:ec cn Ihe Ihercpi:I´: in:ighI IhcI
Ihe criginc| premi:e cf c IhcughI cr Le|ief mcy Le unIrue: Iherefcre, Ihe ¢ue:Iicn: cre
ce:ignec Ic expc:e Ihe cy:funcIicnc| IhcughI cr Le|ief :c IhcI iI mcy Le chc||engec.

Ihe Dy:funcIicnc| IhcughI Feccrc {DIF) i: Ihe :Icp|e cf ccgniIive wcrk in 8rief C8I. Ihe fir:I
Ihree cc|umn: {:ee IhcughI Feccrc hcnccuI cn p. 55) cre u:ec fcr icenIifying IrcuL|ing
:iIucIicn: cnc Ihe ccccmpcnying emcIicn: cnc cy:funcIicnc| IhcughI:. Ihe:e Ihree
cc|umn: cre u:ec in ccnjuncIicn wiIh Mccu|e 8, in IhcI when Ihe :iIucIicn# IhcughI #
fee|ing Iricng|e i: unfc|cec, iI fcrm: Ihe fir:I Ihree cc|umn: cf c DIF {:ee figure).



55
/ :even-cc|umn IhcughI reccrc i: u:ec Ic chc||enge cy:funcIicnc| IhcughI: cnc Le|ief:.
ln:IrucIicn: fcr ccmp|eIing cc|umn: 4-7 cre ce:criLec in ceIci| Le|cw.

Cnce c hcI IhcughI cnc iI: ccccmpcnying emcIicn hcve Leen icenIifiec cnc rcIec, Ihe
hcI IhcughI i: ¢ue:Iicnec Ic genercIe evicence fcr cnc cgcin:I iI. 8ui|cing evicence mcy
Le inIrccucec in Ihe fc||cwing wcy:



















Exomp|e: We hcve icenIifiec c IhcughI IhcI i: very pcwerfu| fcr ycu. Ycu rcIec Ihi:
IhcughI c: º0 cuI cf 100 fcr :ccne::. 8efcre :pencing c |cI cf Iime cnc energy cn Ihi:
IhcughI, l wcnI Ic kncw wheIher cr ncI iI i: Irue. CfIen when pecp|e cre cepre::ec cr
cnxicu:, Ihey Icke IhcughI: |ike Ihi: cI fcce vc|ue, wiIhcuI fir:I c:king wheIher iI i: Irue.
/ccepIing IhcughI: |ike Ihi: c: Irue wcu|c cerIcin|y |ecc Ic Ihe :ympIcm: ycu´ve Leen
:Irugg|ing wiIh. lf l IhcughI, ¨l cm wcrIh|e:: cnc ccn´I cc cnyIhing righI," l wcu|cn´I
wcnI Ic geI cuI cf Lec in Ihe mcrning eiIher, cnc l wcu|c prcLcL|y fee| preIIy hcpe|e::
cnc :cc. When we Ie:I c IhcughI |ike Ihi:, we cre gcing Ic genercIe evicence fcr cnc
cgcin:I Ihe IhcughI. lI i: c: Ihcugh Ihe IhcughI were cn Iric|, cnc ycu were c |cwyer fcr
Ihe cc:e. FememLer, ycu hcve Ic Le cL|e Ic prcve Ihe evicence ycu cre genercIing.
Sc, ncw |eI´: :ee hcw ycur IhcughI :Icnc: up..
Deve|cping 8c|cncec Ihinking

Ihe:e in:IrucIicn: mighI Le u:efu| Ic he|p pcIienI: ceve|cp Lc|cncec Ihinking:
1. He|p Ihe pcIienI ¢ue:Iicn cuIcmcIic IhcughI: Ly c:king
" WhcI evicence i: Ihere IhcI Ihi: IhcughI i: Irue°
" WhcI evicence i: Ihere IhcI Ihi: IhcughI i: ncI Irue°
" WhcI wcu|c l Ie|| :cmecne l |cvec if Ihey were in Ihi: :iIucIicn cnc hcc Ihe:e
IhcughI:°
" lf my cuIcmcIic IhcughI i: Irue, whcI i: Ihe wcr:I IhcI ccu|c hcppen°
" lf my cuIcmcIic IhcughI i: Irue, whcI i: Ihe Le:I Ihing IhcI ccu|c hcppen°

2. Cnce evicence hc: Leen genercIec, ccmLine iI Ic fcrm c mcre Lc|cncec IhcughI. Ihi:
IhcughI wi|| |ike|y Le much |cnger cnc mcre nucncec Ihcn Ihe criginc| hcI IhcughI.
Exomp|e: Icking c|| Ihi: infcrmcIicn {frcm cc|umn: 4-5) inIc ccn:icercIicn, whcI i: c
mcre Lc|cncec IhcughI IhcI mcre cccurcIe|y ref|ecI: Ihe fccI:°
Ycu mighI wcnI Ic c:k Ihe fc||cwing ¢ue:Iicn::
" Icking Ihe infcrmcIicn inIc ccccunI, i: Ihere cn c|IerncIive wcy cf Ihinking cLcuI Ihe
:iIucIicn°
" Ccn :cmecne l Iru:I uncer:Icnc Ihi: :iIucIicn in c cifferenI wcy°

3. FcIe Ihe Le|ievcLi|iIy cf Ihe c|IerncIive IhcughI LeIween 0-100). lf Ihe IhcughI i: ncI mcre
Ihcn 50 Le|ievcL|e, mcre wcrk i: neecec Ic icenIify cn c|IerncIive IhcughI. Gc Lcck Ic Ihe
evicence cnc keep wcrking.

4. Cnce c Le|ievcL|e c|IerncIive IhcughI i: genercIec, re-rcIe Ihe mccc c::ccicIec wiIh
Ihe hcI IhcughI {0-100) cfIer reccing Ihe new IhcughI. Fecucing c IhcughI/Le|ief Ic c
rcIing cf 0 i: ncI c rec|i:Iic gcc|. ln:Iecc, c recucIicn cf 30-50 cfIen prcvice: re|ief. CfIen

pcIienI: wi|| genercIe new emcIicn: frcm Ihe c|IerncIive IhcughI. Hcwever, iI i: mc:I
impcrIcnI fir:I Ic re-rcIe Ihe c|c mccc Lefcre genercIing new emcIicn:.

Ihe :cme :IrcIegy cf genercIing cn c|IerncIive IhcughI fcr c cy:funcIicnc| IhcughI i: u:ec
when chc||enging c ccre Le|ief. Cnce Ihe Le|ief i: icenIifiec, Ihe evicence i: weighec cnc
c new mcre Lc|cncec Le|ief i: genercIec.

















Summory: Comp|et|ng DIks

! lcenIify :iIucIicn cnc ccrre:pcncing IhcughI: cnc fee|ing:.
! lcenIify ccgniIive ci:IcrIicn: in IhcughI: {e.g., c|| cr ncne Ihinking).
! U:e SccrcIic ¢ue:Iicning Ic icenIify hcI IhcughI.
! E|iciI cnc rcIe emcIicn: c::ccicIec wiIh hcI IhcughI.
! FcIe Le|ievcLi|iIy cf hcI IhcughI.
! GenercIe evicence fcr cnc cgcin:I hcI IhcughI.
! GenercIe c|IerncIive IhcughI frcm evicence.
! FcIe Le|ievcLi|iIy cf c|IerncIive IhcughI.
! Fe-rcIe emcIicn cf hcI IhcughI IhcI i: e|iciIec Ly c|IerncIive IhcughI.
IrcuL|e:hccIing IhcughI/8e|ief MccificcIicn

Scme pcIienI: ccn :ee Ihe LenefiI: cf ccing c IhcughI reccrc immecicIe|y, LuI cIher:
mighI neec Ic Le mcIivcIec Ic Le engcgec. lI i: u:efu| Ic u:e pc:iIive reinfcrcemenI Ic
prci:e Ihe effcrI cf ccmp|eIing c DIF, pcinI cuI Ihe :ecIicn: ccmp|eIec ccrrecI|y, cnc
review :ki||: fcr Ihe :ecIicn: ccmp|eIec inccmp|eIe|y cr incccurcIe|y. lf c DIF i: c::ignec fcr
hcmewcrk, iI mu:I c|wcy: Le reviewec curing Ihe :uL:e¢uenI :e::icn. Icking :e::icn Iime Ic
review Ihe DIF emphc:ize: iI: impcrIcnce Ic Ihe pcIienI.

lnIrccucing Ihe DIF c: cn ¨experimenI" he|p: c||evicIe cny perfcrmcnce cnxieIy Ihe
pcIienI mcy hcve cLcuI ccmp|eIing iI cnc mcy genercIe inIere:I {¨Give Ihe DIF c Iry Ihi:
week, cnc we´|| :ee hcw iI wcrk: fcr ycu. LeI me kncw nexI :e::icn hcw Ihe experience Ic
ccmp|eIe iI wc:. IhcI wi|| he|p u: cecice wheIher cr ncI Ihi: i: c u:efu| Icc| fcr ycu.")

Cccc:icnc||y, c pcIienI wi|| :hcw ci:inIere:I in ccing Ihe DIF cr geI Iirec cf iI cfIer c whi|e.
Fcr in:Icnce: |ike Ihi:, Ihere cre cIher wcy: ycu ccn :ugge:I IhcI Ihe pcIienI ccn ccnIinue
Ic cIIempI Ihe DIF:

" lf c pcIienI ccmp|cin: cf never hcving Iime Ic cc c DIF when cerIcin :iIucIicn:
cccur, :ugge:I IhcI Ihe pcIienI ccrry c L|cnk DIF in hi:/her wc||eI cr pur:e.
" lf c pcIienI hc: ccne Ihe DIF fcr cwhi|e cnc i: Leccming ci:inIere:Iec, :ugge:I
ccing c ¨menIc|" DIF, :ince he/:he i: fcmi|icr wiIh Ihe prcce::.
" Sugge:I reccing c|c DIF: IhcI hcve :imi|cr :iIucIicn: cnc cuIcmcIic IhcughI: cf Iheir
cwn.
" Ihe pcIienI ccn verLc||y cicIcIe c DIF Ic :cmecne, cnc hcve IhcI per:cn wriIe iI
ccwn.
57
Ihere wi|| ncI c|wcy: Le cn immecicIe chcnge Ic c pcIienI´: mccc cfIer c IhcughI reccrc
i: ccmp|eIec. lI mighI Le nece::cry Ic c::e:: why Ihere i: nc chcnge. lI ccu|c Le cIIriLuIec
Ic Ihe pcIienI´: ceep|y rccIec Le|ief in Ihe cuIcmcIic IhcughI, Ic cn unchcngec uncer|ying
ccre Le|ief, cr Ic ccciIicnc| cuIcmcIic IhcughI: IhcI hcve ncI Leen evc|ucIec. lI i:
nece::cry Ic c:k: Why wc: Ihere nc mccc chcnge cfIer ccmp|eIicn cf Ihe IhcughI
Feccrc° Ihe:e cIher ¢ue:Iicn: wi|| c|:c Le he|pfu|.

" Hcve l ce:criLec Ihe :iIucIicn in encugh ceIci|°
" Dic l icenIify cnc rcIe Ihe righI mccc:°
" l: Ihe IhcughI l cm Ie:Iing cn cuIcmcIic IhcughI°
" Dc l Le|ieve c cy:funcIicnc| ccre Le|ief i: criving Ihi: IhcughI°
" Dic l |i:I mu|Iip|e IhcughI:° Dc l neec mcre infcrmcIicn fcr ecch incivicuc| IhcughI°
" l: Ihere c :Ircnger cuIcmcIic IhcughI IhcI l hcve ncI puI in my IhcughI Feccrc°
" Dc l Le|ieve Ihe c|IerncIive IhcughI° WhcI cIher c|IerncIive IhcughI: cre cvci|cL|e°

lf IhcughI/Le|ief Ie:Iing i: ineffecIive in recucing negcIive mccc, ycu ccn c|:c exp|cre Ihe
ccvcnIcge: cnc ci:ccvcnIcge: cf mcinIcining c IhcughI/Le|ief. /: we kncw, Ihere cre
mcny ci:ccvcnIcge: Ic negcIive Le|ief: we hcve, LuI Ihere cre c|:c ccvcnIcge:. Ihe
pcIienI´: percepIicn: cf Ihe ccvcnIcge: mcy Le cL:IrucIing Ihe chcnge prcce::.
Uncer:Icncing Ihe funcIicn cf Ihe IhcughI/Le|ief fcr Ihe pcIienI mcy Le u:efu| in c|crifying
why cerIcin IhcughI:/Le|ief: cre re:i:IcnI Ic mccificcIicn. Ihe Ihercpi:I :hcu|c evc|ucIe
LcIh Ihe ccvcnIcge: cnc ci:ccvcnIcge: cf c pcIienI´: c::umpIicn: cnc Le|ief:, LuI in
ccing :c wcrk Ic cimini:h Ihe ccvcnIcge: cnc high|ighI Ihe ci:ccvcnIcge:.

CfIen, when wcrking Ic mccify IhcughI: cnc Le|ief:, Ihe pcIienI mcy finc evicence IhcI
:uppcrI: Ihe negcIive Le|ief in:Iecc cf evicence IhcI ccnIrccicI: iI. lf Ihere i: c gccc
cmcunI cf evicence Ic :uppcrI IhcI negcIive ccre Le|ief, Ihen prcL|em :c|ving, rcIher Ihen
IhcughI Ie:Iing, i: cn cpprcpricIe :IrcIegy {:ee Mccu|e 12).






















Seven I|ps |or E||ect|ve DIks

1. Ycu mu:I hcve mc:Ierec Ihe u:e cf DIF Lefcre inIrccucing iI Ic pcIienI:.
2. Feinfcrce cnc mcke :ure IhcI Ihe pcIienI Le|ieve: in Ihe ccgniIive mcce| Leing u:ec.
3. Iecch Ihe DIF in Iwc :ecIicn:: {1) Ihe fir:I Ihree cc|umn:: SiIucIicn, /uIcmcIic
IhcughI{:), cnc EmcIicn{:), cnc {2) Ihe |c:I fcur cc|umn:: Evicence fcr cnc cgcin:I
IhcughI, /|IerncIive re:pcn:e, cnc New rcIing cf emcIicn.
4. U:e Ihe pcIienI´: exccI wcrc: when reccrcing IhcughI: cnc fee|ing:. Wcrking wiIh
IhcughI: verLcIim pre:erve: Ihe emcIicn: cr per:cnc| mecning fcr ecch IhcughI.
5. Ihe pcIienI :hcu|c Le cL|e Ic cce¢ucIe|y ccmp|eIe Ihe fir:I Ihree cc|umn: cf Ihe DIF
Lefcre |ecrning cLcuI Ihe |c:I fcur cc|umn:.
ó. Ccmp|eIing c DIF i: c :ki|| cnc, |ike cIher 8rief C8I :ki||:, re¢uire: prccIice. Succe::
cepenc: cn Ihe pcIienI´: uncer:Icncing cf Ihe :Iep:. Enccurcge Ihe pcIienI Ic Icke
Iime wiIh Ihe :ki|| cnc wcrk Ihrcugh cny fru:IrcIicn.
7. lf Ihe pcIienI i: ncI cc||cLcrcIive in ccmp|eIing Ihe DIF in :e::icn cr cce: ncI ccmp|eIe
DIF hcmewcrk, iI i: pc::iL|e IhcI he cr :he mighI hcve cuIcmcIic IhcughI: cLcuI Ihi:
Iype cf exerci:e. /:k Ihe pcIienI Ic crecIe c IhcughI reccrc cf Ihe DIF experience.
58
Excmp|e Hcmewcrk /::ignmenI:
1. Li:I Ihe ccvcnIcge: cnc ci:ccvcnIcge: cf keeping c IhcughI Feccrc.
2. U:e cn c|c IhcughI Feccrc cnc cnc|yze iI u:ing Ihe /uIcmcIic IhcughI Cue:Iicn:
we hcve ci:cu::ec.
3. Ccmp|eIe Ihe fir:I Ihree cc|umn: cf c IhcughI reccrc fcr hcmewcrk, cnc ccmp|eIe
cc|umn: 4-7 wiIh ycu in :e::icn.

Supp|emenIc| Feccing:
8eck, J.S. {1ºº5). CcgniIive Ihercpy: 8c:ic: cnc Leycnc. New Ycrk: Gui|fcrc Fre:::
ChcpIer º.
GreenLerg, D. & Fcce:ky, C./. {1ºº5). !"#$ &'() *&&$9 +,-#.( /,( 0-1 1&2 3((4
51 6,-#."#. /,( 0-1 1&2 /,"#7E New Ycrk: Gui|fcrc Fre::: ChcpIer: 5, ó, & 7.

IHObGHI kECOkD
[1} S|tuot|on
[2} Automot|c
Ihought[s} [3} Emot|on[s}
[4} Ev|dence to
Support Ihought
[5} Ev|dence Ihot
Support Ihought
Doesn't [ó} A|ternot|ve
Ihought
[7} kote
Mood Now
CuI cf LrecIh
when l p|cyec in
Ihe pcrk wiIh my
grcncccughIer






















l´m Icc c|c Ic p|cy
wiIh her.

l ccn´I cc whcI l
u:ec Ic cc.

l ccn´I Le her
ccregiver.

l hcve ncIhing Ic
cffer my fcmi|y
cnymcre.

l cm c Lurcen Ic my
fcmi|y.

l cm nc gccc Ic my
fcmi|y.








DefecIec


Scc


Scc


Di:cppcinIec
Hcpe|e::


Hcpe|e::
WcrIh|e::

Hcpe|e:: {80)
WcrIh|e:: {º0)








My fcmi|y hc: Ic
|cck in cn me mcre
cfIen Ihcn Ihey
u:ec Ic.






















l ccn :Ii|| LcLy:iI my
grcnckic:.

l ccnIriLuIe Ic my fcmi|y
in new wcy:, :uch c:
cffering ccvice cnc
:uppcrI.

l :Ii|| |ive incepencenI|y.

l cm cL|e Ic cc mcny
Ihing: phy:icc||y, Ihcugh
cc hcve mcre |imiIcIicn:
Ihcn l u:ec Ic.












l
8eccu:e cf my
CCFD cnc
Leccu:e l cm
geIIing c|cer, l
hcve mcre
phy:icc|
|imiIcIicn: Ihcn
l u:ec Ic, cnc l
cc neec my
fcmi|y´: he|p
frcm Iime Ic
Iime, LuI l cm
cL|e Ic cffer
Ihem mcny
vc|ucL|e
Ihing: cnc
ccnIriLuIe Ic
my grcnckic:´
|ive:.{80)







Hcpe|e::
{10)

WcrIh|e::






















{5)
01-+ -2+3-%%4
1-55'&'.6
01')'6 01-+6
78#6 01'&6
01-+ +183*1+9:; #'&+
+1)83*1 483) ,$&.6
78# ,321 .$. 483
<'%$'(' $+6 9=>=??;
01-+
',8+$8&9:; .$.
483 @''% -+ +1'
+$,'6 A-+' 18#
$&+'&:' #')'
+1'469=>=??;
01-+ 1-:
1-55'&'. +8 ,-B'
483 <'%$'(' +1'
+183*1+ $: +)3'6
01-+ 1-:
5)8(' +1'
+)3'6
1-55'&'. +8
+183*1+ $: &8+
01-+ $:
-&8+1') #-4
+1$&B 8@ +1$:
:$+3-+$8&6
+8
?>=??
ó0
Modu|e 11: 8ehov|oro| Act|vot|on

Object|ves
! Ic uncer:Icnc Ihe impcrIcnI c|inicc| ccmpcnenI: cnc cpp|iccIicn: cf Lehcvicrc|
ccIivcIicn :IrcIegie: in Lrief C8I.
! Ic |ecrn :ki||: cnc Iechni¢ue: Ic effecIive|y u:e Lehcvicrc| :IrcIegie: fcr pc:iIive pcIienI
chcnge {e:pecic||y re|cIec Ic increc:ing p|ec:cnI evenI:)

Whot |s behov|oro| oct|vot|on, ond why |s |t |mportont?

8ehcvicrc| ccIivcIicn inc|uce: c :eI cf prccecure: cnc Iechni¢ue: cimec cI increc:ing
pcIienI ccIiviIy cnc ccce:: Ic reinfcrcing :iIucIicn: IhcI imprcve mccc cnc funcIicning.
8ehcvicrc| ccIivcIicn cmcunI: Ic Ihe ¨8¨ in C8I inIervenIicn:. Frcm Ihi: Lehcvicrc|
:IcncpcinI, cepre::icn, fcr excmp|e, ccnIcin: c hc:I cf chcrccIeri:Iic: IhcI funcIicn Ic
mcinIcin cepre::ive cffecI {e.g., pc::iviIy, fcIigue, fee|ing: cf hcpe|e::ne::) cnc cecrec:e
chcnce: cf cccpIive ccping Ly increc:ing cvciccnce. Ihe key here i: IhcI cifficu|Iy wiIh
mccc cfIen :erve: Ic increc:e cvciccnce cf cccpIive ccping, inc|ucing p|ec:cnI evenI:,
which he|p Ic c||evicIe cnc cvcic cepre::icn. Fe-inIrccucing p|ec:cnI evenI: {cne fcrm cf
Lehcvicrc| ccIivcIicn) ccn :erve Ic imprcve mccc in mcny cifferenI wcy: - 1) rever:ing
cvciccnce, 2) increc:ing phy:icc| ccIiviIy, 3) increc:ing :e|f-ccnficence cnc 4) increc:ing
fee|ing: cf u:efu|ne:: cnc purpc:e. FecenI empiricc| evicence :ugge:I: IhcI Lehcvicrc|
inIervenIicn: imprcve mccc :ympIcm: LuI c|:c recuce mc|cccpIive IhcughI pcIIern:
{JcccL:cn eI c|., 1ººó).

/n impcrIcnI pcinI fcr Ihercpi:I:: 8ehcvicrc| ccIivcIicn {c|IerncIive|y referrec Ic c:
increc:ing p|ec:cnI ccIiviIie:) ccn:i:I: cf c hc:I cf pc::iL|e Lehcvicr: inc|ucing, LuI ncI
|imiIec Ic,
1) Fe-inIrccucing pricr p|ec:cnI ccIiviIie:
2) lnIrccucing new p|ec:cnI ccIiviIie:
3) /cIive ccping {e.g., Icking :cme fcrm cf Lehcvicrc| ccIicn) Ic c||evicIe cr recuce
c |ife :Ire::cr: excmp|e: cf ccIive/Lehcvicrc| ccping IhcI cre ncI p|ec:cnI-evenI
criven inc|uce
" Fi|ing cr geIIing Icxe: ccne
" C|ecning cuI c me::y c|c:eI
" Cc||ing cn e:Ircngec fcmi|y memLer
Ihe gcc| cf ccIive ccping i: Ic cecrec:e :Ire:: Ihrcugh ccccmp|i:hmenI cr
cverccming cvciccnce.

When? [Ind|cot|onsJContro|nd|cot|ons}

8eccu:e cf iI: re|cIive|y :imp|e cnc :IrcighIfcrwcrc cpprccch, Lehcvicrc| ccIivcIicn i: c
gccc Iechni¢ue fcr iniIic| :Icge: cf IrecImenI cnc ccn Le high|y effecIive fcr pcIienI: wiIh
|imiIec in:ighI inIc Iheir cifficu|Iie:. /cIivcIicn i: c|:c ec:i|y mec:urec {e.g., numLer,
fre¢uency, cr curcIicn cf ccIiviIie:) cnc Iherefcre ccn Le u:ec Ic cccumenI cnc ccnvey
prcgre:: Ic pcIienI: {e.g., Ic increc:e IrecImenI inve:ImenI cnc imprcve pcIienI :e|f-
ccnficence cnc ccnIrc| cver :ympIcm:).

8ehcvicrc| inIervenIicn: cre pcrIicu|cr|y pcwerfu| fcr cepre::ec mccc. /cIivcIicn fcr
cepre::icn generc||y :erve: Ic geI Ihe pcIienI mcving. /|mc:I c|| Lehcvicr: IhcI inc|uce
phy:icc| ccIiviIy, p|cnning, cr ccccmp|i:hing Ic:k: cre cpprcpricIe here.
ó1
Ihe u:e cf Lehcvicrc| ccIivcIicn fcr cnxieIy ccnciIicn: re¢uire: c |iII|e mcre ceIci|. FcIienI:
wiIh cnxieIy :ympIcm: cfIen cvcic :iIucIicn: cuI cf fecr cf negcIive ccn:e¢uence
cccurring in re:pcn:e Ic engcging in c pcrIicu|cr ccIiviIy. /|Ihcugh Lehcvicrc| ccIivcIicn
ccn cic Ihe:e pcIienI:, ycu mu:I c|:c uncer:Icnc IhcI Ihe ccIiviIy iI:e|f i: ncI reinfcrcing
{p|ec:cnI) LuI rcIher fecrec. lI i: cn|y Ihe re:u|Iing ccmp|eIicn cf Ihe Ic:k IhcI mcy
genercIe pc:iIive cffecI {e.g., l fccec my fecr, cnc ncIhing IerriL|e hcppenec). Ihi:
re:pcn:e ciffer: frcm cepre::icn in IhcI cepre::ec pcIienI: wi|| cfIen |cck cI Lehcvicrc|
ccIivcIicn c: c pc:iIive cuIccme in cnc cf iI:e|f {e.g., ¨exerci:ing i: enjcycL|e¨ cr ¨l |cve
Ic|king wiIh my grcnc-ccughIer¨). Ic effecIive|y cpp|y Lehcvicrc| ccIivcIicn wiIh cnxicu:
pcIienI:, iI i: impcrIcnI Ic mcniIcr cnxieIy cnc ccmLine Lehcvicrc| ccIivcIicn wiIh re|cxcIicn
Iechni¢ue: Ic increc:e pcIienI ccmfcrI cnc ccnIrc|. Simi|cr|y, Le ccrefu| ncI Ic c||cw
Lehcvicrc| ccIivcIicn prccecure: Ic furIher cic in Ihe pcIienI´: cvciccnce cf fecrfu|
:iIucIicn: {e.g., pre:enIing prcL|em i: cvcicing inIerper:cnc| cifficu|Iie: wiIh :pcu:e, cnc
pcIienI chcc:e: Ic :hcp cr Le cn Ihe inIerneI fcr p|ec:ure LuI :pecificc||y when :pcu:e i: in
Ihe hcu:e Ic cvcic ccnfrcnIcIicn/Ic|king cLcuI i::ue:).

How? [Instruct|onsJHondouts}

SIep ¬1: Frcvice pcIienI wiIh rcIicnc|e fcr Lehcvicrc| ccIivcIicn.
lI i: impcrIcnI Ic ecuccIe Ihe pcIienI c: Ic whcI Lehcvicrc| ccIivcIicn i: cnc hcw iI ccn Le
u:efu| fcr imprcving cepre::icn cnc cnxieIy. LeI him/her kncw IhcI when fee|ing c |iII|e
ccwn cr hcving c Lcc ccy cnc ncI fee|ing we|| phy:icc||y ccn mcke iI mcre |ike|y IhcI he cr
:he wi|| :Icp ccing mcny ccIiviIie: IhcI u:ec Ic Le p|ec:urcL|e. When Ihi: hcppen:, Ihe
pcIienI ccn geI inIc Ihe hcLiI cf cvcicing p|ec:cnI ccIiviIie: IhcI mighI ccIuc||y he|p
him/her fee| LeIIer. lI i: c|:c impcrIcnI fcr Ihe pcIienI Ic uncer:Icnc Ihe ccnnecIicn
LeIween whcI he cr :he cce: cnc hcw he/:he fee|:, LcIh menIc||y cnc phy:icc||y. Ycu cre
enccurcgec Ic exp|cin Ic Ihe pcIienI IhcI increc:ing ccIiviIy cnc/cr Icking ccIicn, even
when we cc ncI fee| |ike iI, he|p cne Ic fee| LeIIer phy:icc||y, c: we|| c: cecrec:e
cepre::icn.




















Iherop|st: I wou|d ||ke to to|k o ||tt|e obout whot your doy |ooked ||ke yesterdoy. Wo|k me
through your doy [e.g., whot d|d you do |n the morn|ng, o|ternoon, even|ng}
FcIienI: We||, in Ihe mcrning l wcke up cI 10 cm cnc cIe Lreckfc:I. l wcIchec IV unIi|
nccn. Ihen l cIe |unch. /rcunc 2:30 l Icck c :hcwer. /I 3:00 l wenI fcr c wc|k wiIh
my ccg.
Iherop|st: Okoy, thonks. How d|d you |ee| |n the morn|ng?
FcIienI: Iirec. l ju:I ccu|cn'I geI mcIivcIec cnc cic ncI wcnI Ic cc cnyIhing. l gue:: l wc:
fee|ing :crry fcr my:e|f - cepre::ec, l gue::.
Iherop|st: You soy you were |ee||ng depressed. I| you hod to rote thot |ee||ng on o sco|e o| 0
to 100 [100 |s worst depress|on} whot wou|d you soy your depress|on wos?
FcIienI: ó5.
Iherop|st: Whot obout |n the o|ternoon o|ter your shower ond wo|k? How wou|d you rote your
depress|on?
FcIienI: 20.
Iherop|st: Io whot do you ottr|bute th|s chonge |n your depress|on?
FcIienI: l gue:: l ju:I gcI cff my ccuch cnc :IcrIec mcving which he|pec me fee| LeIIer.
Iherop|st: Ihot wou|d be my guess os we||. [subsequent|y, exp|o|n the connect|ons between
mood ond behov|or ond encouroge use o| behov|oro| oct|vot|on}.
ó2
Ihe figure Le|cw vi:uc||y ce:criLe: Ihe ccnnecIicn LeIween mccc cnc Lehcvicr cnc ccn
Le cn effecIive cic in ccmmuniccIing wiIh pcIienI:. Ic mcximize Ihe uIi|iIy cf Ihe figure, ycu
cre enccurcgec Ic u:e Ihe pcIienI': cwn excmp|e:. Fcr excmp|e, ycu cnc Ihe pcIienI ccn
wcrk IcgeIher Ic ccmp|eIe c cci|y ccIiviIy |cg {:ee hcnccuI). Frcm Ihi: ccIiviIy |cg, ycu
mighI high|ighI ccIiviIie: IhcI cppecrec Ic rci:e cr |cwer Ihe pcIienI': mccc.



lf cepre::ec per:cn: increc:e Iheir ccIiviIie: cn c cci|y Lc:i:, iI imprcve: mccc cnc
cecrec:e: :ympIcm: cf cepre::icn.



SIep ¬2: lcenIifying 8ehcvicr: - Di:cu::ing /cIiviIie:.
lcenIificcIicn cf pcIenIic| ccIiviIie: Legin: Ly exp|cring wiIh Ihe pcIienI ccIiviIie: IhcI wcu|c
Le mc:I mecningfu|. Hcve c generc| ci:cu::icn cf Iype: cf Ihing: he/:he wcu|c |ike Ic cc
LuI hcve ncI Leen cL|e Ic cc cnc ccIiviIie: he/:he c|reccy cce: LuI wcu|c |ike Ic cc mcre
cfIen wiIhin Ihe ccnIexI cf vc|ue: cr gcc|: IhcI cre impcrIcnI Ic him/her. Ycu mighI wcnI Ic
c:k if Ihere i: :cmeIhing IhcI he cr :he neec: Ic cc IhcI he/:he hc: Leen uncL|e Ic cc cr
hc: Leen cvcicing. Scme pcIienI: mcy wcnI Ic ccccmp|i:h :cmeIhing rcIher Ihcn fccu: cn
ccing :cmeIhing p|ec:cnI.

Fc::iL|e ¢ue:Iicn: mighI inc|uce:
! ¨Ccn ycu Ihink cf cny ccIiviIie: cr hcLLie: IhcI ycu u:ec Ic enjcy ccing LuI hcve
ncw :Icppec ccing°¨
! ¨Ccn ycu Ihink cf cny ccIiviIie: cr hcLLie: IhcI ycu wcu|c |ike Ic cc LuI hcve never
ccne°
! ¨/re Ihere Ihing: in ycur |ife IhcI ycu wcu|c |ike Ic chcnge° lf :c, whcI wcu|c ycu |ike
Ic cc cLcuI Ihe:e i::ue: IhcI ycu hcve previcu:|y ncI ccne°¨

ó3
Fcr pcIienI: whc hcve cifficu|Iy icenIifying ccIiviIie:, ycu ccn inIrccuce c Lehcvicrc|
ccIiviIy check|i:I {:ee /ppencix).

8efcre ccmp|eIing Ihe nexI :Iep: {e.g., :eIIing c p|cn), iI i: impcrIcnI Ic ci:cu:: Ihe pcIenIic|
impcrIcnce cf Ihe Lehcvicr wiIh Ihe pcIienI. lf he/:he repcrI: |cw impcrIcnce, enccurcge
Ihe pcIienI Ic finc cncIher, mcre mecningfu| ccIiviIy.

SIep ¬3: SeIIing cn /cIicn F|cn.
Cnce Ihe pcIienI hc: icenIifiec c mecningfu| ccIiviIy Ic fccu: cn, he|p :hcpe Ihi: wcrk inIc
c mecningfu| IhercpeuIic gcc|. /cIicn p|cn: cre cne mechcni:m cf crecIing mecningfu|
Lehcvicrc| gcc|: fcr Ihercpy. /cIicn p|cn: in Iheir mc:I Lc:ic fcrm :Iipu|cIe Ihe :pecific gcc|
Ic Le cLIcinec, cefinec in Ierm: cf cL:ervcL|e cnc mec:urcL|e chcrccIeri:Iic: cnc c
Iimefrcme fcr mcniIcring prcgre::.







Excmp|e:
Goo|: Ic recc cI |ec:I Ihree Iime: per week {c minimum cf 30 minuIe: per
reccing :e::icn).
I|me|rome: FcIienI wi|| ccmp|eIe Ihree reccing :e::icn: cver Ihe nexI week.
/n expcncec ccIicn p|cn mighI c|:c inc|uce:
c) /cciIicnc| ceIci|: cf Ihe p|cn - e.g., hcw Ihe gcc| wi|| Le cLIcinec
L) Fc::iL|e Lcrrier: Ic recching Ihe gcc| cnc wcy: Ic cccre:: Lcrrier: if Ihey cri:e
c) Fc::iL|e fcci|iIcIcr: cf cLIcining Ihe gcc|, e.g., impcrIcnI pecp|e cr :iIucIicn: IhcI
mighI cic Ihe pcIienI
c) FcIienI': ccnficence in recching Ihe gcc| in Ihe Iime|ine e:IcL|i:hec: if
ccnficence i: |cw, ycu mighI wi:h Ic c|Ier Ihe p|cn Ic increc:e chcnce: cf :ucce::.
e) Ski||: IhcI Ihe pcIienI mighI wcnI Ic en|i:I Ic he|p recch Ihe gcc| {e.g., re|cxcIicn
:ki||:, prcL|em-:c|ving :ki||:, eIc.)

SIep ¬4: McniIcr prcgre:: in mccc, mc:Iery, cnc ccnficence
lI i: impcrIcnI Ic mcniIcr Ihe pcIienI': mccc cnc fee|ing: cf mc:Iery cnc ccnficence.
CuIccme: :uch c: imprcvemenI in mccc, mc:Iery, cr ccnficence ccn Le Le:I icenIifiec
Ihrcugh pcIienI hcmewcrk c::ignmenI: IhcI c:k Ihe pcIienI Ic cccumenI Ihe fre¢uency
cnc u:e cf Ihe Lehcvicrc| ccIiviIy cnc cny ccrre:pcncing emcIicn: cr fee|ing: cf mc:Iery cr
ccnficence.

Cn Ihe Lc:i: cf Ihi: mcniIcring cf cuIccme:, evc|ucIe Ihe ccIicn p|cn cnc Ihe pcIienI':
cLi|iIy Ic wcrk Icwcrc: cchieving gcc|:. lf prcL|em: cri:e, mcke chcnge: ccccrcing|y {e.g.,
Lrecking ccwn gcc|: inIc :mc||er :Iep:, ceIermining pcIienI percepIicn: cf impcrIcnce cnc
chcnging gcc|: ccccrcing|y). McniIcring :hcw: Ihe pcIienI IhcI ycu ccnIinue Ic Le|ieve in
Ihe impcrIcnce cf Ihe Iechni¢ue/exerci:e cnc c|:c :erve: Ic furIher mcIivcIe mcny pcIienI:
Ly increc:ing Ihe effecIivene:: cf Ihe inIervenIicn.

Iip: fcr Mcncging 8crrier: Ic Dcing /cIiviIie:
1) He|p Ihe pcIienI Lreck ccwn mcre cifficu|I ccIiviIie: inIc :mc||er :Iep:. Lcck fcr
c|IerncIive Lehcvicr: Ic ccccmp|i:h c gcc| prchiLiIec Ly c chrcnic i||ne:: cr cIher phy:icc|
|imiIcIicn:. Fcr excmp|e, c :IrucIurc|/mechcnicc| engineer whc wc: fcrcec Ic reIire
Leccu:e cf c phy:icc| |imiIcIicn mcy fee| IhcI hi:/her |ife i: nc |cnger prccucIive. /|Ihcugh
Ihe pcIienI i: phy:icc||y uncL|e Ic fu|fi|| pricr jcL cuIie:, ycu ccn wcrk wiIh him/her Ic icenIify
ó4
mecningfu| ccIiviIie: re|cIec Ic Ihe pricr cccupcIicn. ln Ihi: cc:e, Ihe pcIienI mighI LenefiI
frcm vc|unIeering cI c univer:iIy, prcvicing ccn:u|IcIicn {e.g., cver emci| cr Ie|ephcne cc||:),
cr vc|unIeering fcr c |ccc| :chcc|, ycuIh cr church crgcnizcIicn {e.g., Ic|king cLcuI
engineering).

2) lI i: c|:c he|pfu| cnc :uppcrIive Ic |cck fcr wcy: IhcI cIher: ccn he|p. Fcmi|y cr cIher
:ccic| neIwcrk: IhcI Ihe pcIienI hc: ncI yeI fu||y engcgec mighI exi:I, which mighI c::i:I Ihe
pcIienI in mcving fcrwcrc cn gcc|:.

3) F|ec:cnI ccIiviIie: cre Ihe Le:I fir:I :Iep. F|ec:cnI ccIiviIie: cre ccuL|y Leneficic| Ic Ihe
pcIienI, c: Ihey increc:e ccIiviIy cnc fee|ing: cf p|ec:ure. /cIiviIie: ce:ignec Ic cverccme
cvciccnce cr increc:e c :en:e cf ccccmp|i:hmenI :hcu|c Le enIerIcinec c: Ihe fir:I gcc|:
cn|y if high|y impcrIcnI Ic Ihe pcIienI cr cppcrenI|y :c|ienI Ic Ihe cIIcinmenI cf fuIure gcc|:.










Excmp|e: cf Hcmewcrk /::ignmenI:
1. WhcI ccIiviIie: cic ycu previcu:|y u:e Ic enjcy IhcI ycu wcu|c |ike Ic :IcrI
pcrIicipcIing in cgcin°
2. Li:I ccIiviIie: IhcI ycu neec Ic cc Ic LeIIer ycur currenI :iIucIicn {enrc|| in :chcc|, geI
ycur in:pecIicn :Iicker, eIc.).
3. CrecIe c :checu|e cf Ihe new ccIiviIie: ycu wi|| perfcrm. Which cne: cic ycu
ccccmp|i:h° Were Ihere cny Lcrrier:° Why° Hcw cic ycu hcnc|e Ihem°

Supp|emenIc| Feccing::
Hcpkc, Lejuez, Fuggierc, eI c|. CcnIempcrcry Lehcvicrc| ccIivcIicn IrecImenI: fcr
cepre::icn: prccecure:, princip|e:, cnc prcgnc:i:. C|in F:ychc| Fev 2003: 23 {5): óºº-717.
Summory o| Steps

SIep 1. lnIrccuce Lehcvicrc| ccIivcIicn cnc iI: pcIenIic| inf|uence Ic Ihe pcIienI.
SIep 2. U:e pcIienI excmp|e: Ic :hcw re|cIicn:hip LeIween mccc cnc Lehcvicr.
SIep 3. lcenIify p|ec:cnI ccIiviIie:/ccIive-ccping Lehcvicr:.
SIep 4. SeI cn ccIicn p|cn.
SIep 5. McniIcr prcgre::.

ó5
Fcr ecch L|cck cf Iime, |i:I Ihe ccIiviIy ycu cic cnc rcIe
Mood Mon|tor|ng ond
{frcm 0-100) Ihe |eve| cf
Act|v|ty
/nxieIy
Chort
{/) cnc Depre::icn {D) ycu experiencec cI IhcI Iime.
I|me Sundoy Mondoy Iuesdoy Wednesdoy Ihursdoy Fr|doy Soturdoy
ó-7 /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
7-8 /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
8-º /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
º-10 /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
10-11 /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
11-12 Nccn /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
12-1 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
1-2 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
2-3 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
3-4 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
4-5 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
5-ó FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
ó-7 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
7-8 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
8-º FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:

óó
Modu|e 12: Frob|em So|v|ng

Object|ves
" Ic inIrccuce prcL|em :c|ving cnc iI: pcIenIic| u:e in p:ychcIhercpy
" Ic |ecrn hcw Ic cpp|y prcL|em-:c|ving :ki||: curing 8rief C8I

Whot |s prob|em so|v|ng, ond why |s |t |mportont |n theropy?

FrcL|em-:c|ving Iechni¢ue: generc||y invc|ve c prcce:: Ly which cn incivicuc| cIIempI: Ic
icenIify effecIive mecn: cf ccping wiIh prcL|em: cf everyccy |iving. Ihi: cfIen invc|ve: c :eI
cf :Iep: fcr cnc|yzing c prcL|em, icenIifying cpIicn: fcr ccping, evc|ucIing Ihe cpIicn:,
cecicing upcn c p|cn, cnc ceve|cping :IrcIegie: fcr imp|emenIing Ihe p|cn.

FrcL|em-:c|ving :IrcIegie: ccn Le u:ec wiIh c wice rcnge cf prcL|em:, inc|ucing
cepre::icn, cnxieIy, cnger cnc cggre::icn, :Ire:: mcncgemenI, ccping wiIh mecicc| i||ne::,
cccicIicn, cnc re|cIicn:hip/fcmi|y cifficu|Iie:. FrcL|em-:c|ving Iechni¢ue: Iecch :ki||: IhcI
cic Ihe pcIienI in fee|ing increc:ec ccnIrc| cver |ife i::ue: IhcI previcu:|y fe|I cverwhe|ming
cr unmcncgecL|e. ln Ihi: mcnner, prcL|em :c|ving ccn he|p wiIh prccIicc| prcL|em
re:c|uIicn c: we|| c: emcIicn-fccu:ec ccping {e.g., increc:ing ccnIrc|, cecrec:ing :Ire::,
cnc increc:ing hcpefu|ne::).

When? [Ind|cot|onsJContro|nd|cot|ons}

IhcughI: cnc Le|ief: cre chc||engec when c IhcughI cr Le|ief i: ncI Irue cr c :iIucIicn i:
unchcngecL|e. /|IerncIive|y, prcL|em :c|ving mcy Le u:ec when Ihe rccI cf cn i::ue i: c
chcngecL|e :iIucIicn: cnc Ihe IhcughI: c::ccicIec wiIh Ihe ncxicu: :iIucIicn mighI Le
cccurcIe. FrcL|em :c|ving ccn Le e:pecic||y effecIive when c :pecific prcL|em i: cL|e Ic
Le cccre::ec cnc cpercIicnc|izec. / :pecific cpercIicnc|izec prcL|em i: cne IhcI i: ec:i|y
exp|cinec, icenIifiec, cnc/cr mec:urec. FrcL|em :c|ving wcrk: Le:I when c prccIicc|
:c|uIicn i: cvci|cL|e. Fcr excmp|e, c pcIienI ccmp|cining cf :ccic| i:c|cIicn |ike|y hc:
pcIenIic| :c|uIicn: Ic Ihi: cifficu|Iy {e.g., cc||ing c frienc, jcining c grcup, engcging in c
:ccic||y criven hcLLy).

Excmp|e: cf prcL|em: cpprcpricIe fcr prcL|em :c|ving inc|uce:
1) Hcw Ic ccmmuniccIe wiIh c pcrIner cLcuI c cifficu|I i::ue
2) Hcw Le:I Ic ccpe wiIh Ihe funcIicnc| |imiIcIicn: cf c mecicc| ccnciIicn
3) Hcw Ic recuce fincncic| ci:Ire::

NcIe IhcI ycu cre ncI re:pcn:iL|e fcr fincing cn:wer: Ic Ihe:e ¢ue:Iicn: LuI rcIher :hcu|c
cic Ihe pcIienI in fincing hi: cr her cwn cn:wer:. ln Ihi: mcnner ycu cre c fcci|iIcIcr whc
pc::e::e: prcL|em-:c|ving :ki||:.

FrcL|em :c|ving mcy Le cifficu|I fcr Ihe fc||cwing incivicuc|::
1) Fer:cn: wiIh :ericu: menIc| i||ne:: {p:ychcIic ci:crcer:, Lipc|cr ci:crcer)
2) Fer:cn: wiIh :evere cepre::icn, whc mighI re¢uire mcre fccu:ec ccgniIive wcrk cr
meciccIicn:
3) Fer:cn: whc hcve cifficu|Iy Ihinking cLcuI |cng-Ierm effecI: {e.g., per:cn: wiIh
ccgniIive impcirmenI)
4) Fer:cn: wiIh prcL|em: IhcI cre |crge|y emcIicnc|: fcr excmp|e, c per:cn whc fee|:
inccmpeIenI cI wcrk cnc cfIen fee|: IhcI cIher: cre cver|y criIicc| mcy Le
ó7
reccIing Ic emcIicn: {e.g., cepre::icn). Ihi: prcL|em mcy Le LeIIer :ervec u:ing
cncIher :ki|| {e.g., mc|cccpIive IhcughI: mccu|e).

How? [Instruct|onsJHondouts}

FrcL|em-Sc|ving Ihercpy {FSI)
ln prcL|em-:c|ving Ihercpy, iI i: impcrIcnI IhcI ycu fir:I ecuccIe Ihe pcIienI cLcuI Ihe
prcL|em-:c|ving :IrcIegie: IhcI wi|| Le u:ec curing :e::icn:. Ic encL|e Ihe pcIienI Ic u:e Ihe
:IrcIegie: cfIer Ihercpy enc:, Iecch him/her Ic ccrefu||y excmine c prcL|em, crecIe c |i:I cf
:c|uIicn:, cnc mcke ceci:icn: cLcuI which :IrcIegie: cre cpprcpricIe fcr c vcrieIy cf
prcL|em:.

Generc| guice|ine: fcr u:ing prcL|em-:c|ving :IrcIegie: cre c: fc||cw::

" Ircining :hcu|c Le Ici|crec cnc :pecific Ic ecch pcIienI.
" CLIcin c Ihcrcugh c::e::menI cf Ihe prcL|em Lefcre prcceecing wiIh prcL|em-
:c|ving Ihercpy.
" Enccurcge Ihe pcIienI Ic Iry c: mcny :c|uIicn: c: pc::iL|e.
" Decice wheIher Ihe pcIienI re¢uire: mcre prcL|em-:c|ving wcrk cr mcre emcIicnc|
wcrk Ic experience grcwIh Ihrcugh Ihe IhercpeuIic prcce::.

SIrcIegie: fcr EffecIive FrcL|em Sc|ving

Ihe SCLVED Iechni¢ue he|p: guice ycu Ihrcugh Ihe :Iep: Ic mc:I effecIive|y icenIify cnc
:c|ve prcL|em: in ycur |ife.

S {Se|ecIing c FrcL|em) . Ihe pcIienI wcu|c |ike Ic :c|ve.
/:k Ihe pcIienI Ic Ihink cLcuI :iIucIicn: when he cr :he fee|: ci:Ire:: cr cifficu|Iy prcL|em
:c|ving. lf p|cnning cce: ncI :eem Ic Le pc::iL|e, :ugge:I c cifferenI IhercpeuIic Iechni¢ue
{e.g., chcnging mc|cccpIive IhcughI:). Ihe ceci:icn Ic remcin wiIh prcL|em :c|ving cr
mcve Ic c cifferenI :ki|| i: |crge|y cepencenI cn ycu Ic cirecI.

C {Cpening Ycur Minc Ic /|| Sc|uIicn:)
Here, iI i: impcrIcnI Ic Le c: Lrccc c: pc::iL|e. Ycu cre enccurcgec Ic wcrk wiIh pcIienI: Ic
¨Lrcin:Icrm" c|| pc::iL|e :c|uIicn:. WriIing mcy Le pcrIicu|cr|y he|pfu| fcr :cme pcIienI:. Even
icec: IhcI :eem ricicu|cu: cI fir:I mcy genercIe rec|i:Iic :c|uIicn:.









Fcr excmp|e, 8erIhc´: fcmi|y wcu|c cfIen crcp Ly :everc| Iime: c week wiIhcuI cc||ing
Lefcrehcnc cnc expecI her Ic ccre fcr Iheir chi|cren. She enjcyec Ihi:, LuI fe|I Iirec mcny
Iime: cnc wc: Leginning Ic geI ccncernec cLcuI her cLi|iIy Ic ccnIinue chi|c :iIIing cI :uch
c fre¢uenI pcce. Her fir:I icec wc: Ic Ie|| Ihem :he ccu|c nc |cnger LcLy-:iI. /|Ihcugh :he
cic ncI |ike Ihi: icec, iI |ec her Ic ccn:icer re|cIec icec:, :uch c: Ie||ing Ihem Ihey hcc Ic cc||
Lefcrehcnc Ic mcke :ure :he fe|I up Ic Ihe Ic:k.
Iip: fcr genercIing pc::iL|e :c|uIicn::
! /: k Ihe pcIienI Ic Ihink cLcuI ccvice he cr :he wcu|c give :cmecne e|:e wiIh Ihi:
prcL|em.
! /:

k Ihe pcIienI Ic excmine Ihe wcy: he cr :he hcve hcnc|ec :imi|cr :iIucIicn:.
! ln:IrucI Ihe pcIienI Ic consu|t w|th o c|ose |r|end or re|ot|ve fcr ccciIicnc| :c|uIicn:.
ó8
L {Li:Iing Ihe FcIenIic| Frc: cnc Ccn: cf Ecch FcIenIic| Sc|uIicn)
CfIen, wriIing cpIicn:, c|cng wiIh |i:Iing prc: cnc ccn:, ccn Le he|pfu| in ccn:icering
pcIenIic| cpIicn:. WriIing c||cw: ccciIicnc| IhcughI, c: we|| c: c vi:uc| imcge cf cpIicn:.
Feccmmenc IhcI pcIienI: ccn:icer :c|uIicn: in c |cgicc| mcnner, Ihu: recucing Ihe Iime
:penI rumincIing. lI mcy c|:c he|p Ic icenIify ccciIicnc| IhcughI: IhcI mighI LenefiI frcm
chcnge: u:ing Ihe Iechni¢ue:, :uch c: chcnging IhcughI:. ln :cme cc:e:, icenIificcIicn cf
prc:/ccn: mcy re¢uire cLIcining infcrmcIicn frcm cIher pecp|e, :uch c: |cwyer: cr fincncic|
ccvi:cr:.

V {Verifying Ihe 8e:I Sc|uIicn)
Excmine Ihe prc: cnc ccn: cf Ihe :c|uIicn: |i:Iec. FcIienI: mcy wi:h Ic ¨rcnk crcer" Ihe
:c|uIicn: Lc:ec cn which :c|uIicn: cre mc:I prccIicc| cnc/cr ce:ircL|e.

E {EnccIing Ihe F|cn)
lcenIify Ihe :Iep: neecec Ic ccrry cuI Ihe :c|uIicn :e|ecIec. FcIienI: mcy neec Ic Lreck
ccIicn: ccwn inIc :Iep: :mc|| encugh Ic fcci|iIcIe cchievemenI cf gcc|:. Cnce ycu cnc Ihe
pcIienI fini:h fcrmu|cIing c :pecific p|cn, enccurcge Ihe pcIienI Ic ccrry iI cuI.

D {Decicing if Ihe F|cn Wcrkec)
Fc||cw-up wiIh Ihe pcIienI Ic :ee hcw we|| Ihe chc:en :c|uIicn ccIuc||y wcrkec. lf Ihe
:c|uIicn wc: effecIive, give pc:iIive reinfcrcemenI. lf Ihe :c|uIicn wc: ncI effecIive, reIurn Ic
Ihe fir:I :Iep in Ihe SCLVED Iechni¢ue Ic :pecify c new prcL|em cr mcve Ic ¨C" cr ¨L" Ic
icenIify cIher gcc|: cr pcIenIic| :c|uIicn: fcr Ihe :cme prcL|em. Ihe ceci:icn Ic mcve Lcck
cnc Ic which :Iep i: |crge|y up Ic ycu, whc mighI ncw hcve ccciIicnc| infcrmcIicn cLcuI
prc: cnc ccn: cnc pc::iL|e :c|uIicn:.

FrcL|em-Sc|ving Excmp|e:

Ic fcci|iIcIe pcIienI |ecrning, ycu mighI wi:h Ic prcvice excmp|e: cf Ihe SCLVED prcgrcm cI
wcrk. Ihe fc||cwing :ecIicn prcvice: :everc| excmp|e: cf Ihe SCLVED Iechni¢ue.











Exomp|es o| Spec||y|ng the Frob|em |n SOLVED: Common Frob|ems |n Chron|c I||ness
EmcIicnc|/Sccic|/Fe|cIicn:hip FrcL|em:
Mcncging Mccc
Difficu|Iy /:king fcr He|p
Difficu|Iy CcmmuniccIing
McriIc| SIre::
Fcmi|y SIre::
**Ic effecIive|y u:e Ihe SCLVED Iechni¢ue, prcL|em: mcy neec Ic Le mcre :pecific Ihcn Ihc:e
|i:Iec cLcve.
Fhy:icc|/SympIcm FrcL|em:
Cverccming cr Wcrking WiIh Fhy:icc| LimiIcIicn:
MeciccIicn /cherence l::ue:
Ircn:pcrIcIicn cnc McLi|iIy l::ue:
Minimizing lnf|uence cf SympIcm:
Minimizing lnf|uence cf MeciccIicn Sice-EffecI:
óº

Open|ng Your M|nd Ihrough 8ro|nstorm|ng to So|ve Frob|ems through SOLVED


SELECI / SFEClFlC FFC8LEM: Minimizing EffecI

cf SympIcm:
OFEN your MIND to
ALL poss|b|e SOLbIIONS
1. Ic|k Ic ycur cccIcr.
2. Chcnge cr mccify meciccIicn:.
3. Engcge in hec|Ihy |ife chcice:, inc|ucing prcper cieI cnc exerci:e.
4. EcuccIe ycur:e|f Ly Ic|king Ic cIher: cnc Ly reccing cLcuI ycur i||ne::.
5. Exp|cre c|IerncIive IrecImenI:.

SELECI / SFEClFlC FFC8LEM: FcrgeIIing Ic Icke MeciccIicn:

OFEN your MIND to
ALL poss|b|e SOLbIIONS
1. Iurn :everc| c|crm c|cck: cn Ic reminc ycu.
2. FuI ycur meciccIicn in c p|cce ycu wi|| ncIice iI cI Ihe Iime ycu cre :uppc:ec Ic Icke iI.
3. Hcve c frienc cr fcmi|y memLer reminc ycu.
4. 8uy c meciccIicn ci:pen:er Ic he|p ycu rememLer wheIher ycu hcve Icken Ihe meciccIicn.
5. Icke iI cI Ihe :cme Iime every ccy.


CIher excmp|e: cf prcL|em-:c|ving wcrk:heeI: cre |i:Iec cI Ihe enc cf Ihi: mccu|e. Ihe:e
wcrk:heeI: expcnc Ihe ccmmcn prc: cnc ccn: |i:I: Ic he|p c pcIienI ccn:icer mu|Iip|e
per:pecIive: cnc cuIccme: Lefcre mcking c ceci:icn.

Hcmewcrk Excmp|e::
1. CrecIe c |i:I cf pc::iL|e :c|uIicn: Ic ycur icenIifiec prcL|em {Lrcin:Icrm).
2. lmp|emenI ycur icenIifiec :c|uIicn, c::e:: iI effecIivene::, cnc mccify c:
nece::cry.

Supp|emenIc| Feccing:
8eck, J.S. {1ºº5). CcgniIive Ihercpy: 8c:ic: cnc Leycnc. New Ycrk: Gui|fcrc Fre:::
ChcpIer ó.
Ccrmier, W.H. & Ccrmier, L.S. {1ºº1). lnIerviewing :IrcIegie: fcr he|per:: FunccmenIc|
:ki||: cnc ccgniIive Lehcvicrc| inIervenIicn:, 3
rc
ec. Fccific Grcve, C/: 8rcck:/Cc|e
FuL|i:hing Ccmpcny: ChcpIer 13.
70
SOLVED: Frob|em-So|v|ng Exerc|se

pec|||c Frob|em:_________________________________________________
_________________________________________________________________________________________
_______________________________________
pen Ycur Minc i:I
Ic Fc::iL|e Sc|uIicn: FFCS /ND CCNS _____
1.



2.



3.



4.


er||y the best so|ut|on by c|rc||ng your cho|ce.

noct the So|ut|on.

SIep: cnc Iime Frcme cf Sc|uIicn:

1._____________________________________________Iime:_____________

2._____________________________________________Iime:_____________

3._____________________________________________Iime:_____________

ec|de || Your So|ut|on Worked: [ ] YES [ ] NO
71
Fros ond Cons

8ehov|or: _____________________________

Fos|t|ve E||ects o| Do|ng the 8ehov|or Fos|t|ve E||ects o| Not Do|ng the 8ehov|or

Negot|ve E||ects o| Do|ng the 8ehov|or Negot|ve E||ects o| Not Do|ng the 8ehov|or

72

Short-Ierm Fos|t|ve Consequences Long-Ierm Fos|t|ve Consequences
Short-Ierm Negot|ve Consequences Long-Ierm Negot|ve Consequences
73
Modu|e 13: ke|oxot|on

Object|ves
" Ic uncer:Icnc Ihe ccncepI cnc impcrIcnce cf re|cxcIicn in Lrief C8I
" Ic cc¢uire :pecific re|cxcIicn :ki||: {e.g., mu:c|e re|cxcIicn, ceep LrecIhing, imcgery)

Whot ore re|oxot|on techn|ques ond why ore they |mportont?

Fe|cxcIicn Iechni¢ue: ccn:i:I cf c cc||ecIicn cf p:ychcIhercpeuIic Iechni¢ue: ce:ignec Ic
recuce Ien:icn, :Ire::, wcrry, cnc/cr cnxieIy. Fe|cxcIicn Iechni¢ue: vcry in Iheir fccu: {e.g.,
phy:icc| :en:cIicn: cr chcnge: in ccgniIicn/IhcughI:) cnc ccn Le :e|ecIec Lc:ec cn
pre:enIing cifficu|Iie:, c: we|| c: pcIienI preference:. Scme pcIienI: re:pcnc Ic phy:icc|
prccecure: {e.g., mu:c|e re|cxcIicn cnc/cr ceep LrecIhing, whi|e cIher: re:pcnc fcvcrcL|y
Ic guicec imcgery.

Fe|cxcIicn Iechni¢ue: cre impcrIcnI fcr Lrief Ihercpy fcr :everc| rec:cn:. Fir:I, Ihey fccu: cn
:ki||: IhcI c||evicIe :Ire::, cnxieIy, wcrry, cnc Ien:icn IhcI cre cfIen ceLi|iIcIing cnc inIerfere
wiIh pcIienI funcIicning. Seccnc, :Ire::, cnxieIy, wcrry, cnc Ien:icn cre cfIen very
unccmfcrIcL|e fcr pcIienI:, cnc prcvicing he|p Ic c||evicIe Iheir ci:Ire:: ccn gc c |cng wcy
Icwcrc: increc:ing pc:iIive IrecImenI expecIcIicn: cnc rcppcrI. Fe|cxcIicn Iechni¢ue: cre
ec:i|y ccnveyec c: c meIhcc cf increc:ing ccnIrc| cnc cfIen cc ncI inc|uce c cirecI
ci:cu::icn cf menIc| hec|Ih cifficu|Iie:, which ccn Le impcrIcnI fcr :cme pcIienI: whc cre
ccncernec cLcuI menIc| hec|Ih :Iigmc. Finc||y, re|cxcIicn Iechni¢ue: cre generc||y ec:y Ic
Iecch cnc |ecrn. Fcr Ihe:e rec:cn:, iI i: cfIen ccvcnIcgecu: Ic Iecch Ihe:e Iechni¢ue:
ecr|y in IrecImenI Ic give pcIienI: cn ec:y-Ic- |ecrn, yeI high|y effecIive, :ki|| :eI.

When? [Ind|cot|onsJContro|nd|cot|ons}

/: inciccIec, re|cxcIicn Iechni¢ue: cre ¢uiIe effecIive ecr|y in IrecImenI Ic recuce Ien:icn
cnc increc:e ecr|y IrecImenI :ucce::e:. Ihey genercIe increc:ec :e|f-efficccy, perceivec
ccnIrc| cver :Ire::, cnc imprcvec ccping.

Fe|cxcIicn Iechni¢ue: cre u:efu| fcr Lrccc cpp|iccIicn cr fcr c :pecific pcIienI :iIucIicn. /n
excmp|e cf Lrccc cpp|iccIicn: mighI inc|uce cci|y re|cxcIicn exerci:e: Ic recuce cn cverc||
:en:e cf Ien:icn cr :Ire:: ncI cffi|icIec wiIh cny :pecific :iIucIicn {e.g., generc| wcrry cr
cpprehen:icn). Fe|cxcIicn ccn c|:c Le cpp|iec Ic :pecific :iIucIicn: :uch c: c neec|e
phcLic, :ccic| cnxieIy, cr :Ire::cr: cI wcrk.

Fe|cxcIicn prccecure: ccn c|:c Le cpprcpricIe fcr per:cn: wiIh cepre::ive :ympIcm: Ic
increc:e Iheir percepIicn: cf ccnIrc|. Hcwever, iI mighI ncI Le cpprcpricIe fcr cepre::ive
:ympIcm: cccurring cuI:ice ccmcrLic cnxieIy/wcrry. Fcr excmp|e, Iecching c :evere|y
cepre::ec per:cn, whc i: experiencing fcIigue cnc |cck cf mcIivcIicn, Ic re|cx wcu|c ncI
Le u:efu| un|e:: Ihe pcIienI hc: c :pecific neec fcr re|cxcIicn.

How? [Instruct|onsJHondouts}

Fegcrc|e:: cf Ihe ccIuc| re|cxcIicn Iechni¢ue, iI i: impercIive IhcI Ihe phy:icc| envircnmenI
Le cIIencec Ic :c c: Ic mcximize re:u|I:. 8efcre Leginning re|cxcIicn Iechni¢ue:, iI i:
:ugge:Iec IhcI ycu crecIe c :cfe, ¢uieI, cnc ccmfcrIcL|e envircnmenI. Ycu cre
enccurcgec Ic wcrk wiIh pcIienI: Ic crecIe :uch cn envircnmenI. FcIienI: mcy Le
74
ccmfcrIcL|e wiIh cerIcin reccmmenccIicn: {e.g., unfc|cing crm:) LuI mcy Le uncerIcin cr
unccmfcrIcL|e wiIh cIher: {e.g., c|c:ing Iheir eye:). Ihe fc||cwing |i:I cf cpIicn: ccn Le u:ec
Ic crecIe cn effecIive cImc:phere fcr re|cxcIicn-Lc:ec inIervenIicn:.

SeIIing up Ihe rccm:
" CcmfcrIcL|e chcir {c high-Lcckec chcir Ic :uppcrI Ihe pcIienI´: neck, if pc::iL|e)
" Scfe cnc re|cxing rccm {e.g., IempercIure, nci:e, cnc |ighIing)












Ihe fc||cwing :ecIicn: cf Ihi: mccu|e cccre::e: Ihree :pecific Iechni¢ue:: prcgre::ive
mu:c|e re|cxcIicn, ceep LrecIhing, cnc imcgery. Ycu |crge|y ceIermine :e|ecIicn cf c
:pecific Iechni¢ue, LuI ycu :hcu|c :e|ecI iI wiIh Ihe pcIienI': expre::ec inIere:I: cnc
|ecrning preference:/cLi|iIie: in minc. Fcr excmp|e, pcIienI: whc cre |crge|y :cmcIicc||y
fccu:ec mcy prefer mu:c|e re|cxcIicn cr ceep LrecIhing. CIher pcIienI:, e:pecic||y Ihc:e
whc cpprecicIe Ihe c::ccicIicn LeIween IhcughI: cnc mccc, mighI Le Le:I :ervec u:ing
guicec imcgery prccecure:. Hcwever, Ihe u|IimcIe ceci:icn cf which prccecure Ic u:e
mcy re|cIe Ic expc:ure Ic c|| Ihree Iechni¢ue: cnc c Iric|-cnc-errcr cpprccch.

Frcgre::ive Mu:c|e Fe|cxcIicn {FMF)
FMF ccn:i:I: cf |ecrning hcw Ic Ien:e cnc Ihen re|cx vcricu: grcup: cf mu:c|e: c|| Ihrcugh
Ihe Lccy in c :e¢uenIic| fc:hicn, whi|e pcying c|c:e cIIenIicn Ic Ihe fee|ing: c::ccicIec
wiIh LcIh Ien:icn cnc re|cxcIicn. /|Ihcugh mu:c|e re|cxcIicn hc: Leen crcunc fcr mcny
yecr:, iI hc: Leccme mcre pcpu|cr recenI|y fcr cec|ing wiIh cifferenI cnxieIy cnc pcnic
ci:crcer:. WiIh Ihi: prccecure, Ihe pcIienI |ecrn: hcw Ic re|cx cnc hcw Ic reccgnize cnc
pinpcinI Ien:icn cnc re|cxcIicn in Ihe Lccy Ic icenIify Ien:icn cnc recuce iI: inf|uence
Lefcre ecch recche: high |eve|:/impcirmenI.

ln Iecching pcIienI: mu:c|e re|cxcIicn, ycu :hcu|c fir:I exp|cin Ihe rec:cn fcr u:ing mu:c|e
re|cxcIicn cnc hcw iI wi|| LenefiI Ihe pcIienI {rcIicnc|e). Ycu :hcu|c c|:c give c fu||
exp|cncIicn cnc cemcn:IrcIicn cf hcw iI i: ccne.

SIep ¬1: FMF lncrec:e: CcnIrc|.
lnIrccuce FMF princip|e: cnc prccecure:. FMF Legin: Ly |eIIing Ihe pcIienI kncw IhcI
he/:he ccn crecIe :en:cIicn: cf re|cxcIicn cnc IhcI Ihi: prcce:: cf ¨incucing" re|cxcIicn
Legin: Ly Leing cL|e Ic icenIify cnc ci:crimincIe LeIween :en:cIicn: cf Ien:icn cnc
re|cxcIicn.

SIep ¬2: NcIe Ihe lnccngruence cf Ien:icn cnc Fe|cxcIicn.
lnfcrm Ihe pcIienI IhcI :en:cIicn: cf Ien:icn cnc re|cxcIicn ccnncI cccur cI Ihe :cme Iime.
Nc mu:c|e: in Ihe Lccy ccn Le Ien:ec cnc re|cxec cI Ihe :cme Iime. Ihi: princip|e i:
Other t|ps to |ncreose stress-monogement e||ect|veness |nc|ude:
" Hcving Ihe pcIienI |cc:en IighI c|cIhing {cc||cr:, Le|I:, :hce:, eIc) cr remcve
g|c::e:
" Hcving Ihe pcIienI :iI in c ccmfcrIcL|e fc:hicn {e.g., uncrc::ing crm: cnc |eg:,
p|ccing feeI f|cI cn Ihe f|ccr)
" Dimming Ihe |ighI: cr remcving LrighI :un:hine frcm Ihe rccm
" Hcving Ihe pcIienI c|c:e hi: cr her eye:
" /:king Ihe pcIienI wheIher he cr :he neec: c LcIhrccm Lreck Lefcre :IcrIing
" /:king Ihe pcIienI Ic c|ecr Ihe minc cnc fccu: cn ycur vcice cnc in:IrucIicn:

75
criIicc|, cnc ycu :hcu|c en:ure IhcI pcIienI: fu||y uncer:Icnc hcw Ihi: cpp|ie: Ic Iheir currenI
cifficu|Iie:.

SIep ¬3: lcenIify SIcIe: cf Ien:icn.
Exp|cin Ic Ihe pcIienI IhcI Ien:icn cfIen Lui|c: grccuc||y wiIhcuI ccn:cicu: cwcrene::.
Lecrning Ic ceIecI Ihe iniIic| :ign: cf cn increc:e i: cn impcrIcnI :Iep Icwcrc: cvcicing c
fu||- L|cwn cccurrence cf Ien:icn. lnfcrm Ihe pcIienI IhcI, nc mcIIer Ihe |eve| cf inIen:iIy, he
cr :he ccn :Icp cnc rever:e Ihe Ien:icn u:ing kncw|ecge cf FMF - in e::ence, iI i: never Icc
|cIe Ic recuce Ien:icn. Cver Iime pcIienI: Leccme increc:ing|y :ki||ec cI icenIifying :Ire::
ecr|ier cnc ecr|ier {e.g., Iheir cwcrene:: increc:e:).

SIep ¬4: Ien:e Mu:c|e Grcup:.









A br|e| word o| cout|on: I| ot ony po|nt dur|ng the techn|que o pot|ent exper|ences
po|n, o|ter or comp|ete|y d|scont|nue the techn|que. I| the pot|ent exper|ences
chron|c po|n |n ony port o| the body, |t |s best to ovo|d the tens|ng component |or
musc|es |n thot oreo; just do the re|ox|ng component when the pot|ent gets to those
musc|e groups.
FMF c:k: Ihe pcIienI Ic Ien:e cnc re|ec:e cifferenI mu:c|e grcup: in :e¢uence, mcving
frcm Ihe crm: Ic Ihe fcce, neck, che:I cnc :hcu|cer:, Icr:c, cnc |eg:. Fcr ecch :pecific
mu:c|e grcup, iI´: impcrIcnI Ic Iry Ic Ien:e cn|y IhcI mu:c|e grcup curing Ihe Ien:ing pcrI cf
Ihe exerci:e. IhrcughcuI Ihe prccecure, iI i: impcrIcnI Ic ccncenIrcIe cn Ihe :en:cIicn:
prccucec Ly Ihe cifferenI exerci:e:. /:king Ihe pcIienI Ic ce:criLe Lcci|y :en:cIicn: i: very
impcrIcnI fcr Ihe |ecrning prcce::. SIcIemenI: cr phrc:e: frcm ycu mighI inc|uce: ¨WhcI
cre ycu ncIicing cLcuI ycur Lccy righI ncw°" Ihe:e ¢ue:Iicn: he|p Ihe pcIienI Ic fccu: cn
Ihe wcy Ihe Lccy ¨fee|:" when Ien:e cnc re|cxec.

Ien:ing ln:IrucIicn:
Mcce| ecch Ien:icn prccecure. /:k Ihe pcIienI Ic prccIice, cnc prcvice feecLcck. Check
Ic Le :ure IhcI Ihe pcIienI ccn icenIify Ien:icn in ecch grcup Lefcre mcving cn Ic Ihe nexI.

c. DcmincnI crm. Mcke c fi:I cnc Ien:e Licep:: pu|| wri:I upwcrc, whi|e pu:hing
e|Lcw ccwn cgcin:I Ihe crm cf chcir cr Lec.
L. NcnccmincnI crm. Scme c: cLcve.
c. Fcrehecc, |cwer cheek: cnc jcw. LifI eyeLrcw: c: high c: pc::iL|e, LiIe IeeIh
IcgeIher, cnc pu|| ccrner: cf mcuIh IighI|y.
c. Neck cnc IhrccI. Fu|| chin ccwn Icwcrc che:I: cI Ihe :cme Iime, Iry Ic prevenI
iI frcm ccIuc||y Icuching Ihe che:I. CcunIerpc:e mu:c|e: in frcnI pcrI cf neck
cgcin:I Ihc:e in Ihe Lcck pcrI cf neck.
e. Shcu|cer:, che:I, cnc upper Lcck/cLccmen. Icke c ceep LrecIh cnc hc|c iI.
/I Ihe :cme Iime, pu|| Ihe :hcu|cer L|cce: Lcck cnc IcgeIher, Irying Ic mcke
Ihem Icuch. Iry Ic keep ycur crm: c: re|cxec c: pc::iL|e whi|e Ien:ing Ihi:
mu:c|e grcup. /I Ihe :cme Iime mcke Ihe :Icmcch hcrc Ly pre::ing iI cuI, c: if
:cmecne were gcing Ic hiI ycu in Ihe :Icmcch.
f. DcmincnI |eg. LifI fccI cff Ihe f|ccr cnc pu:h ccwn cn Ihe chcir wiIh Ihigh.
g. NcnccmincnI |eg. Scme c: cLcve.


SIep ¬5: DeLrief /fIer Ihe Exerci:e.
/fIer re|cxcIicn Ircining, ¢ue:Iicn Ihe pcIienI cLcuI hi: cr her reccIicn Ic Ihe mu:c|e-
re|cxcIicn exerci:e. lI i: c|:c impcrIcnI Ic mcke cny ccju:ImenI: neecec Ic Ihe Ircining.
McniIcr cny pcin Ihe pcIienI experiencec Ic cccpI cnc imprcve Ihe Iechni¢ue fcr Ihe
incivicuc| pcIienI´: neec:.

SIep ¬ó: CcnIinue Ic FrccIice CuI:ice Se::icn.
lI wi|| Le impcrIcnI fcr Ihe pcIienI Ic prccIice FMF cI |ec:I cnce c ccy cver Ihe fir:I week cr
Iwc Ic Lui|c :ki||: cnc ccnficence. /: he cr :he Leccme: increc:ing|y :ki||ec cI FMF, he/:he
mighI finc iI pc::iL|e Ic re|cx wiIhcuI hcving Ic ccIive|y Ien:e Ihe mu:c|e:. Ihe pcIienI
:hcu|c u:e regu|cr|y :checu|ec hcmewcrk Ic prccIice in c ncnci:IrccIing envircnmenI.
When he cr :he hc: |ecrnec Ic re|cx in c cc|m envircnmenI, iI :hcu|c Le ec:ier Ic re|cx in
mcre ci:IrccIing :iIucIicn:, whenever he cr :he ncIice: Ien:icn ceve|cping.

Deep-8recIhing Iechni¢ue
/ncIher phy:ic|cgicc|-Lc:ec re|cxcIicn Iechni¢ue i: ceep LrecIhing. Deep LrecIhing
fccu:e: cn recucing rcpic cnc :hc||cw {ineffecIive) LrecIhing IhcI cfIen cccur: curing
pericc: cf :Ire::, wcrry, cr cnxieIy. Fcpic cnc :hc||cw LrecIh: ccn |ecc Ihe pcIienI Ic hcve
cecrec:ec cxygen in Ihe :y:Iem, which ccn ccu:e hypervenIi|cIicn, cizzine::,
|ighIheccecne::, cr cecrec:ec cLi|iIy Ic ccncenIrcIe. /|IerncIive|y, Icking c ceep, fu||
LrecIh ccn prccuce c fee|ing cf cc|mne:: cr :|cwing Ly increc:ing cxygen rich L|ccc f|cw.
8y c:king Ihe pcIienI Ic cIIenc Ic LrecIhing cnc chcnging Ihe rcIe cnc wcy he cr :he
LrecIhe:, ycu encL|e him cr her Ic Le cL|e Ic fee| mcre re|cxec cnc funcIicn mcre -rich
L|ccc,) c: we|| c: Ihe minc {fee|ing: cf cc|mne::). lI ccn c|:c :IrengIhen mu:c|e: in Ihe
che:I cnc :Icmcch, which ccn mcke iI ec:ier Ic LrecIhe cn c cci|y Lc:i:.
SIep: Ic Deep 8recIhing
SIep ¬1: lnIrccuce Ihe pcIienI Ic Deep 8recIhing. lnciccIe why Deep 8recIhing wc:
chc:en cnc prcvice cn cverview cf Ihe prccecure: cnc pcIenIic| LenefiI:.
SIep ¬2: /:k Ihe pcIienI Ic puI cne hcnc cn Ihe cLccmen, wiIh Ihe |iII|e finger cLcuI 1
inch cLcve Ihe ncve|, cnc Ic p|cce cne hcnc cn Ihe che:I.
SIep ¬3: /:k Ihe pcIienI Ic pcy cIIenIicn Ic hi: cr her LrecIhing {pcu:e fcr :everc| :eccnc:
Ic c||cw Ihe pcIienI Ihe cppcrIuniIy Ic c::e:: LrecIhing) cnc c:k him/her Ic Ie|| ycu which
hcnc i: ccing mcre cf Ihe mcving° lcec||y, Ihe hcnc cn Ihe cLccmen :hcu|c Le mcving:
whi|e Ihe hcnc cver Ihe che:I remcin: :Ii||. Ihi: en:ure: IhcI Ihe LrecIh: cre ceep.
SIep ¬4: Wcrk wiIh Ihe pcIienI Ic Icke ceeper LrecIh: Ly geIIing Ihe hcnc cver Ihe
:Icmcch Ic mcve whi|e hcving |iII|e mcvemenI cf Ihe hcnc cver Ihe che:I. lnfcrm Ihe
pcIienI, "Ycur hcnc cn ycur cicphrcgm :hcu|c mcve cuI c: ycu inhc|e cnc in c: ycu
exhc|e."



SIep ¬5: /:k Ihe pcIienI Ic ccnIinue :|cw, even, ceep LrecIh:. Ic pcce Ihe pcIienI, ycu
mighI :ugge:I IhcI he/:he :cy Ihe wcrc: "# cnc &2/ :|cw|y, whi|e Icking LrecIh:. lnhc|cIicn:
cnc exhc|cIicn: :hcu|c Lui|c Ic cpprcximcIe|y 3 :eccnc: in curcIicn.
NOIE: lf Ihe pcIienI hc: c |ung cr hecrI ccnciIicn, he/:he mighI hcve cifficu|Iy
wiIh ceep LrecIhing. lf he/:he repcrI: cifficu|Iy, :|cw Ihe prcce:: ccwn cnc
he|p him/her Ic mcximize Ihe exerci:e ccmfcrIcL|y.
77
SIep ¬ó: /:k Ihe pcIienI if he cr :he ncIice: cny chcnge: in LrecIhing cnc fee|ing: cf
re|cxcIicn. /:k fcr generc| feecLcck cLcuI Ihe Iechni¢ue.
SIep ¬7: FepecI Ihe LrecIhing exerci:e Ihree cr mcre Iime: unIi| Ihe pcIienI repcrI: :ki||
uncer:Icncing cnc LenefiI.
SIep ¬8: /:k Ihe pcIienI if he cr :he ccn icenIify :iIucIicn: when ceep LrecIhing mighI Le
cpprcpricIe.
SIep ¼: CcnIinue prccIice cuI:ice cf :e::icn. Wcrk wiIh Ihe pcIienI Ic :eI c hcmewcrk
c::ignmenI IhcI enccurcge: cpp|iccIicn cf ceep LrecIhing Ic :iIucIicn: when Ihe pcIienI
fee|: :Ire::.









lmcgery
lmcgery i: c ncnphy:ic|cgicc| {ccgniIive) re|cxcIicn Iechni¢ue IhcI ccn Le u:ec Ic ec:e
:Ire:: cnc prcmcIe cn cverc|| :en:e cf we||-Leing. lmcgery fccu:e: cn increc:ing ccgniIive,
emcIicnc|, cnc phy:icc| ccnIrc| Ly chcnging Ihe fccu: cf cn incivicuc|´: IhcughI:. We c||
hcve ccycrecmec cLcuI p|ec:cnI Ihing: IhcI hcve ci:IrccIec u: cnc mcce u: fee| LeIIer.
lmcgery u:e: much Ihe :cme prcce:: LuI enccurcge: pc:iIive cccpIive ¨crecming" IhcI
ci:IrccI: cnc re|cxe: Ihe incivicuc|. lmcgery i: high|y effecIive fcr cepre::icn cnc cnxieIy, c:
we|| c: :pecific :iIucIicn: IhcI re¢uire c|criIy, fccu:, ci:IrccIicn, cr fee|ing: cf mc:Iery. Ihe
fc||cwing cre excmp|e::
Other t|ps |or deep breoth|ng:
1) lnhc|e Ihrcugh nc:e cnc cuI cf mcuIh.
2) /:k pcIienI Ic pur:e |ip: {c: if L|cwing cn hcI :cup) whi|e exhc|ing.
3) Dc ncI pcu:e LeIween inhc|e: cnc exhc|e:.
4) /:k pcIienI Ic c|c:e eye: curing Ihe exerci:e.
5) FcIienI mcy wcnI Ic u:e mcnIrc :uch c: ¨re|cx" curing ecch exhc|e.
ó) Fcir up ceep LrecIhing wiIh imcgery cnce Ihe pcIienI hc: Legun Ic
mc:Ier LrecIhing :ki||:.
"# FcinI cuI IhcI ceep LrecIhing i: c pcrIcL|e :ki|| IhcI ccn Le u:ec in c
vcrieIy cf :iIucIicn: cnc re|cIive|y wiIhcuI ncIice cf cIher: {FMF i: |e::
pcrIcL|e).
Iop|c Focused Iop|c Imoge Outcome
Depre::icn NegcIive
wcrIh
Se|f- lmcge: cf :ucce:: cr
:iIucIicn: cf :ucce:::
cf c p|ec:cnI pc:I
experience
pc:I
imcge:
lncrec:ec :e|f-ccnficence:
recucec negcIive IhcughI::
ci:IrccIicn frcm negcIive
mccc
/nxieIy/Wcrry FuL|ic Specking lmcge cf :peech IhcI gce:
we||: imcge cf :cmeIhing
funny
Fecucec negcIive fccu:,
ci:IrccIicn, increc:ec pc:iIive
expecIcIicn:
Mecicc|
/nxieIy
Fecr cf
Frccecure
neec|e:)
{e.g.,
Fe|cxcIicn: peccefu|ne:::
pcin-free envircnmenI
Le:: Ien:icn, recucec cnxieIy,
Ic|ercIicn cf prccecure wiIh
|e:: ci:Ire::
SpcrI:
Ferfcrmcnce
Fccu:ec effcrI:
curing gc|f
gcme
Envi:icning Ihe ce:irec :hcI:
pc:iIive wcrc: cf ccvice
lncrec:ec fccu:,
:e|f-ccnficence,
Ihinking
increc:ec
pc:iIive
78
Hcw Guicec lmcgery Wcrk:
Fe:ecrch hc: :hcwn IhcI Ihe minc ccn ccIuc||y cffecI hcw Ihe Lccy funcIicn:. lI :eem: Ihe
Lccy mcy ncI kncw Ihe cifference LeIween cn ccIuc| evenI cnc c IhcughI. Guicec
imcgery u:e: Ihe pcwer cf Ihe Lrcin-imcge: cnc Ihe percepIicn IhcI ycu cre eiIher
:cmewhere e|:e cr in c cifferenI :IcIe cf minc-Ic increc:e p|ec:cnI experience: cnc
perfcrmcnce Ic prcmcIe we||ne:: cnc hec|Ih. Cn Ihe f|ip :ice, imcgery he|p: Ic recuce
:Ire:: Ien:icn cnc cnxieIy Ly chcnging IhcughI: cnc emcIicn: cr Ihrcugh ci:IrccIicn.
lmcgery i: ccmmcn|y referrec Ic c: guicec imcgery. Guicec imcgery refer: Ic c prcce::
whereLy ycu fcci|iIcIe: cr guice Ihe iniIic| imcge: Ihe pcIienI u:e:. Ihe fc||cwing :ecIicn
ce:criLe: hcw ycu ccn guice Ihe pcIienI inIc Ihe effecIive u:e cf imcgery fcr re|cxcIicn cr
perfcrmcnce imprcvemenI.
SIep ¬1: lnIrccuce lmcgery.
lnIrccuce imcgery Ic Ihe pcIienI, pcinIing cuI Ihe pcwer cf Ihe Lrcin cr IhcughI: cnc hcw
imcge:, when ccce::ec ccrrecI|y, ccn ccIuc||y chcnge phy:icc| cnc emcIicnc| :IcIe:.
SIep ¬2: lcenIify Ihe De:irec CuIccme:, Such c: Decrec:ec /nxieIy, lncrec:ec Fccu:,
Di:IrccIicn.
SIep ¬3: Deve|cp cn lmcge cr Scene.
Wcrk wiIh Ihe pcIienI cn Ihe Ihirc :Iep Ic icenIify c :iIucIicn, eiIher in Ihe pc:I cr c p|cce
he/:he wcu|c |ike Ic Le, IhcI LcIh ycu cnc Ihe pcIienI fee| mighI LenefiI cr prccuce Ihe
ce:irec cuIccme. Scmp|e imcgery :cripI: cre prcvicec Le|cw cnc ccn Le u:ec if Ihe
pcIienI hc: cifficu|Iy crecIing c per:cnc| :iIucIicn. Se|ecIicn cf c pcwerfu| imcge i: criIicc|
Ic Ihe :ucce:: cf Ihi: Iechni¢ue. Se|ecIicn cf cn imcge IhcI Ihe pcIienI i: cL|e Ic fu||y
emLrcce increc:e: Ihe ccc: cf IrecImenI :ucce::. Se|ecIicn cf c ¨weck" imcge {e.g., ncI
viewec c: impcrIcnI Ly Ihe pcIienI cr uncL|e Ic Le fu||y vi:uc|izec) wi|| |ike|y |ecc Ic
IrecImenI fci|ure.
SIep ¬4: lncrec:e Vivicne:: cf Ihe lmcge.
Ic en:ure IhcI pcIienI: finc c ¨:Ircng" imcge, c:k Ihem Ic exp|cre c: mcny :en:e: c:
pc::iL|e Ic increc:e vivicne:: cf Ihe imcge. Fcr excmp|e, when imcgining c g|c:: cf
|emcncce, imcgine hc|cing c g|c:: IhcI fee|: icy cnc cc|c, vi:uc|ize Ihe cc|cr cf Ihe
|emcncce, Ihink cf Ihe fre:h ciIru: :me||, cnc finc||y Ihink cf hcw Ihe |emcncce Ic:Ie:. Ihi: i:
cn excmp|e cf imcgery IhcI u:e: mu|Iip|e :en:e: cnc increc:e: vivicne:: cf Ihe imcge.
lncrec:ing vivicne:: i: |crge|y c mcIIer cf increc:ing Ihe ceIci|: Ihe pcIienI experience:. Ihe
mcre ceIci|: ce:criLec Ly Ihe pcIienI, Ihe mcre pcwerfu| Ihe Iechni¢ue.
SIep ¬5: /:k Ihe FcIienI if He cr She NcIice: /ny Chcnge: /fIer Ihe lmcgery Exerci:e. /:k
fcr generc| feecLcck cLcuI Ihe Iechni¢ue.
SIep ¬ó: FepecI Ihe lmcgery Exerci:e UnIi| Ihe FcIienI FepcrI: Ski|| Uncer:Icncing cnc
8enefiI.
SIep ¬7: /:k Ihe FcIienI Ic lcenIify SiIucIicn: When lmcgery MighI 8e /pprcpricIe. Expcnc
upcn Ihe pcIienI´: re:pcn:e: Ly cccing cIher :iIucIicn: {e.g., hcw Ihe Iechni¢ue ccn Le
u:ec).
SIep ¬8: CcnIinue FrccIice CuI:ice Se::icn. Wcrk wiIh Ihe pcIienI Ic :eI c hcmewcrk
c::ignmenI IhcI enccurcge: cpp|iccIicn cf imcgery Ic :iIucIicn: when Ihe pcIienI fee|:
:Ire:: cr fee|: IhcI imcgery mighI Le Leneficic|.








































Other t|ps |or |mogery:
1) Fcir up imcgery wiIh ceep-LrecIhing exerci:e:.
2) /:k pcIienI Ic c|c:e eye: curing Ihe exerci:e Ic increc:e vivicne::.
3) lnIerjecI curing Ihe imcgery experience c:pecI: IhcI ycu fee| mighI
LenefiI Ihe pcIienI. Fcr excmp|e, c pcIienI mighI u:e Ihe Lecch imcge:
cnc ycu mighI c:k hcw Ihe :un fee|: cn Ihe :kin, wheIher he cr :he hecr:
cnyIhing, cr whcI e|:e he cr :he :ee:.
4) He|p Ihe pcIienI fccu: cn c:pecI: cf Ihe imcge IhcI wi|| guice him/her
Icwcrc: Ihe gcc|. He|p Ihe pcIienI Ic cvcic Icc mcny unnece::cry
ceIci|: IhcI mighI ci:IrccI frcm Ihe gcc|.
5) FcinI cuI IhcI imcgery i: c pcrIcL|e :ki|| IhcI Ihe pcIienI ccn u:e in c
vcrieIy cf :iIucIicn: cnc ccmp|eIe|y wiIhcuI ncIice cf cIher: {FMF i: |e::
pcrIcL|e).
ó) /vcic imcgery wiIh p:ychcIic pcIienI:, whc mighI ccnfu:e rec|iIy wiIh
imcge:.

lmcgery: Excmp|e ScripI:/Guice: fcr Ihercpi:I:
I6)"8/ JK9 A(#()"6 LD-*84(

Cnce ycur whc|e Lccy fee|: re|cxec, Ircve| Ic ycur fcvcriIe p|cce. iI ccn Le
cny Iime pericc cr cny p|cce. Ihi: p|cce i: cc|m cnc :cfe. Ihere cre nc wcrrie:
here. Lcck crcunc Ihi: p|cce. WhcI cc ycu :ee° Dc ycu hecr Ihe :cunc:
crcunc ycu° WhcI cre :cme cf Ihe :cunc: ycu hecr in Ihi: p|cce ycu cre
imcgining° Hcw cce: Ihi: :pecic| p|cce :me||° Wc|k crcunc c |iII|e, cnc Icke in
c|| Ihe wcncerfu| :ighI:. Fee| Ihe cir crcunc ycu cnc re|cx.. Ihe cir i: fre:h,
cnc iI´: ec:y Ic LrecIhe here. Fcy cIIenIicn Ic hcw ycur Lccy fee|:... Scy Ic
ycur:e|f, ¨l cm IcIc||y re|cxec. wiIhcuI wcrrie:. c|| Ihe Ien:icn hc: crcinec
cwcy frcm my Lccy." Icke c mcmenI Ic fu||y experience ycur fcvcriIe p|cce..
NcIice Ihe :cunc:, Ihe :ighI:, :me||:, cnc hcw iI fee|: Ic Le in Ihi: very :pecic|
p|cce. FememLer IhcI ycu ccn vi:iI Ihi: p|cce c: cfIen c: ycu wcnI cnc IhcI iI i:
wcncerfu|. Scy Ic ycur:e|f, ¨l cm re|cxec here. Ihi: p|cce i: :pecic| cnc mcke:
me fee| cI pecce.

When ycu cre ccne wiIh ycur vi:iI Ic Ihi: :pecic| p|cce, cpen ycur eye: cnc :Icy
in ycur ccmfcrIcL|e pc:iIicn. CcnIinue Ic LrecIhe :mccIh|y, in c re|cxec cnc
rhyIhmic fc:hicn. Icke c: |cng c: ycu wcnI Ic enjcy cnc re|cx. Fee| cI ec:e
kncwing ycur :pecic| p|cce i: c|wcy: cvci|cL|e Ic ycu, cnc finc IhcI ycu fee|
re|cxec, even cfIer ycu |ecve.
80

















































I6)"8/ JM N O,( :(-6,9

lmcgine ycur:e|f wc|king ccwn c :cncy Lecch. Ihe :cnc i: whiIe cnc wcrm LeIween
ycur Ice:. Ycu cre |ccking cuI cver Ihe cc|m, L|ue wcIer. Ihe wcve: cre genI|y |cpping
cI Ihe :hcre. Ycu fee| Ihe p|ec:cnI wcrmIh cf Ihe :un cn ycur :kin. iI´: c perfecI|y
ccmfcrIcL|e IempercIure cuI:ice. 8recIhe in ceep|y. Ihere i: c genI|e Lreeze, cnc Ihe
:un i: :hining. 8ig, ccIIcn-|ike c|cuc: crifI Ly c: ycu hecr :ec gu||: in Ihe ci:Icnce. Ycu
Ic:Ie Ircce: cf :c|I cn ycur |ip:. Ycu cre ccmp|eIe|y re|cxec. Ihere cre nc wcrrie: cn Ihi:
Lecch. Ihere i: ncIhing Ic ci:IrccI ycu frcm fee|ing Ircn¢ui|. Wcrrie: crifI cwcy. NcIice
Ihe :cunc:, :ighI:, :me||:, cnc hcw iI fee|: Ic Le in Ihi: very :pecic| p|cce.
Fee| Ihe :cnc uncer ycur feeI. ycu cecice Ic :IreIch cuI cn Ihe wcrm, fine, whiIe
:cnc. LrecIhe ceep|y. fee| Ihe wcrm cir. Ycur Lccy i: ccmp|eIe|y re|cxec, cnc ycu
hcve cn cverc|| fee|ing cf wcrmIh cnc ccmfcrI. Ycu |cck up cI Ihe c|cuc: pc:: Ly :|cw|y
ccrc:: Ihe LecuIifu| L|ue :ky. Ycu cre fee|ing rejuvencIec cnc ccmp|eIe|y cI pecce.
FememLer IhcI ycu ccn vi:iI Ihi: p|cce c: cfIen c: ycu wcnI cnc IhcI iI i: wcncerfu|. Scy
Ic ycur:e|f, ¨l cm re|cxec here. Ihi: p|cce i: :pecic| cnc mcke: me fee| peccefu| cnc
ccnIenI."
When ycu cre ccne wiIh ycur vi:iI, cpen ycur eye: cnc :Icy in ycur ccmfcrIcL|e
pc:iIicn. CcnIinue Ic LrecIhe :mccIh|y, in c re|cxec cnc rhyIhmic fc:hicn: Icke c: |cng
c: ycu wcnI Ic enjcy cnc re|cx. Ycu fee| cI ec:e kncwing ycur :pecic| p|cce i: c|wcy:
cvci|cL|e Ic ycu, cnc ycu finc IhcI ycu fee| re|cxec even cfIer ycu |ecve.
I6)"8/ J? N O,( !(-$&0;9

lmcgine ycur:e|f wc|king Ihrcugh c |cve|y mecccw. Ihe Lreeze fee|: p|ec:cnI cgcin:I
ycur :kin. Ycu cre |ccking cuI cver Ihe cc|m, LecuIifu| green grc::. Ihe L|cce: cf grc::
cre genI|y :wcying in Ihe Lreeze. Ycu fee| Ihe p|ec:cnI wcrmIh cf Ihe :un cn ycur :kin.
iI´: c perfecI|y ccmfcrIcL|e IempercIure cuI:ice. 8recIhe in ceep|y. Ihere i: c genI|e
Lreeze, cnc Ihe :un i: :hining. 8ig, ccIIcn-|ike c|cuc: crifI Ly c: ycu hecr Lirc: in Ihe
ci:Icnce. Ycu hecr Ihe winc L|cw genI|y Ihrcugh Ihe Iree:. Ycu Ic:Ie Ihe :weeI :ummer
cir cn ycur |ip:. Ycu cre ccmp|eIe|y re|cxec. Ihere cre nc wcrrie: in Ihi: mecccw. Ihere
i: ncIhing Ic ci:IrccI ycu frcm fee|ing Ircn¢ui|. Wcrrie: crifI cwcy. NcIice Ihe :cunc:, Ihe
:ighI:, Ihe :me||:, cnc hcw iI fee|: Ic Le in Ihi: very :pecic| p|cce.
Fee| Ihe ccc| grc:: uncer ycur feeI. ycu cecice Ic :IreIch cuI cn Ihe :cfI, cu:hicny
grc::. LrecIhe ceep|y. fee| Ihe wcrm cir. Ycur Lccy i: ccmp|eIe|y re|cxec, cnc ycu
hcve cn cverc|| fee|ing cf wcrmIh cnc ccmfcrI. Ycu |cck up c: Ihe c|cuc: pc:: Ly :|cw|y
ccrc:: Ihe LecuIifu| L|ue :ky. Ycu cre fee|ing rejuvencIec cnc ccmp|eIe|y cI pecce.
FememLer IhcI ycu ccn vi:iI Ihi: p|cce c: cfIen c: ycu wcnI cnc IhcI iI i: wcncerfu|. Scy
Ic ycur:e|f, ¨l cm re|cxec here. Ihi: p|cce i: :pecic| cnc mcke: me fee| peccefu| cnc
ccnIenI."
When ycu cre ccne wiIh ycur vi:iI, cpen ycur eye: cnc :Icy in ycur ccmfcrIcL|e pc:iIicn.
CcnIinue Ic LrecIhe :mccIh|y, in c re|cxec cnc rhyIhmic fc:hicn: Icke c: |cng c: ycu
wcnI Ic enjcy cnc re|cx. Ycu fee| cI ec:e kncwing ycur :pecic| p|cce i: c|wcy: cvci|cL|e
Ic ycu, cnc ycu finc IhcI ycu fee| re|cxec even cfIer ycu |ecve.

81















lmcgery: IrcuL|e:hccIing cnc Iip:
Dc ncI u:e imcgery wiIh p:ychcIic pcIienI:.

Supp|emenIc| Feccing:
Ccrmier, W.H. & Ccrmier, L.S. {1ºº1). lnIerviewing :IrcIegie: fcr he|per:: FunccmenIc|
:ki||: cnc ccgniIive Lehcvicrc| inIervenIicn:, 3
rc
ec. Fccific Grcve, C/: 8rcck:/Cc|e
FuL|i:hing Ccmpcny: ChcpIer: 1ó {pg: 514-52º), 15 cnc 12.

Hcmewcrk /::ignmenI Excmp|e:
1. FrccIice FMF Lefcre ycu gc Ic Lec ecch nighI Ihi: week.
2. /IIempI ycur ceep-LrecIhing exerci:e curing c :Ire::fu| Iime Ihi: week.
3. CrecIe ycur cwn per:cnc| guicec imcgery :cripI, cnc cIIempI Ic u:e iI Ihi: week.
8ring iI Ic Ihe nexI :e::icn.
CIher Guicec lmcgery Scene Sugge:Iicn::

! / gcrcen where ycu wcIch Lig, LecuIifu| c|cuc: in c L|ue :ky, whi|e ycu
inhc|e Ihe :cenI cf f|cwer: cnc fee| c genI|e Lreeze cn ycur :kin c: Ihe
:un:hine wcrm: ycu.

! / mcunIcin :cene where ycu fee| cc|m cnc re|cxec c: ycu |cck cuI cver Ihe
vc||ey. Ju:I ycu cnc Ihe vegeIcIicn cnc ycu cip ycur feeI inIc c ccc|
mcunIcin :Irecm: cnc |eI ycur fccI re:I cn c Lig, :|ippery :Icne c: Ihe :un:hine
wcrm: ycu cnc Ihe winc L|cw: Ihrcugh Ihe Iree:.

! /cvcncec :cencric: ceve|cpec wiIh c::i:Icnce cf pcIienI {fcmi|y, pc:I
experience:, eIc).

82
Modu|e 14: End|ng Ireotment ond Mo|nto|n|ng Chonges

Object|ves
! Ic uncer:Icnc Ihe prcce:: fcr prepcring Ihe pcIienI fcr encing IrecImenI
! Ic |ecrn Iechni¢ue: fcr prevenIing re|cp:e

Whot |s end|ng treotment, ond why |s |t |mportont to p|on |or |t?

Enc-cf-IrecImenI p|cnning i: Ihe cc||cLcrcIive prcce:: cf prepcring Ihe pcIienI cnc
c::e::ing hi:/her reccine:: fcr encing IrecImenI cnc mcving Leycnc re|icnce cn Ihe
Ihercpi:I Ic cpp|y :ki||:. F|cnning c||cw: Ihe pcIienI Ic prepcre fcr Ihe enc cf IrecImenI, Ic
review :ki||: |ecrnec in IrecImenI, cnc Ic vccc|ize cnc prcL|em-:c|ve ccncern: cLcuI
funcIicning cuI:ice IrecImenI. /|| Ihe:e fccIcr: recuce cnxieIy cnc c||cy fecr: c pcIienI
mighI hcve cLcuI encing c IhercpeuIic re|cIicn:hip.

When? [Ind|cot|onsJContro|nd|cot|ons}

Enc-cf-IrecImenI p|cnning Legin: cI Ihe fir:I :e::icn when ycu give Ihe pcIienI :cme
inciccIicn cf Ihe fre¢uency cnc curcIicn cf IrecImenI. Enc-cf-IrecImenI p|cnning i: cn
cngcing prcce::, cu|mincIing in Ihe finc| :e::icn: wiIh c review cf IrecImenI cnc
inIrccucIicn cf re|cp:e-prevenIicn :ki||:.

FcIienI: wiIh per:cnc|iIy ci:crcer: cr ci:crcer: cf cIIcchmenI mcy Le pcrIicu|cr|y :en:iIive Ic
fee|ing cLcnccnec cr up:eI c: c re:u|I cf encing Ihe IhercpeuIic re|cIicn:hip. Fcr Ihe:e
pcIienI:, iI i: impcrIcnI Ic ci:cu:: IrecImenI IermincIicn in cn empcwering cnc IhcughIfu|
wcy-reccgnizing cnc ncrmc|izing Iheir fecr:, c::uring Ihem :cfegucrc: cre in p|cce {e.g.,
emergency re:curce:, Lcc:Ier :e::icn:), cnc enccurcging Ihem vic remincer: IhcI Ihe
purpc:e cf C8I i: :e|f-mcncgemenI cf :ympIcm:.

How? [Instruct|onsJHondouts}

Feviewing WhcI Wc: Lecrnec
Ihe |c:I :e::icn cf 8rief C8I :hcu|c Le :penI reviewing cnc reccrcing Ihe cifferenI ccgniIive
cnc Lehcvicrc| :ki||: Ihe pcIienI hc: |ecrnec. U:e SccrcIic ¢ue:Iicning Ic e|iciI Ihi: |i:I {¨WhcI
hcve ycu |ecrnec c: c re:u|I cf cur Iime IcgeIher° l: Ihere cnyIhing IhcI wc: pcrIicu|cr|y
mecningfu| Ic ycu cLcuI ycur Iime in Ihercpy°"), c: pcIienI: mcy genercIe :ki||: cr LenefiI:
cf Ihercpy ncI kncwn Ic ycu. FcIienI: :hcu|c hcve c |i:I cf Ihe:e :ki||: Ihey ccn Icke wiIh
Ihem. Ihey :hcu|c c|:c Le enccurcgec Ic keep Ihe cIher hcnccuI: {e.g., IhcughI reccrc:)
ccmp|eIec curing IrecImenI c: c remincer cf Iheir :ki||:.

Fe|cp:e FrevenIicn
Mcny pcIienI: cre ccncernec IhcI Ihey wi|| ncI Le cL|e Ic mcncge fuIure p:ychc|cgicc|
prcL|em: cr p:ychc:ccic| :Ire::cr: wiIhcuI Ihe cic cf Ihercpy. ln p|cnning fcr Ihe enc cf
IrecImenI, ycu cnc Ihe pcIienI cnIicipcIe pcIenIic| :Ire::cr: cnc :ympIcm: cnc p|cn: 1)
WhcI Icc|: Ihe pcIienI hc: |ecrnec in Ihercpy IhcI he cr :he ccu|c u:e fcr pcrIicu|cr
:Ire::cr:/:ympIcm:, cnc 2) when he/:he mighI neec Ic ccnIccI c menIc| hec|Ih
prcfe::icnc| fcr ccciIicnc| c::i:Icnce {e.g., :uicicc| icecIicn). Frepcring fcr ineviIcL|e
cifficu|Iie: i: empcwering cnc enccurcging fcr pcIienI:. / funcIicnc| c::e::menI mcy Le
u:ec Ic icenIify fuIure prcL|emcIic :iIucIicn: {:ee Mccu|e 4).

83














IrcuL|e:hccIing Enc cf IrecImenI

Give Ycur:e|f /ce¢ucIe Iime Ic Enc IrecImenI.
F|cn cn cn enIire :e::icn cevcIec Ic encing IrecImenI, wrcpping up, cnc mcinIcining
chcnge:. lI i: high|y reccmmencec IhcI ycu ncI inIrccuce new ccncepI: curing Ihe finc|
:e::icn, c: new i::ue: mcy cri:e: cnc encing IrecImenI curing Ihe :e::icn mcy Leccme
impc::iL|e.

Give Ihe FcIienI CreciI.
Depre::ec cr cnxicu: pcIienI: cfIen cIIriLuIe pc:iIive chcnge Ic exIernc| enIiIie: cnc
negcIive chcnge Ic Ihem:e|ve:. Iherefcre, cI Ihe enc cf IrecImenI, ci:cu:: Ihe pcIienI´:
prcgre:: {u:ing cLjecIive ccIc, :uch c: :ympIcm-rcIing :cc|e:, when cvci|cL|e), prci:e Ihe
pcIienI, cnc emphc:ize hi: cr her rc|e in pc:iIive chcnge:.

Fe:pcnc Ic Ccncern:.
Checking in wiIh Ihe pcIienI regu|cr|y cLcuI ¢ue:Iicn: cr ccncern: cLcuI encing IrecImenI
he|p: mcinIcin Ihe IhercpeuIic re|cIicn:hip cnc cff:eI negcIive emcIicn: cLcuI IrecImenI
IhcI ccu|c re:u|I in negcIive cuIccme:, :uch c: fee|ing cLcnccnec. lf Ihe pcIienI :eem:
pcrIicu|cr|y ccncernec cLcuI encing IrecImenI, he cr :he ccu|c u:e c IhcughI reccrc Ic
icenIify cnc chc||enge cy:funcIicnc| IhcughI: c::ccicIec wiIh |ecving Ihercpy.

F|cn Se|f-McncgemenI Iime.
FcIienI: mcy Le inIere:Iec in p|cnning :e|f-mcncgemenI Iime when prepcring fcr Ihe enc
cf IrecImenI. Se|f-mcncgemenI Iime: cre c few minuIe: ecch week IhcI Ihe pcIienI :eI:
c:ice, cnce Ihercpy i: ccmp|eIe, Ic check mccc cnc u:e cf :ki||: cnc prcL|em :c|ve
:iIucIicn: cr fee|ing: IhcI mcy Le negcIive|y cffecIing Iheir mccc. Ihe:e Iime: |c:I
cpprcximcIe|y 10-15 minuIe: cnc fc||cw c :IrucIure :imi|cr Ic Ihercpy. Se|f-mcncgemenI
Iime i: Leneficic| Leccu:e iI i: free, ccn Le ccncucIec cI cnc when cnc where iI i:
ccnvenienI fcr Ihe pcIienI, cnc he|p: prevenI re|cp:e. / :e|f-mcncgemenI wcrk:heeI {:ee
p. 82) mcy Le u:ec curing Ihe:e Iime:.

8cc:Ier Se::icn:
8cc:Ier :e::icn: ccn Le :checu|ec cpprcximcIe|y 1 mcnIh fc||cwing Ihe enc cf IrecImenI
cnc Ihen c: neecec IherecfIer. During c Lcc:Ier :e::icn, ycu:
! Check in wiIh Ihe pcIienI cLcuI hi:/her :e|f-mcncgemenI cf :ympIcm: cnc :Ire::cr:.
! Fefre:h :ki||: |ecrnec in Ihercpy.
ke|opse-Frevent|on Quest|ons

1} When I |ee| [symptom}, I w||| [too| |eorned |n theropy}.
2} I| _[stressor}___, I w||| [too| |eorned |n theropy}.

Exomp|e:
When l fee| :cc fcr 2 ccy:, l wi|| gc fcr c wc|k cnc cc|| c frienc Ic hcve |unch.

When l fee| cepre::ec fcr c mcnIh, l wi|| :checu|e cn cppcinImenI wiIh my primcry
ccre phy:icicn/menIc| hec|Ih prcvicer.

lf my Lcyfrienc Lreck: up wiIh me, l wi|| cc c IhcughI reccrc Ic evc|ucIe cny
cy:funcIicnc| IhcughI:.
84
! Di:cu:: ¢ue:Iicn: cr ccncern: Ihe pcIienI mighI hcve cLcuI Ihe Ircn:iIicn.
! Feview IrecImenI gcc|: cnc mcinIencnce cf IrecImenI gcin:.

Supp|emenIc| Feccing:
/||:cp, S. & Scuncer:, 8. {1ºº1). Feinfcrcing rcLu:I re:c|uIicn:: McIivcIicn in re|cp:e
prevenIicn wiIh :evere|y cepencenI prcL|em crinker:. ln Mi||er, W.F. & Fc||nick, S. {Ec:.).
!&/"'-/"&#-4 "#/()'"(0"#.9 P)(8-)"#. 8(&84( /& 6,-#.( -$$"6/"'( 5(,-'"&). New Ycrk:
Gui|fcrc Fre::, pp. 23ó-247.
8eck, J.S. {1ºº5). CcgniIive Ihercpy: 8c:ic: cnc Leycnc. New Ycrk: Gui|fcrc Fre:::
ChcpIer 15.
85
Se||-Monogement I|me Gu|de

I. Mood Check
o. Li:I five emcIicn: ycu cre fee|ing righI ncw, cnc rcIe Iheir inIen:iIy frcm 0-
1007.





b. Li:I Ihree emcIicn: ycu hcve fe|I Ihi: pc:I week, cnc rcIe Iheir inIen:iIy frcm 0-
1007.




II. kev|ew the Frev|ous Week
c. Dic l u:e cny Icc|: l |ecrnec in Ihercpy Ihi: week°
i. lf l cic ncI, whcI prcL|em cic l hcve Ihi: week IhcI ccu|c hcve Leen
he|pec Ihrcugh Ihe u:e cf Ihe:e :ki||:°






L. WhcI gccc Ihing: hcppenec Ihi: week°
i. Hcw cic l mcke Ihc:e gccc Ihing: hcppen°






III. Current ond Future Frob|emot|c S|tuot|ons
c. WhcI cre my currenI prcL|em:°
i. Hcw ccn l Ihink cLcuI Ihe:e prcL|em: in c cifferenI wcy°
ii. WhcI ccn l cc Ic chcnge Ihe fee|ing: c::ccicIec wiIh Ihe:e
prcL|em:°






L. WhcI prcL|em: ccn cccur Lefcre my nexI :e|f-mcncgemenI Iime°
i. WhcI :ki||: ccn l u:e Ic cec| wiIh Ihe:e prcL|em:°



REFERENCES
88
!"##$%&$' )*' !"++,$-$*&), .$)'/*#%


/||:cp, S. & Scuncer:, 8. {1ºº1). Feinfcrcing rcLu:I re:c|uIicn:: McIivcIicn in re|cp:e
prevenIicn wiIh :evere|y cepencenI prcL|em crinker:. ln Mi||er, W.F. & Fc||nick, S.
{Ec:.) !!"#$%"#!&%' #&")*$#)+#&,- .*)/%*#&, /)!/') "! 01%&,) %22#0"#$) 3)1%$#!*4
New Ycrk: Gui|fcrc Fre::: pp. 23ó-247.

8eck, J. S. {1ºº5). 5!,&#"#$) "1)*%/6- 7%8#08 %&2 3)6!&24 New Ycrk: Gui|fcrc Fre::.

8erncrc, J. M., & Gcccyecr, F. G. {2003). 9:&2%;)&"%'8 !< 0'#&#0%' 8:/)*$#8#!& {3nc ec.).
Neechcm HeighI:, M/: /||yn & 8cccn.

8cnc F. W. & Drycen W. {2002). =%&23!!> !< 3*#)< 0!,&#"#$) 3)1%$#!:* "1)*%/6. Scn
Frcnci:cc: Wi|ey.

8urn:, D. D. {1ººº). 9))'#&, ,!!2 1%&23!!>. New Ycrk: F|ume {Fenguin).

Ccrmier, W. H., & Ccrmier, L. S. {1ºº1). ?&")*$#)+#&, 8"*%"),#)8 <!* 1)'/)*8- 9:&2%;)&"%' 8>#''8
%&2 0!,&#"#$) 3)1%$#!*%' #&")*$)&"#!&8 {3
rc
EciIicn). Fccific Grcve: 8rcck:/Cc|e
FuL|i:hing Ccmpcny.

GreenLerg, D. & Fcce:ky, C. /. {1ºº5). @#&2 !$)* ;!!2- 51%&,) "1) +%6 6!: <))' 36
01%&,#&, "1) +%6 6!: "1#&>4 New Ycrk: Gui|fcrc Fre::.

Hcpkc, Lejuez, Fuggierc, eI c|. {2003). CcnIempcrcry Lehcvicrc| ccIivcIicn IrecImenI: fcr
cepre::icn: prccecure:, princip|e:, cnc prcgnc:i:. C|in F:ychc| Fev 23 {5): óºº-717.

JcccL:cn, McrIe||, Dimicjicn {2001). 8ehcvicrc| ccIivcIicn IrecImenI fcr cepre::icn:
reIurning Ic ccnIexIuc| rccI:. C|in F:ychc| Sci Frcc 8: 255-270.
Lie:e, 8.S., & 8eck, J. S. {1ºº7). CcgniIive Ihercpy :upervi:icn. ln WcIkin:, C.E., Jr. {Ec.),
=%&23!!> !< /8601!"1)*%/6 8:/)*$#8#!&. New Ycrk: Jchn Wi|ey & Scn:: pp. 114-133.
Mi||er, W. F., & Fc||nick, S. {1ºº1). @!"#$%"#!&%' #&")*$#)+#&,- .*)/%*#&, /)!/') "! 01%&,)
%22#0"#$) 3)1%$#!*4 New Ycrk: Gui|fcrc Fre::.

Mi||er, W.F. & Fc||nick, S. {2002). @!"#$%"#!&%' ?&")*$#)+#&,- .*)/%*#&, /)!/') <!* 01%&,)4
Seccnc EciIicn New Ycrk: Gui|fcrc Fre::.

Fer:cn: J. 8. & Icmpkin: M. /. {1ººº). CcgniIive-Lehcvicrc| cc:e fcrmu|cIicn. ln E||:, I. {Ec.).
=%&23!!> !< /8601!"1)*%/6 %&2 0%8) <!*;:'%"#!&. New Ycrk: Gui|fcrc Fre::: pp.
314-33º

Fc||nick, S., Mc:cn, F. & 8uI|er, C. {1ººº). =)%'"1 3)1%$#!* 01%&,)4 A ,:#2) <!* /*%0"#"#!&)*84
New Ycrk: Churchi|| Living:Icne.

Scfrcn, J. D., & GreenLerg, L. S. {1º82). E|iciIing ¨hcI ccgniIicn:" in ccgniIive Lehcvicrc|
Ihercpy: FcIicnc|e cnc prccecurc| guice|ine:. 5%&%2#%& .8601!'!,6B CDB 83-8ó.

APPENDIX A:
PATIENT HANDOUTS
º2


º3
8kIDGING SESSIONS


1. WhcI mcin pcinI: cic we recch in cur |c:I :e::icn° WhcI cic ycu |ecrn
frcm |c:I :e::icn° Dic cnyIhing ccme Ic minc in Ihe pc:I week cLcuI cur
|c:I :e::icn IhcI ycu´c |ike me Ic kncw cr IhcI ycu´c |ike Ic ci:cu::°







2. Were ycu unccmfcrIcL|e cLcuI cnyIhing we Ic|kec cLcuI in cur |c:I
:e::icn° l: Ihere cny Ihing ycu wi:h we hcc ci:cu::ec IhcI we cicn´I°








3. Hcw i: ycur mccc° Ccmpcrec wiIh |c:I week, i: iI LeIIer cr wcr:e°







4. WhcI IrecImenI gcc|: wcu|c ycu |ike Ic wcrk cn Icccy° WhcI prcL|em:
wcu|c ycu |ike Ic puI cn Ihe cgencc°








5. WhcI hcmewcrk cic ycu cIIempI cr ccmp|eIe fcr |c:I :e::icn° WhcI cic
ycu |ecrn frcm ccing iI°

º4
Cogn|t|ve D|stort|ons
1. A||-or-Noth|ng Ih|nk|ng: Viewing :iIucIicn: cn cne exIreme cr cncIher in:Iecc cf cn c
ccnIinuum.
Ex. ¨lf my chi|c cce: Lcc Ihing:, iI´: Leccu:e l cm c Lcc pcrenI."

2. Cotostroph|z|ng: FrecicIing cn|y negcIive cuIccme: fcr Ihe fuIure.
Ex. ¨lf l fci| my finc|, my |ife wi|| Le cver."
3. D|squo|||y|ng or D|scount|ng the Fos|t|ve: Ie||ing ycur:e|f IhcI Ihe gccc Ihing: IhcI hcppen
Ic ycu ccn´I ccunI.
Ex. ¨My ccughIer Ic|c her frienc IhcI l wc: Ihe Le:I Dcc in Ihe wcr|c, LuI l´m :ure
:he wc: ju:I Leing nice."
4. Emot|ono| keoson|ng: Fee|ing cLcuI :cmeIhing cverru|e: fccI: Ic Ihe ccnIrcry.
Ex. ¨Even Ihcugh SIeve i: here cI wcrk |cIe everyccy, l kncw l wcrk hcrcer Ihcn
cnycne e|:e cI my jcL."
5. Lobe||ng: Giving :cmecne cr :cmeIhing c |cLe| wiIhcuI fincing cuI mcre cLcuI iI/Ihem.
Ex. ¨My ccughIer wcu|c never cc cnyIhing l ci:cpprcvec cf."
ó. Mogn|||cot|onJM|n|m|zot|on: Emphc:izing Ihe negcIive cr ccwnp|cying Ihe pc:iIive cf c
:iIucIicn.
Ex. ¨My prcfe::cr :cic he mcce :cme ccrrecIicn: cn my pcper, :c l kncw l´||
prcLcL|y fci| Ihe c|c::."
7. Mento| F||terJIunne| V|s|on: F|ccing c|| ycur cIIenIicn cn Ihe negcIive: cf c :iIucIicn cr
:eeing cn|y Ihe negcIive: cf c :iIucIicn..
Ex. ¨My hu:Lcnc :cy: he wi:hec l wc: LeIIer cI hcu:ekeeping, :c l mu:I Le c
|cu:y wife."
EX. ¨My ccughIer´: Lcyfrienc gcI :u:pencec frcm :chcc|. He´: c |c:er cnc wcn´I
ever cmcunI Ic cnyIhing."
8. M|nd keod|ng: 8e|ieving ycu kncw whcI cIher: cre Ihinking.
Ex. ¨My hcu:e wc: cirIy when my frienc: ccme cver, :c l kncw Ihey Ihink l´m c
:|cL."
º. Overgenero||zot|on: Mcking cn cverc|| negcIive ccnc|u:icn Leycnc Ihe currenI :iIucIicn.
Ex. ¨My hu:Lcnc cicn´I ki:: me when he ccme hcme Ihi: evening. McyLe he
cce:n´I |cve me cnymcre."
10. Fersono||zot|on: Ihinking Ihe negcIive Lehcvicr cf cIher: hc: :cmeIhing Ic cc wiIh ycu.
Ex. ¨My ccughIer hc: Leen preIIy ¢uieI Icccy. l wcncer whcI l cic Ic up:eI her."
11. "Shou|d" ond "Must" Stotements: Hcving c ccncreIe icec cf hcw pecp|e :hcu|c Lehcve.
Ex. ¨l :hcu|c geI c|| !´: Ic Le c gccc :IucenI."











º5
THOUGHT RECORD
(5) EvidenceThat (7) Rate
(2) Automatic (3) Emotion(s) & (4) Evidence to Doesn't Support (6) AIternative Mood
(1) Situation Thought(s) Mood Support Thought Thought Thought Now

What
emotion(s) did
you feel at the
time? How Rate
What thought(s) went intense were from 1 to-
What actually happened? through your mind? they?(1-100) What has happened What has happened to What is another way 100
Where? What? How? How much did you Rate your to make you believe prove the thought is not to think of this (worst to
When? (Date and time) believe it? (1-100) mood. the thought is true? true? situation? best)

ºó
0$,+1", Quest|ons


S|tuot|ono|
Quest|ons


Fee||ng
Quest|ons

Ihought
Quest|ons

!


!


!


!


!


!

WhcI hcppenec° WhcI were
ycu ccing°
Whc wc: Ihere°
Ic whcm were ycu :pecking°
When cic Ihi: hcppen°
WhcI Iime cf ccy wc: iI°
Where cic Ihi: incicenI cccur°

!


!


!


!
Hcw were ycu fee|ing Lefcre
Ihi: hcppenec°
Hcw cic ycu fee| whi|e iI wc:
hcppening°
WhcI mccc were ycu in cfIer
Ihi: hcppenec°
Ccn ycu rcIe ycur mccc cn c
:cc|e cf 1-100°

!

!

!

!

!

!

!

!

!
WhcI wc: gcing Ihrcugh ycur
minc Lefcre ycu :IcrIec Ic fee|
IhcI wcy°
WhcI mcce ycu fee| IhcI wcy°
/ny cIher IhcughI:°
Which IhcughI LcIherec ycu
Ihe mc:I°
WhcI imcge: cic ycu hcve wiIh
Ihe:e IhcughI:°
WhcI cre ycu cfrcic mighI
hcppen°
WhcI if Ihi: i: Irue° WhcI cce:
Ihi: :cy cLcuI ycu°
WhcI ccu|c hcppen if Ihi: were
Irue°
WhcI cIher wcy: ccu|c we Ihink
cf Ihi:°
º7
THOUGHT RECORD
(5) Evidence That (7) Rate
(2) Automatic (3) Emotion(s) & (4) Evidence to Doesn't Support (6) AIternative Mood
(1) Situation Thought(s) Mood Support Thought Thought Thought Now

What
emotion(s) did
you feel at the
time? How Rate
What thought(s) went intense were from 1
What actually happened? through your mind? they? (1-100) What has happened What has happened to What is another way to100
Where? What? How? How much did you Rate your to make you believe prove the thought is not to think of this (worst to
When? (Date and time) believe it? (1-100) mood. the thought is true? true? situation? best)


º8
2"nct|ono| Assessment: A8C's
/nIececenI: 8ehcvicr: ShcrI-Ierm Ccn:e¢uence: Lcng-Ierm Ccn:e¢uence:
{WhcI hcppenec {WhcI cic ycu cc°) {WhcI wc: Ihe re:u|I 1 :eccnc, 1 {WhcI were Ihe |c:Iing re:u|I:°)
Lefcre°) hcur fc||cwing Lehcvicr°)

ºº
3ood ond 8ehov|or






Fcr cepre::ec per:cn:, increc:ing Iheir ccIiviIie: cn c cci|y Lc:i: imprcve: mccc
cnc cecrec:e: :ympIcm: cf cepre::icn.




100
!"#$%$#$&' )*&"+,$'#

EXCbkSIONSJCOMMbNIIY
! !! !

SOCIAL ACIIVIIIES AND
INIEkACIIONS WIIH OIHEkS
! !! !

1. Gcing Ic Ihe pcrk cr Lecch 1. GeIIing IcgeIher wiIh frienc:

2. Gcing cuI Ic cinner 2. Vi:iIing c neighLcr

3. Gcing Ic Ihe |iLrcry cr c Lcck :Icre 3. Hcving fcmi|y vi:iI cr vi:iIing fcmi|y

4. Gcing Ic Ihe mcvie: 4. EcIing cuI wiIh frienc: cr c::ccicIe:

5. Gcing :hcpping 5. Gcing Ic c |ccc| ccmmuniIy cenIer

ó. Gcing fi:hing ó. F|cying Lingc, ccrc:, ccminc: wiIh cIher:
! !! ! ! !! !
HEALIH AND WELLNESS FHYSICAL ACIIVIIY

1. FuIIing cn mckeup cr perfume 1. Wc|king fcr exerci:e cr p|ec:ure

2. EcIing hec|Ihier 2. LighI hcu:ekeeping, :uch c: :weeping

3. Fe|cxing, meciIcIing cr ccing ycgc 3. Swimming cr ccing wcIer exerci:e

4. lmprcving cne´: hec|Ih 4. Gcrcening cr p|cnIing
! !! ! ! !! !
SFIkIIbAL, kELIGIObS, kECkEAIIONAL AND OIHEk LEISbkE ACIIVIIIES
AND KIND ACIS

1. Gcing Ic c p|cce cf wcr:hip 1. KniIIing, :ewing cr neec|ewcrk

2. /IIencing c weccing, LcpIi:m, Lcr 2. WriIing in c jcurnc| cr cicry cr
miIzvch, re|igicu: ceremcny cr funcIicn keeping c :crcpLcck cr phcIc c|Lum

3. Feccing Ihe 8iL|e 3. F|cying wiIh cr hcving c peI

4. /IIencing c 8iL|e :Iucy grcup 4. Drcwing, pcinIing cr crcfI:

5. Dcing fcvcr: fcr cIher: cr vc|unIeering 5. Singing cr |i:Iening Ic mu:ic

ó. Vc|unIeering fcr c :pecic| ccu:e ó. Feccing Ihe new:pcper cr mcgczine:

7. WcIching IV cr |i:Iening Ic Ihe rccic

8. Dcing wcrc puzz|e: cr p|cying ccrc:
Scurce: /ccpIec, wiIh permi::icn, frcm Lejuez, C.W., Hcpkc, D. F., & Hcpkc, S. D. {2001). / Lrief
Lehcvicrc| ccIivcIicn IrecImenI fcr cepre::icn. "#$%&'() +(,'-'.%/'(0 123255-28ó.Wcrk:heeI -
lcenIifying p|ec:cnI evenI: cnc mecningfu| ccIiviIie:

101
Fcr ecch L|cck cf Iime, |i:I Ihe ccIiviIy ycu cic cnc rcIe
3ood Mon|tor|ng ond Act|v|ty Chort
{frcm 0-100) Ihe |eve| cf /nxieIy {/) cnc Depre::icn {D) ycu experiencec cI IhcI Iime.
I|me Sundoy Mondoy Iuesdoy Wednesdoy Ihursdoy Fr|doy Soturdoy
ó-7 /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
7-8 /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
8-º /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
º-10 /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
10-11 /M /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
11-12 Nccn /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
12-1 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
1-2 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
2-3 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
3-4 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
4-5 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
5-ó FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
ó-7 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
7-8 FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:
8-º FM /: /: /: /: /: /: /:
D: D: D: D: D: D: D:

102
SOLVED: Frob|em-So|v|ng Exerc|se

pec|||c Frob|em:_________________________________________________
____________________________________________________________________________________
_______________________________________
pen Ycur Minc i:I
Ic Fc::iL|e Sc|uIicn: FFCS /ND CCNS _____
1.



2.



3.



4.


er||y the best so|ut|on by c|rc||ng your cho|ce.

noct the So|ut|on.

SIep: cnc Iime Frcme cf Sc|uIicn:

1._____________________________________________Iime:_____________

2._____________________________________________Iime:_____________

3._____________________________________________Iime:_____________

ec|de || Your So|ut|on Worked: [ ] YES [ ] NO
_____
103
45os ond Cons

8ehov|or: _____________________________

Fos|t|ve E||ects o| Do|ng the 8ehov|or Fos|t|ve E||ects o| Not Do|ng the 8ehov|or

Negot|ve E||ects o| Do|ng the 8ehov|or Negot|ve E||ects o| Not Do|ng the 8ehov|or

104
Short-Ierm Fos|t|ve Consequences Long-Ierm Fos|t|ve Consequences
Short-Ierm Negot|ve Consequences Long-Ierm Negot|ve Consequences
105
6$ns|ng Instruct|ons


Mcce| ecch Ien:icn prccecure:

Dom|nont orm:
Mcke c fi:I cnc Ien:e Licep:: pu|| wri:I upwcrc whi|e pu:hing e|Lcw ccwn cgcin:I Ihe crm
cf chcir cr Lec.

Nondom|nont orm:
Scme c: cLcve.

Foreheod, |ower cheeks ond jow:
LifI eyeLrcw: c: high c: pc::iL|e, LiIe IeeIh IcgeIher cnc pu|| ccrner: cf mcuIh IighI|y.

Neck ond throot:
Fu|| chin ccwn Icwcrc che:I: cI Ihe :cme Iime, Iry Ic prevenI iI frcm ccIuc||y Icuching Ihe
che:I. CcunIerpc:e mu:c|e: in frcnI pcrI cf neck cgcin:I Ihc:e in Ihe Lcck pcrI cf neck.

Shou|ders, chest, ond upper bockJobdomen:
Icke c ceep LrecIh cnc hc|c iI. /I Ihe :cme Iime, pu|| Ihe :hcu|cer L|cce: Lcck cnc
IcgeIher, Irying Ic mcke Ihem Icuch. Iry Ic keep ycur crm: c: re|cxec c: pc::iL|e whi|e
Ien:ing Ihi: mu:c|e grcup. /I Ihe :cme Iime mcke :Icmcch hcrc Ly pre::ing iI cuI, c: if
:cmecne were gcing Ic hiI ycu in Ihe :Icmcch.

Dom|nont |eg:
LifI fccI cff Ihe f|ccr, cnc pu:h ccwn cn Ihe chcir wiIh Ihigh.

Nondom|nont |eg:
Scme c: cLcve.




10ó
Deep-8reoth|ng Iechn|que

Step #1: FuI cne hcnc cn ycur cLccmen, wiIh Ihe |iII|e finger cLcuI 1 inch cLcve Ihe
ncve|, cnc p|cce cne hcnc cn ycur che:I.

Step #2: Fcy cIIenIicn Ic ycur LrecIhing {pcu:e fcr :everc| :eccnc: Ic c::e:: ycur
LrecIhing). lcec||y, Ihe hcnc cn Ihe cLccmen :hcu|c Le mcving, whi|e Ihe hcnc cver Ihe
che:I remcin: :Ii||. Ihi: en:ure: IhcI Ihe LrecIh: cre ceep.

Step #3: Icke ceeper LrecIh: Ly geIIing Ihe hcnc cver Ihe :Icmcch Ic mcve, whi|e
hcving |iII|e mcvemenI cf Ihe hcnc cver Ihe che:I.

45673 8- 9(: $%&# % ;:0< () $#%)/ .(0,'/'(0 %0, 9(: %)# $%&'0< ,'--'.:;/9 ='/$ /$'> #?#).'>#@
>;(= /$# A)(.#>> ,(=0 /( 9(:) .(B-()/ ;#&#;C

Step #4: CcnIinue ycur :|cw, even, ceep LrecIh:. Ic pcce ycur:e|f, ycu ccn :cy Ihe wcrc: '0
cnc (:/ :|cw|y whi|e Icking LrecIh:. lnhc|cIicn: cnc exhc|cIicn: :hcu|c Lui|c Ic
cpprcximcIe|y 3 :eccnc: in curcIicn.

Step #5: FepecI Ihe LrecIhing exerci:e Ihree cr mcre Iime:.

CIher Iip: fcr ceep LrecIhing:
1) lnhc|e Ihrcugh ycur nc:e cnc cuI ycur mcuIh.
2) Fur:e ycur |ip: {c: if L|cwing cuI hcI :cup) whi|e exhc|ing.
3) Dc ncI pcu:e LeIween inhc|e: cnc exhc|e:.
4) C|c:e ycur eye: curing Ihe exerci:e.
5) U:e mcnIrc :uch c: ¨re|cx" curing ecch exhc|e
ó) Fcir up ceep LrecIhing wiIh imcgery cnce ycu hcve mc:Ierec Ihe LrecIhing :ki||:.
7) FEMEM8EF: Deep LrecIhing i: c pcrIcL|e :ki|| IhcI ccn Le u:ec in c vcrieIy cf
:iIucIicn: cnc re|cIive|y wiIhcuI ncIice cf cIher:.


107
Imogery: Exomp|e Scr|pts










D.)'A/ E F3 G#0#)'. 7?%BA;#


Cnce ycur whc|e Lccy fee|: re|cxec, Ircve| Ic ycur fcvcriIe p|cce. iI ccn Le cny Iime pericc

cr cny p|cce. Ihi: p|cce i: cc|m cnc :cfe. Ihere cre nc wcrrie: here. Lcck crcunc Ihi:

p|cce. WhcI cc ycu :ee° Dc ycu hecr Ihe :cunc: crcunc ycu° WhcI cre :cme cf Ihe :cunc:

ycu hecr in Ihi: p|cce ycu cre imcgining° Hcw cce: Ihi: :pecic| p|cce :me||° Wc|k crcunc c
|

iII|e cnc Icke in c|| Ihe wcncerfu| :ighI:. Fee| Ihe cir crcunc ycu cnc re|cx.. Ihe cir i: fre:h,
cnc iI´: ec:y Ic LrecIhe here. Fcy cIIenIicn Ic hcw ycur Lccy fee|:... Scy Ic ycur:e|f, ¨l cm
IcIc||y re|cxec. wiIhcuI wcrrie:. c|| Ihe Ien:icn hc: crcinec cwcy frcm my Lccy." Icke c
mcmenI Ic fu||y experience ycur fcvcriIe p|cce.. NcIice Ihe :cunc:, :ighI:, :me||:, cnc hcw iI
fee|: Ic Le in Ihi: very :pecic| p|cce. FememLer IhcI ycu ccn vi:iI Ihi: p|cce c: cfIen c: ycu
wcnI cnc IhcI iI i: wcncerfu|. Scy Ic ycur:e|f, ¨l cm re|cxec here. Ihi: p|cce i: :pecic| cnc
mcke: me fee| cI pecce."

When ycu cre ccne wiIh ycur vi:iI Ic Ihi: :pecic| p|cce, cpen ycur eye:: cnc :Icy in ycur
ccmfcrIcL|e pc:iIicn. CcnIinue Ic LrecIhe :mccIh|y, in c re|cxec cnc rhyIhmic fc:hicn. Icke
c: |cng c: ycu wcnI Ic enjcy cnc re|cx. Ycu fee| cI ec:e kncwing ycur :pecic| p|cce i: c|wcy:
cvci|cL|e Ic ycu, cnc ycu finc IhcI ycu fee| re|cxec even cfIer ycu |ecve.

D.)'A/ E 1 H 6$# "#%.$3

lmcgine ycur:e|f wc|king ccwn c :cncy Lecch. Ihe :cnc i: whiIe cnc wcrm LeIween ycur
Ice:. Ycu cre |ccking cuI cver Ihe cc|m, L|ue wcIer. Ihe wcve: cre genI|y |cpping cI Ihe
:hcre. Ycu fee| Ihe p|ec:cnI wcrmIh cf Ihe :un cn ycur :kin. iI´: c perfecI|y ccmfcrIcL|e

IempercIure cuI:ice. 8recIhe in ceep|y. Ihere i: c genI|e Lreeze, cnc Ihe :un i: :hining. 8ig,

ccIIcn-|ike c|cuc: crifI Ly c: ycu hecr :ec gu||: in Ihe ci:Icnce. Ycu Ic:Ie Ircce: cf :c|I cn

ycur |ip:. Ycu cre ccmp|eIe|y re|cxec. Ihere cre nc wcrrie: cn Ihi: Lecch. Ihere i: ncIhing Ic

ci:IrccI ycu frcm fee|ing Ircn¢ui|. Wcrrie: crifI cwcy. NcIice Ihe :cunc:, :ighI:, :me||:, cnc hcw

iI fee|: Ic Le in Ihi: very :pecic| p|cce.


Fee| Ihe :cnc uncer ycur feeI. ycu cecice Ic :IreIch cuI cn Ihe wcrm, fine whiIe :cnc.

LrecIhe ceep|y. fee| Ihe wcrm cir. Ycur Lccy i: ccmp|eIe|y re|cxec, cnc ycu hcve cn
cverc|| fee|ing cf wcrmIh cnc ccmfcrI. Ycu |cck up c: Ihe c|cuc: pc:: Ly :|cw|y ccrc:: Ihe
LecuIifu| L|ue :ky. Ycu cre fee|ing rejuvencIec cnc ccmp|eIe|y cI pecce. FememLer IhcI
ycu ccn vi:iI Ihi: p|cce c: cfIen c: ycu wcnI cnc IhcI iI i: wcncerfu|. Scy Ic ycur:e|f, ¨l cm
re|cxec here. Ihi: p|cce i: :pecic| cnc mcke: me fee| peccefu| cnc ccnIenI."
When ycu cre ccne wiIh ycur vi:iI, cpen ycur eye: cnc :Icy in ycur ccmfcrIcL|e pc:iIicn.
CcnIinue Ic LrecIhe :mccIh|y, in c re|cxec cnc rhyIhmic fc:hicn: Icke c: |cng c: ycu wcnI Ic

enjcy cnc re|cx. Ycu fee| cI ec:e kncwing ycur :pecic| p|cce i: c|wcy: cvci|cL|e Ic ycu, cnc

ycu finc IhcI ycu fee| re|cxec even cfIer ycu |ecve.


108















































D.)'A/ EI H 6$# +#%,(=>3

lmcgine ycur:e|f wc|king Ihrcugh c |cve|y mecccw. Ihe Lreeze fee|: p|ec:cnI cgcin:I ycur
:kin. Ycu cre |ccking cuI cver Ihe cc|m, LecuIifu| green grc::. Ihe L|cce: cf grc:: cre genI|y
:wcying in Ihe Lreeze. Ycu fee| Ihe p|ec:cnI wcrmIh cf Ihe :un cn ycur :kin. iI´: c perfecI|y
ccmfcrIcL|e IempercIure cuI:ice. 8recIhe in ceep|y. Ihere i: c genI|e Lreeze, cnc Ihe :un i:
:hining. 8ig, ccIIcn-|ike c|cuc: crifI Ly c: ycu hecr Lirc: in Ihe ci:Icnce. Ycu hecr Ihe winc
L|cw genI|y Ihrcugh Ihe Iree:. Ycu Ic:Ie Ihe :weeI :ummer cir cn ycur |ip:. Ycu cre
ccmp|eIe|y re|cxec. Ihere cre nc wcrrie: in Ihi: mecccw. Ihere i: ncIhing Ic ci:IrccI ycu
frcm fee|ing Ircn¢ui|. Wcrrie: crifI cwcy. NcIice Ihe :cunc:, :ighI:, :me||:, cnc hcw iI fee|: Ic
Le in Ihi: very :pecic| p|cce.
Fee| Ihe ccc| grc:: uncer ycur feeI. ycu cecice Ic :IreIch cuI cn Ihe :cfI, cu:hicny grc::.
LrecIhe ceep|y. fee| Ihe wcrm cir. Ycur Lccy i: ccmp|eIe|y re|cxec, cnc ycu hcve cn
cverc|| fee|ing cf wcrmIh cnc ccmfcrI. Ycu |cck up c: Ihe c|cuc: pc:: Ly :|cw|y ccrc:: Ihe
LecuIifu| L|ue :ky. Ycu cre fee|ing rejuvencIec cnc ccmp|eIe|y cI pecce. FememLer IhcI
ycu ccn vi:iI Ihi: p|cce c: cfIen c: ycu wcnI cnc IhcI iI i: wcncerfu|. Scy Ic ycur:e|f, ¨l cm
re|cxec here. Ihi: p|cce i: :pecic| cnc mcke: me fee| peccefu| cnc ccnIenI."
When ycu cre ccne wiIh ycur vi:iI, cpen ycur eye: cnc :Icy in ycur ccmfcrIcL|e pc:iIicn.
CcnIinue Ic LrecIhe :mccIh|y, in c re|cxec cnc rhyIhmic fc:hicn: Icke c: |cng c: ycu wcnI Ic
enjcy cnc re|cx. Ycu fee| cI ec:e kncwing ycur :pecic| p|cce i: c|wcy: cvci|cL|e Ic ycu, cnc
ycu finc IhcI ycu fee| re|cxec even cfIer ycu |ecve.

CIher Guicec lmcgery Scene Sugge:Iicn::

! / gcrcen where ycu wcIch Lig, LecuIifu| c|cuc: in c L|ue :ky, whi|e ycu inhc|e Ihe
:cenI cf f|cwer: cnc fee| c genI|e Lreeze cn ycur :kin c: Ihe :un:hine wcrm: ycu.

! / mcunIcin :cene where ycu fee| cc|m cnc re|cxec c: ycu |cck cuI cver Ihe
vc||ey. Ju:I ycu cnc Ihe vegeIcIicn, cnc ycu cip ycur feeI inIc c ccc| mcunIcin
:Irecm, cnc |eI ycur fccI re:I cn c Lig, :|ippery :Icne c: Ihe :un:hine wcrm: ycu
cnc Ihe winc L|cw: Ihrcugh Ihe Iree:.

! /cvcncec :cencric: ceve|cpec wiIh c::i:Icnce cf pcIienI {fcmi|y, pc:I
experience:, eIc).

10º
kot|ng Moods

De:criLe c recenI evenI. FcIe Ihe inIen:iIy cf ycur mccc cI Ihe Iime Ihe evenI
cccurrec cn c :cc|e cf 0-100 {Ihere i: c |i:I cf cifferenI mccc: cI Ihe LcIIcm if ycu neec
he|p).

1.
Event:_______________________________________________________________________________
_____________________________________________________________________________________
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
2.
Event:_______________________________________________________________________________
_____________________________________________________________________________________
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
3.
Event:_______________________________________________________________________________
_____________________________________________________________________________________
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
4.
Event:_______________________________________________________________________________
_____________________________________________________________________________________
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100
Mccc:_____________: 0 10 20 30 40 50 ó0 70 80 º0 100

/ngry /nxicu: /:hcmec CcnficenI Depre::ec Di:gu:Iec EmLcrrc::ec
Enrcgec ExciIec Furicu: FrighIenec Fru:IrcIec Gui|Iy Hcppy Hcpefu|
Hcpe|e:: HurI Humi|icIec ln:ecure lrriIcIec Jec|cu: Livic Mcc
Nervcu: Fcnicky Scc Sccrec Ien:e Wcrm
110
Se||-Monogement I|me Gu|de

I. Mood Check
o. Li:I five emcIicn: ycu cre fee|ing righI ncw, cnc rcIe Iheir inIen:iIy frcm 0-
1007.




b. Li:I Ihree emcIicn: ycu hcve fe|I Ihi: pc:I week, cnc rcIe Iheir inIen:iIy frcm 0-
1007.




II. kev|ew the Frev|ous Week
c. Dic l u:e cny Icc|: l |ecrnec in Ihercpy Ihi: week°
i. lf l cic ncI, whcI prcL|em cic l hcve Ihi: week IhcI ccu|c hcve Leen
he|pec Ihrcugh Ihe u:e cf Ihe:e :ki||:°






L. WhcI gccc Ihing: hcppenec Ihi: week°
i. Hcw cic l mcke Ihc:e gccc Ihing: hcppen°






III. Current ond Future Frob|emot|c S|tuot|ons
c. WhcI cre my currenI prcL|em:°
i. Hcw ccn l Ihink cLcuI Ihe:e prcL|em: in c cifferenI wcy°
ii. WhcI ccn l cc Ic chcnge Ihe fee|ing: c::ccicIec wiIh Ihe:e
prcL|em:°






L. WhcI prcL|em: ccn cccur Lefcre my nexI :e|f-mcncgemenI Iime°
i. WhcI :ki||: ccn l u:e Ic cec| wiIh Ihe:e prcL|em:°


APPENDIX B:
SAMPLE TREATMENT OUTLINES
!!"
!"#$%& ()*&+ ,(- ./0%*1& 23

4"0*&10 5&67)*$0*81
$%&'% '( % )*+,-%&+./0 %'&/'1- 2'/.3 45. '( %6.73 3. &-3'&- 8&.9 !: ,-%&( .8 8/,'1;< $%&'% 4%(
0'%;1.(-0 4'35 =,2- >> 0'%6-3-( : ,-%&( %;. %10 5%( 5%0 0'88'?7/3'-( 9%'13%'1'1; 5-& 5-%/35
('1?- 35%3 3'9-< @5- 5%( (788-&-0 6.73( .8 (-A-&- 8%3';7- %10 0'BB'1-((< $%&'% (%,( 35%3 8/,'1;
'( 5-& C8'&(3 /.A-DE 673 35%3 '3 5%( 6-?.9- '1?&-%('1;/, 0%1;-&.7( 8.& 5-& 3. 8/,< @5- (3%3-( 35%3
(5- C8--/( /'F- % 8%'/7&-E 6-?%7(- (5- 4.&F-0 (. 5%&0 3. 6-?.9- % 2'/.3 %10 1.4 C'3 '( .A-&<E
$%&'% (%,( 35%3 (5- '( 7(7%//, % A-&, %?3'A- 2-&(.1 673 5%( /.(3 '13-&-(3 '1 5-& 5.66'-( %10
0.-(1G3 5%A- 35- -1-&;, 3. 0. 35-9D %1,4%,< @5- (%,( 35%3 5-& 0-2&-(('.1 5%( 6--1
4.&(-1-0 6, 5-& 0-3-&'.&%3'1; 5-%/35<

H%(- H.1?-237%/'B%3'.1I $%&'% '( -J2-&'-1?'1; 0-2&-(('.1 '1 &-(2.1(- 3. % 0'%;1.('( .8
0'%6-3-(< @5- '( 71(7&- 5.4 3. ?5%1;- 5-& 35.7;53( %10 6-5%A'.&( 3. %0K7(3 3. 5-& 1-4
9-0'?%/ ?.10'3'.1< =5-&%2, 4'// %'0 5-& %0K7(39-13 6, 3%&;-3'1; 0,(871?3'.1%/ 35.7;53(
%6.73 6-'1; % C8%'/7&-E %10 -J2/.&'1; %10 '1?&-%('1; 35- 35'1;( 35%3 (5- -1K.,( %10 8--/( %
(-1(- .8 %?5'-A-9-13 8&.9D 6.35 8.& 4.&F %10 &-?&-%3'.1<

L.%/(
M-5%A'.&%/ N?3'A%3'.1
>0-13'8,'1; $%/%0%23'A- =5.7;53(OM-/'-8(
H5%//-1;'1; $%/%0%23'A- =5.7;53(OM-/'-8(

!&66*81 3
P(3%6/'(5 &-/%3'.1(5'2<
>0-13'8, $%&'%G( 2&-(-13'1; 2&.6/-9<
>13&.07?- H.;1'3'A- M-5%A'.&%/ =5-&%2,<
>13&.07?- 35- H.;1'3'A-+M-5%A'.&%/ $.0-/<
Q-(?&'6- R&.6/-9 '1 H.13-J3 .8 $.0-/<
@-3 L.%/(<
S-?-'A- T--06%?F 8&.9 $%&'%<

!&66*81 9
H5-?F $..0<
>13&.07?- M-5%A'.&%/ N?3'A%3'.1D %10 PJ2/.&- R.3-13'%/ N?3'A'3'-( 3. >92&.A- $..0<
@-3 U.9-4.&FI $..0 %10 N?3'A'3, =&%?F'1;<
S-?-'A- T--06%?F T&.9 $%&'%<

!&66*81 :
H5-?F $..0<
S-A'-4 $..0 %10 N?3'A'3, =&%?F'1;<
V(- =&%?F'1; @5--3 3. R/%1 W5-&- %10 W5%3 M-5%A'.&%/ N?3'A%3'.1 W'// M- P92/.,-0<
=&.76/-(5..3 H.92/-3'1; N?3'A'3,<
N((';1 U.9-4.&FI ! M-5%A'.&%/+N?3'A%3'.1 PJ-&?'(-<
S-?-'A- T--06%?F T&.9 $%&'%<





!!:
!&66*81 ;
H5-?F $..0<
S-A'-4 M-5%A'.&%/ N?3'A%3'.1D
>13&.07?- =5&--+H./791 =5.7;53 S-?.&0 %10 >0-% .8 CU.3 =5.7;53<E
R&%?3'?- =5&-- H./791 W'35 PA-13 T&.9 R%(3 W--F<
U.9-4.&FI ! 6-5%A'.&%/ %?3'A%3'.1
! 35&--+?./791 35.7;53 &-?.&0
S-?-'A- T--06%?F T&.9 $%&'%<

!&66*81 <
H5-?F $..0<
Q'(?7(( R&.;&-(( .8 =5-&%2, %10 =-&9'1%3'.1<
S-A'-4 U.9-4.&F<
>13&.07?- H.;1'3'A- Q'(3.&3'.1(<
H.92/-3- =5&--+H./791 '1 @-(('.1D %10 U%A- $%&'% >0-13'8, U.3 =5.7;53<
>13&.07?- H.1?-23 .8 H5%//-1;'1; U.3 =5.7;53<
U.9-4.&FI ! 6-5%A'.&%/ %?3'A%3'.1
! 35&--+?./791 35.7;53 &-?.&0
S-?-'A- T--06%?F T&.9 $%&'%<

!&66*81 =
H5-?F $..0<
S-A'-4 U.9-4.&F<
>13&.07?- H5%//-1;'1; =5.7;53( %10 @-A-1+H./791 =5.7;53 S-?.&0<
H.92/-3- @-A-1+H./791 '1 @-(('.1<
>13&.07?- H.1?-23 .8 H5%//-1;'1; U.3 =5.7;53<
U.9-4.&FI ! 6-5%A'.&%/ %?3'A%3'.1
! 35&--+?./791 35.7;53 &-?.&0
S-?-'A- T--06%?F T&.9 $%&'%<

!&66*81 >
H5-?F $..0<
S-A'-4 U.9-4.&F<
H.92/-3- @-A-1+H./791 '1 @-(('.1 XW'35 $%&'% W&'3'1; %10 =%/F'1; =5&.7;5 %(@(5-
H.92/-3-( >3Y
U.9-4.&FI ! 6-5%A'.&%/ %?3'A%3'.1
! (-A-1+?./791 35.7;53 &-?.&0
S-?-'A- T--06%?F T&.9 $%&'%<

!&66*81 ?
H5-?F $..0<
S-A'-4 U.9-4.&F<
S-A'-4 R&.;&-(( .8 =&-%39-13<
H.92/-3- S-/%2(- R&-A-13'.1<
>13&.07?- %10 @?5-07/- @-/8+$%1%;-9-13 @-(('.1(<
U.9-4.&FI @-/8+$%1%;-9-13 @-(('.1
!!)
!"#$%& ()*&+ ,(- ./0%*1& 29

4"0*&10 5&67)*$0*81
Z%9-( '( % ["+,-%&+./0 ?.//-;- (370-13 .1 % 87// %?%0-9'? (?5./%&(5'2< U- ?%//-0 35-
35-&%2'(3 3. 0'(?7(( 5'( 8--/'1;( .8 %1J'-3, %10 45-35-& 35-&- '( %1,35'1; 35%3 ?%1 5-/2 5'9
C?%/9 5'( 1-&A-(<E Z%9-( (%'0 35%3 5- '( 7(-0 3. ;-33'1; %1J'.7( '1 ?-&3%'1 ('37%3'.1(D 673 35%3
'3 '( (3%&3'1; 3. %88-?3 %// %&-%( .8 5'( /'8-< U- (%,( 35%3 5- 0.-(1G3 5%A- % ;'&/8&'-10 6-?%7(-
5- ;-3( C3.. 8&-%F-0 .73E 3. %(F %1,.1- .1 % 0%3-< U- %/(. (%,( 35%3 5'( %1J'-3, '( (3%&3'1; 3.
%88-?3 5'( ;&%0-( 6-?%7(- 5- ;-3( (. 1-&A.7( 07&'1; -J%9( 35%3 5- 6&-%F( '13. % ?./0
(4-%3 %10 ?%11.3 ?.1?-13&%3-< U- 4%13( 3. 6- %6/- 3. ?.13&./ 5'( %1J'-3, 673 8--/( 35-&- '(
1. 5.2-<

H%(- H.1?-237%/'B%3'.1I Z%9-( '( -J2-&'-1?'1; ?.;1'3'A- %10 25,('./.;'?%/ %1J'-3, '1
&-(2.1(- 3. -A%/7%3'A- ('37%3'.1(< =5-&%2, 4'// 8.?7( .1 (3&-((+9%1%;-9-13 (F'//( 8.& 5'(
25,('./.;'?%/ (,923.9( %10 '0-13'8,'1; 0,(871?3'.1%/ 35.7;53( .& 4.&&'-( %6.73 5'(
2-&8.&9%1?- '1 %?%0-9'? %10 (.?'%/ ('37%3'.1(< @2-?'8'?%//,D 35-&%2, 4'// '0-13'8,
?%3%(3&.25'? 35.7;53( 5- 5%( %6.73 8%'/7&-<

L.%/(
S-/%J%3'.1
>0-13'8,'1; $%/%0%23'A- =5.7;53(OM-/'-8(
H5%//-1;'1; $%/%0%23'A- =5.7;53(OM-/'-8(

!&66*81 3
P(3%6/'(5 &-/%3'.1(5'2<
>0-13'8, Z%9-(G 2&-(-13'1; 2&.6/-9<
>13&.07?- ?.;1'3'A- 6-5%A'.&%/ 35-&%2,<
>13&.07?- 35- ?.;1'3'A-+6-5%A'.&%/ 9.0-/<
Q-(?&'6- 2&.6/-9 '1 ?.13-J3 .8 9.0-<
@-3 ;.%/(<
S-?-'A- 8--06%?F 8&.9 Z%9-(<

!&66*81 9
H5-?F 9..0<
>13&.07?- %10 2&%?3'?- 2&.;&-(('A- 97(?/- &-/%J%3'.1<
@-3 5.9-4.&FI R/%1 34. 3'9-( 07&'1; 4--F 3. 2&%?3'?- 2&.;&-(('A- 97(?/- &-/%J%3'.1<
S-?-'A- 8--06%?F 8&.9 Z%9-(<

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