Cognitive Behavioral Therapy (CBT)

Introduction

Summary

In my portfolio I will be outlining my current professional activities where I have been using cognitive behavioural therapy (CBT), the background as to why I choose to do the Masters in CBT and the current skill base I have learned and continue to improve to help me become a more reflective and effective practitioner. I will describe principles and standards I adhere to that help protect my clients from harm and the models of reflection I use in my practice. I will discuss case studies that will reflect higher order learning including my strengths and weakness and highlight areas that I have been developing and will need to develop ongoing throughout my professional life.

Background

I currently work as a dietitian in

The didactic approach has been defined as a sequence where the practitioner gives information and attempts to persuade the client to follow this information. This approach tends to render the client a passive recipient to the knowledge imparted and reduces patient autonomy and can generate resistance to change (Heritage and Sefi, 1992). More recently NICE guidelines on behaviour change recognised the need for a person centred approach. (NICE 2007, NICE 2014). In the person centred approach the client is the expert about themselves. The client is also the decision maker and the client has the right not to change. The practitioner needs to demonstrate that they understand the clients view point by using reflective listening skills. The guidelines concluded that the evidence does not support any one particular model for behaviour change but that generic competencies and skills should be employed in any given intervention. The intervention needs to take into account the physical, psychological and social context which the client finds themselves in. The interventions should be grounded in a theoretical model and have components like cognitive restructuring, goal setting, and relapse prevention.

Before committing to doing the Ma in CBT I had completed behavioural change skills training specifically designed for dietitians by Dympna Pearson one of the leading figures in the UK for behaviour change. The course is based on the principles of motivational interviewing which is guided by four principles, resist the “righting” reflex where practitioners try to fix their clients, to understand and explore the client’s own motivations, to listen with empathy, and to empower the client, encouraging hope and optimism. (Rollnick, Mason & Butler, 2008). The course introduced me to skills all aimed at building the therapeutic relationship with my client. I tend to open my consultations by inviting my clients to describe what led them to making the appointment. I have become more aware of non-verbal communication paying particular attention to body language, facial expressions and even physically placing myself at the same level as my client. In hospital my consultations will often take place by the clients’ bedside. All too often we as health professionals will stand above our clients creating an imbalance in the relationship straight away. In the hospital setting I will always ask permission from my clients to speak with them. This I feel is very important as the client may not be ready to see me when I call on them. I am more aware of pace and tone when