For this week's MFT practice question, we continue our focus on treatment, shifting from the initial phase to the middle phase of treatment. On the exam, you can expect to see a large number of questions on this subject; some will ask about general interventions, while others will focus on interventions linked to specific theories. So what should we be looking for when it comes to middle phase questions?
The main objective of middle stage treatment is to elicit change in the client’s presenting problem. At this stage of treatment, the therapist has already laid the foundations of therapy, including completing a thorough assessment, building rapport, and educating the client about the process of therapy. Therefore, whether a question is more generally asking about middle stage interventions or those that are theory-specific, you are going to prioritize answers that help the client achieve his or her goals for treatment. Let’s take a look at a practice question, keeping this goal in mind as we evaluate the available answer choices.
Question:
A 46-year-old man who emigrated from Ecuador eight years earlier has been in therapy for several months to address symptoms of anxiety and difficulties with sleep. During the first month of treatment, the therapist developed a good rapport with the client and collaboratively identified goals for treatment. The client’s chief complaint is that he is up most evenings with his mind racing about finances, and his family that is still in Ecuador, including his inability to care for his aging parents who are so far away. The client shares that due to the lack of sleep he has been exhausted at work and is constantly scared he is going to lose his job. Which of the following actions would a Cognitive Behavioral Therapist utilize in the middle stage of treatment?
A. Practice diaphragmatic breathing in sessions with the client and discuss how he can integrate these skills into his daily routine to decrease anxiety levels.
B. Utilize an automatic thought record on a daily basis to better understand cognitive distortions and develop healthier alternative thoughts.
C. Ask the client to identify times when his anxiety did not interfere with his sleep and compliment his ability to use successful techniques.
D. Educate the client about the different cognitive distortions and collaboratively identify those he is employing that cause his anxiety and sleep disorder.
Which action do you think would be most appropriate for a Cognitive Behavioral Therapist to take? Share your answer and rationale in the comments below and check back in tomorrow for a discussion of the answer and rationale!
Comments
I would choose D. as the answer for the following reasons:
A. is a great intervention as part of a treatment objective, but not specifically related to CBT.
B. Is a great CBT intervention but I would educate someone first about what those thoughts look like and define them before keeping a record. Also, when you are anxious and can't sleep, you need immediate relief not a 30 day record to keep if you are in fear of losing your job.
C. Is a solution focused intervention not CBT.
D. Is the answer because it provides education about what is going on for the client in the moment and helps him with immediate relief to counter the thoughts and challenge the beliefs.
You have met with the client for 2 months and have not gotten any further with obtain information to complete the biopsychosocial assessment. This would be the time to address resistance or explore where it is coming from. B
Also he talks about mind racing so, B, the thought record would address that
I chose C because it identify the client problem with sleeping
I'm guessing D because it's more specific to his issue of his anxiety and sleep disorder even though C states "to better understand" and those words make me think middle phase.
I chose B. Both B and D are CBT-based, but D described early stage techniques.
I chose B because it increases his awareness of the problematic thought patterns that contribute to increased anxiety hence his lack of sleep. With this awareness he can taught how to reframe his thoughts and allow him more control over his situation, less anxiety, more sleep, and greater productivity at work.
I chose answer B
Most CBT middle stage.
A is good, although sounds more DBT
C sounds postmodern (exception question)
D sounds CBT early stage
I answered "B" because you are using CBT which would link thoughts with emotions and behaviors. Since this is the middle phase you would be seeking some sort of action to address the issue.
For this practice question I used answer "C" because it will help the client to identify his strenghs