Communication in Cognitive Behavioral Therapy (eBook)

Michela Rimondini (Herausgeber)

eBook Download: PDF

2010 | 2011
X, 273 Seiten
Springer New York (Verlag)
978-1-4419-6807-4 (ISBN)

Infos

Research has shown that the therapeutic alliance is a key factor in the success of treatment, and a critical component of establishing this alliance is the communication between therapist and client. The efficacy of treatment depends on the therapist's ability to collect reliable client information and create the foundation for a good relationship that involves the client in the healing process. Communication in Cognitive Behavioral Therapy provides an overview of the research and theory underlying the importance of therapeutic communication with a specific focus on cognitive behavioral psychotherapy. It brings together an international group of experts from the relevant disciplines of communication, psychotherapy, research and teaching to create an integrated perspective of this crucial area. The book offers a review of the main evidence-based theories, and is highlighted with specific examples and flow charts.Insight for trainers is given by providing learner-centered teaching methods that enhance the acquisition of these communication skills. For researchers, it offers both qualitative and quantitative analyses of the subject as well as a comprehensive review of the main analysis methods adopted in the field.

Inhalt

Communication in Cognitive Behavioral Therapy 3
Preface 5
Contents 7
Contributors 9
Chapter 1: Background Theories and Main Systems of Analysis of Communication in Cognitive-Behavioral Therapy 11
1.1 Introduction 11
1.2 Interpersonal Communication: Models, Definitions, and Key Notes 12
1.3 From Interpersonal Communication to Communication Skills 13
1.3.1 Communication Skills and Clinical Outcomes: Why Effective Communication Enhances the Quality of Care 14
1.4 Communication Skills in the Medical Setting 15
1.4.1 Translating Communication Skills and Patient-Centered Approach from the Medical Setting to Psychotherapy 16
1.4.1.1 The Biopsychosocial Model in Psychotherapy 16
1.4.1.2 Therapist-Centered vs. Person-Centered Approach 17
1.4.1.3 Shared Decision-Making Model 18
1.5 Communication Skills in Psychotherapy 19
1.5.1 Systems of Analysis of Therapist-Patient Communication 21
1.5.1.1 Rutter´s System of Analysis of Therapist´s Communication 21
1.5.1.2 Verona Coding Definitions of Emotional Sequences to Code Health Providers´ Responses 22
1.5.1.3 Verona Psychiatric Interview Classification System 23
1.5.1.4 Goldberg´s Classification System 24
1.5.1.5 The Three Interactograms of Cobb and Lieberman 25
1.5.1.6 Sheffield Psychotherapy Rating Scale 26
1.5.1.7 The Cognitive Therapy Scale Revised 27
1.6 Conclusion 28
References 29
Chapter 2: Assessment Stage: Data Gathering and Structuring the Interview 34
2.1 Introduction 34
2.2 Knowledge and Evidence on Doctor-Patient Communication in Medical Settings 35
2.2.1 Theoretical Background 35
2.2.2 Research Findings on Doctor-Patient Communication 37
2.3 The Data-Gathering Process 38
2.3.1 Setting and Barriers 39
2.3.2 The Data-Gathering Process: Aims and Contents 39
2.3.3 Data-Gathering Process: Communication Skills 42
2.3.3.1 Listening 43
Passive Listening 43
Active Listening 44
2.3.3.2 Facilitations 44
2.3.3.3 Reflections 45
2.3.3.4 Clarification 45
2.3.3.5 Open-Ended Questions 46
2.3.3.6 Closed Questions 47
2.3.3.7 Checking 48
2.3.3.8 Summarizing 49
2.3.3.9 Reformulation 50
2.4 Structuring the Interview in Psychotherapy 50
2.4.1 Structuring the Interview: The Goals 52
2.4.2 Communication Skills for Structuring the Interview 53
2.4.2.1 Setting the Agenda 53
2.4.2.2 Time Framing and Sequencing 54
2.4.2.3 Orienting Expressions (Transitions and Sign-Posting) 55
2.4.2.4 Summarizing 55
2.5 Conclusion 56
References 57
Chapter 3: Building the Working Alliance in Brief Psychotherapies 61
3.1 Introduction 61
3.1.1 The Working Relationship and Other Communicative Functions 61
3.1.2 What Do We Mean by ``Working Alliance´´? 62
3.2 Alliance and Outcome: Some Selected Empirical Findings 64
3.3 What Communicative Behavior Is Relevant for the Working Alliance? 66
3.3.1 Alliance Building in the Assessment Interview 67
3.3.2 Communicative Interventions Contributing to Alliance over the Course of Psychotherapy 69
3.3.3 Alliance Ruptures and Critical Communication Incidents 71
3.4 Conclusion 74
References 75
Chapter4: Providing Information and Involving the Patient in the Therapeutic Process 78
4.1 Introduction 78
4.2 Knowledge and Evidence on Doctor-Patient Communication in the Medical Setting 79
4.2.1 Doctor-Patient Communication in the Medical Setting: Theoretical Background 80
4.2.1.1 The Patient-Centered Interview and the Three-Function Model 80
4.2.1.2 The Shared Decision-Making Model 81
4.2.1.3 The Motivational Interview 82
4.2.2 From Theory to Practice: Findings from Research on Doctor-Patient Communication in the Medical Setting 83
4.2.3 From Theory to Practice: Discussion on the Evidence from Psychiatric Literature 85
4.3 Providing Information and Involving the Patient in Cognitive-Behavioral Therapy 86
4.3.1 Setting 88
4.3.2 Objectives and Tasks of Providing Information and Involving the Patient 88
4.3.3 Communication Skills 89
4.3.3.1 Drawing Attention to Patient´s Problem(s) and Structuring Information 92
4.3.3.2 Exploring Patient´s Opinions, Preferences, Expectations, and Past Experiences 93
4.3.3.3 Providing Information 93
4.3.3.4 Focusing Patient´s Attention 97
4.3.3.5 Checking the Patient´s Understanding (Feedback) 97
4.3.3.6 Exploring Patient´s Reaction to Received Information 98
4.3.3.7 Offering Opportunities to Ask Questions 100
4.3.3.8 Sharing Therapist´s Own Thoughts Feelings and Experiences (Self-Disclosure) 100
4.3.3.9 Negotiating Skills 101
4.3.3.10 Exploring Patient´s Social Resources and Providing Support 104
4.3.3.11 Closing the Encounter and Planning Future Sessions 104
References 106
Chapter 5: Nonverbal Communication in Clinical Contexts 113
5.1 Introduction 113
5.1.1 A Definition of Nonverbal Communication 113
5.1.2 Child Development, Implicit Communication, and Nonverbal Behavior 114
5.1.3 The Psychophysiology of Nonverbal Behavior 115
5.1.4 Nonverbal Communication in Clinical Settings 117
5.2 Assessment of Nonverbal Communication 117
5.2.1 Assessment of Nonverbal Decoding 118
5.2.2 Assessment of Nonverbal Encoding 118
5.2.3 Assessment of Nonverbal Communication in Clinical Settings 119
5.3 Categories of Provider Nonverbal Behavior and Effect on Outcome 120
5.3.1 Eye Contact and Facial Expression 120
5.3.2 Bodily Posture 121
5.3.3 Tone of Voice 121
5.3.4 Silence as Nonverbal Behavior 122
5.3.5 Patterns of Nonverbal Behavior 122
5.3.6 Quality of Rapport 123
5.3.7 Context (Seating, Distance, Level) 123
5.4 Nonverbal Communication in Psychiatric and Psychotherapy Contexts 124
5.4.1 A Review of the Literature 124
5.4.2 An Example of the Analysis of Nonverbal Behavior During Psychotherapy 127
5.5 Conclusions 127
References 129
Chapter6: Communication in Depressive States 135
6.1 Introduction 135
6.2 Depression According to Beck and Ellis 135
6.3 The Problem on the Problem 137
6.4 Communicative Styles of a Depressed Patient 139
6.5 The Case of Francesco 140
6.6 Conversation Analysis on the Case of Francesco: A Research Project on Linguistic Interactions in CBT 143
6.6.1 Method 144
6.6.1.1 Methodological Steps 144
6.6.2 Results 144
6.6.2.1 Analysis of the Conversation 147
6.7 Conclusion 152
References 153
Chapter 7: Interpersonal Vicious Cycles in Anxiety Disorders 154
7.1 Introduction 154
7.2 The Vicious Cycles 156
7.2.1 Luigi 156
7.2.2 Federico 157
7.2.3 Marta 158
7.2.4 Gianni 159
7.2.5 Brando 159
7.2.6 Valeria 160
7.2.7 ``Pat on the Back´´ 162
7.2.8 ``White Lie´´ 163
7.2.9 Rational Debating 165
7.2.10 Solution Prompter 167
7.2.11 Compliant Rescue 169
7.2.12 Blame 170
7.3 Acknowledgment of the Vicious Cycles 173
7.4 The Problem of Reassurance and the Importance of Acceptance 176
7.4.1 Federico 176
7.4.2 Luigi 177
7.4.3 Gianni 177
7.4.4 Drawing Out the Ineffectiveness of the Reassurance Attempts 179
7.4.5 Drawing Out the Disadvantages of Reassurance Attempts 182
7.4.6 Legitimizing the Relinquishment of Reassurance Attempts 183
7.5 Conclusions 186
References 186
Chapter 8: Cognitive-Behavioral Family Interventions in Psychosis 189
8.1 Introduction 189
8.2 Background 189
8.3 The Physical and Psychological Implications of Caregiving 190
8.4 The Relationship Between Carer Burden and Patient Functioning 191
8.4.1 Carer Burden and Coping Styles 191
8.5 Expressed Emotion and Families with Psychosis 192
8.6 Patient Appraisals of Caregiving Relationships 195
8.7 Cognitive-Behavioral Family Interventions with Patients with Psychosis and Their Families 196
8.8 Conclusion 198
8.9 Key Resources 198
References 199
Chapter 9: Learner-Centered Interactive Methods for Improving Communication Skills 206
9.1 Introduction 206
9.2 Can You Teach and Learn Communication Skills in Psychotherapy? 207
9.3 Why Use Experiential Learning Methods? 208
9.3.1 Systematic Delineation and Definition of Essential Skills 209
9.3.2 Observation 209
9.3.3 Well-Intentioned, Detailed, and Descriptive Feedback 209
9.3.4 Video and Audio Playback 210
9.3.5 Repeated Practice and Rehearsal 211
9.3.5.1 Practicing Skills in Safety 211
9.3.5.2 Enabling Ongoing Feedback and Rehearsal 212
9.3.5.3 Developing an Individual Approach 212
9.3.6 Active Small Group or One-to-One Learning 212
9.4 Why Use a Learner-Centered Approach to Communication Skills Teaching? 213
9.5 Why Use a Problem-Based Approach in Practice? 214
9.5.1 Discovering Learners´ Perceived Needs 214
9.5.2 Creating a Supportive Climate 215
9.5.3 Developing Appropriate Experiential Material 215
9.5.4 Taking a Problem-Based Approach to Analyzing the Consultation 215
9.6 What Place Is There for More Didactic Teaching Methods? 216
9.7 What Experiential Approaches Are Available? 216
9.7.1 Audio and Video Feedback 217
9.7.1.1 Practical Issues in the Use of Video Recording 217
Expense 217
Technology 217
Setting 217
Time 218
Apprehension 218
Patients´ Diagnoses 218
9.7.2 Real Patients 219
9.7.2.1 Prerecorded Videotapes of Real Consultations 219
9.7.2.2 Live Interviews of Patients Brought to the Communication Unit 219
Rehearsal Limitations 220
Restricted Types of Patients 220
Realism 221
Consent 221
9.7.3 Simulated Patients 221
9.7.3.1 Advantages of Simulated Patients 222
Rehearsal 222
Improvisation 223
Standardization 223
Customization 223
Specific Issues and Difficult Situations 225
Availability 225
Time Efficiency 225
Feedback 225
9.7.3.2 Challenges in the Use of Simulated Patients 226
Expense 226
Selection 226
Hidden Agendas 226
Administrative Time 226
Training 227
9.7.4 Role-Play 227
9.7.4.1 Difficult Cases 228
9.7.4.2 Problem Scenarios 228
9.7.4.3 Specific Issues 228
9.7.4.4 Disadvantages of Role-Play 229
9.8 Planning a Curriculum 230
9.8.1 A Curriculum Rather Than a Course 230
9.8.2 A Helical Rather Than Linear Curriculum 230
9.8.3 Integrated Not Separated from, the Rest of the Medical Curriculum 230
9.9 Conclusion 231
References 231
Chapter 10: Quantitative Methods for the Analysis of Verbal Interactions in Psychotherapy 235
10.1 Introduction 235
10.2 Quantitative Approach to a Verbal Interaction: An Overview 235
10.3 Moving from Recorded Interviews to Statistical Results 237
10.3.1 How to Turn a Psychotherapeutic Interview from a Taped Dyadic Conversation into a Systematic Observation of Coded Behavioral Sequences 239
10.3.2 Quality Standards in the Quantitative Approach to Qualitative Research: Validity and Reliability of the Coding System 240
10.3.3 Some Statistical Approaches to Analyze Conversation Sequences 241
10.3.4 How You Can Organize the Coded Text Sequences into a Database to Be Statistically Processed? 245
10.4 Conclusions 246
References 246
Chapter 11: Qualitative Methods for the Analysis of Verbal Interactions in Psychotherapy 250
11.1 Overview of Chapter 250
11.2 Introduction 250
11.2.1 Qualitative Studies of Psychotherapy 250
11.2.2 Qualitative vs. Quantitative Methodology 251
11.3 Examples of Qualitative Methods Used to Analyze Psychotherapeutic Interactions 252
11.3.1 Clinical Case Studies 252
11.3.2 Qualitative Interviews 253
11.4 Conversation Analysis 255
11.4.1 The Method of Conversation Analysis 255
11.4.2 CA and the Analysis of Consultations and Psychotherapy 255
11.4.3 Research Procedures in CA 256
11.4.4 Data Analysis in CA 257
11.4.5 Example of Analysis in CA 259
11.4.6 Some Limitations of CA 260
11.5 Quality Standards in Qualitative Research 260
11.6 Conclusions 261
References 262
Index 265

Produkt-Details

• Erscheint lt. Verlag: 3.12.2010
• Zusatzinfo: X, 273 p.
• Verlagsort: New York
• Sprache: englisch
• Themenwelt: Geisteswissenschaften ► Psychologie ► Klinische Psychologie
• Themenwelt: Geisteswissenschaften ► Psychologie ► Persönlichkeitsstörungen
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Psychiatrie / Psychotherapie
• Themenwelt: Medizin / Pharmazie ► Studium
• Themenwelt: Sozialwissenschaften ► Pädagogik ► Sozialpädagogik
• Themenwelt: Sozialwissenschaften ► Soziologie
• Schlagworte: CBT • clinical interview • psychotherapy • therapeutic relationship • therapist communication
• ISBN-10: 1-4419-6807-5 / 1441968075
• ISBN-13: 978-1-4419-6807-4 / 9781441968074