In-Session Structure and Collaborative Empiricism

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Abstract

This article examines the interplay between in-session structure and collaborative empiricism in the therapeutic relationship. The standard structure of a cognitive-behavior therapy session is presented, including the three major phases of beginning the session, the detailed working phase, and the final ending phase. Details of the typical manner in which a cognitive-behavioral therapist would structure each of these phases is provided. The description of the typical session structure is followed by discussion of factors that can influence this structure, including factors related to the client, the therapist, and the nature of CBT itself. It is noted that while a standard session structure is often recommended, at times these various factors affect the collaborative process and may at times warrant deviation from a standard session structure. The article ends with a hypothetical case that demonstrates some of the above processes, and how they can affect the ability to develop a collaborative and evidence-based therapy relationship.

Highlights

► Examine interplay of cognitive therapy in-session structure and collaborative empiricism ► Describe structure and phases of “standard” CBT session ► Discuss factors that can influence the in-session structure ► Present case study to illustrate collaborative empiricism

Section snippets

Standard In-Session Structure

Orientation to the therapeutic model begins during the assessment or even earlier, at the initial contact with the client. Part of orientation to this model includes describing the in-session structure and its rationale. This rationale includes the need for the efficient use of session time, the importance of using homework as a part of the treatment plan, and, most significantly, the importance of client participation and collaboration with the therapeutic work. Orientation to the model is

Flexible Structure and the Therapeutic Alliance

A major difference between cognitive therapy and cognitive behavioral treatments and other types of psychotherapies is the use of structured sessions. In the following section we discuss how to use structure in flexible ways, and provide suggestions both about the use of structure and how it may be used to either advance or disadvantage the therapeutic alliance. These factors are examined from both the perspective of the client and therapist.

A Case Study in Session Structure

Janet N.1 was a 48-year-old woman who was referred for therapy following an inpatient admission. The admission was precipitated by a suicide attempt, which involved an overdose of prescription medications. During the intake interview, Janet reported that she was divorced, but had two young adult children, a son and a daughter, both of whom lived at home. Shortly after her overdose, she called her daughter, who

Summary and Conclusions

This article has addressed the issues that are implicated in cognitive therapy, related to both in-session structure and the use of collaborative empiricism in the therapeutic relationship. Although very little evidence exists to support the ideas and suggestions expressed in this article, we have highlighted what has become more or less accepted wisdom, or canon, in the field. It is perhaps axiomatic that further research related to session structure, collaborative empiricism, and the process

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    Citation Excerpt :

    In this special series, the relational construct of collaborative empiricism will be discussed and illustrated in detail by experts in the field. Designed for the practicing clinician, this series will center on how this construct is present in culturally responsive CBT (Wong, 2013--this issue), in case formulation (Persons, Lemle Beckner, & Tomkins, 2013--this issue), through the structure of the therapy session (Dobson & Dobson, 2013--this issue), in the use of self-monitoring (Cohen, Edmunds, Brodman, Benjamin, & Kendall, 2013--this issue), in interventions focused on cognitive change for psychosis (Hutton & Morrison, 2013--this issue), and in exposure to emotions and situations (Clark, 2013--this issue). A concluding piece offering a summary and synthesis for the special series is also provided.

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