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Unread February 27th, 2006, 04:01 AM
Michael Vurek
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Default Re: Is it important to change the client's dysfunctional cognitions?

As a recent explorer of ACT and a long-time fairly traditional CBT therapist I follow this discussion with delight. I have always found mindfulness and acceptance practices in cognitive restructuring, and now I think I can still see cognitive restructuring in ACT. What is currently interesting to observe is my own shifting between guided exploration and broadening of a client's thoughts or beliefs, and guided practice of "acceptance technologies" depending on what's happening in the context of the session or course of treatment. From my CBT training I try to keep an eye on our collaborative conceptualization, and from recent undertandings of DBT and ACT I watch for my own experiential avoidances.

Please excuse the length of the following. It is an outline I recently did for myself in preparation for training in some basic CBT skills.

Doing thought records, in any of a variety of forms, facilitates and is facilitated by mindfulness. We can learn how to observe, describe and write down automatic thoughts, without judgment, and just noticing with curiosity how they are linked to states of mind.

For “facts that support the hot thought” I tend to use the language “what is true” or “what I need to accept”. The point is the same, I believe: to state in objective, factual terms what grains of truth reside in the hot thought. There is more opportunity to practice when we shift "emotional mind" thoughts back up to the automatic thoughts section. It can also be interesting to discern the difference between the emotions associated with these facts, and the ones associated with the hot thoughts - often sadness instead of hopelessness; disappointment instead of anger; etc.

For “facts that don’t support the hot thought” I tend to use the language “what else is true” or “what data lies outside the emotional mind view of the situation”. I emphasize that the practice is designed to “broaden” our view, not necessarily “correct” it. The balanced thought becomes what is true, and what is also true.

The thought record becomes another skill, built of several sub-skills, which the client can take or leave, once they have some sense of it.

Continuums are a parallel tool, giving clients the opportunity to validate the energy associated with the emotion and hot thought, which is the gap between how we want things to be and how they are. We also identify the more complex and variable nature of how things are when we look objectively, rather than via the absolute nature of hot thoughts or rigid beliefs associated with negative states of mind.

I enjoy the natural progression into action plans and experiments. Action plans speak to conditions and behaviors that are associated with the “true” side of thought records or continuums. When our actions or the conditions of our lives are inconsistent with our values, we seek to make changes. It helps to have structure to guide those changes, and a means for predicting the predictable problems that will arise in the process.

Experiments seem to emerge from balanced thoughts (that are logical/reasonable, but not credible) and identified values or aspirations. Values and aspirations emerge from lines of constructive Socratic questioning. Predictions are often about the pain that is naturally inherent in the new behavior – pain that may have been greatly intensified by years of “experiential avoidance”. Beliefs become mile-markers. We can observe how they shift, or gain/lose credibility, over the time of experimentation.

I’m exploring the clinical value of working with core beliefs and schemas. I know that I am interested and curious about them, and encouraging that curiosity can be helpful to clients. There are various “teaching points” regarding observable habits of mind, specifically its propensity to create short-cuts for understanding experiences. We can learn how these short-cuts are 1) conditioned by events and our response to those events; and 2) become “facts” that subsequently influence/distort future responses to unique and new experiences. There is also the very moving experience of clients contacting their schemas with kindness and compassion. It seems to evoke a rich sadness, and may lead to extending kind and compassionate curiosity about other contents and habits of mind.
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