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There are many strategies available to the CBT therapist and their application will depend on what they consider will be the most useful for a client. Some may be used regularly and some may not be used at all. Clients can sometimes really engage with a strategy whilst being completely unreceptive to another one. Once again, it all depends on the client’s circumstances. Let’s consider four, which are used often in CBT.
Analogies
In English, an analogy means that information is transferred from one thing to another. In CBT it is used in exactly this way in an attempt to show clients that their thoughts and behaviours may be being based on information that is not necessarily true. The therapist may find ways of representing the information in another way so that the client can challenge their thoughts in behaviour; in other words, the therapist uses an analogy. To make better sense of this, let’s try and apply it to a situation where a client is angry because her daughter and son-in-law are buying a new house, which isn’t quite as local to her as where they are now.
Case study
Client: I cannot believe that they are just going to move house, I mean it’s over ten miles away and they have already put their house on the market. Why didn’t they ask me before they went ahead with all this? How am I supposed to just drop in on them when they’re miles away?
Clearly the client is upset but her demands appear to be quite unreasonable given the short distance that her family is considering moving. The therapist might point this out and then use an analogy to engage the client in discussion about what is considered to be a reasonable expectation.
Therapist: If I wrote it into our contract here that you had to bring coffee for me and everyone else in this office each time you attended a session, would you consider that to be a reasonable demand?
Expectations are still being discussed, but they have been reframed in the hope that the client can see how unreasonable she is being and perhaps then amend her beliefs about the situation accordingly. Being able to come up with an appropriate analogy is a real skill and this will come with practice, some might be usable in more than one situation.
Modelling
Many clients are acutely aware that their behaviours and thought processes are irrational but they are unable to change them – this is what brings them to therapy. They are also likely to be very aware that others around them deal with situations in a much more positive way than they do and it is the behaviour of significant others in a client’s life that they can use to model their own behaviour.
This is a really important strategy for a client to take on board and practise – they allow themselves time to stop and think before becoming irrational. Instead they think about what the significant person would do in the same situation and try and model their response on that behaviour.
Role reversal
This technique involves the therapist becoming the client and vice versa. This way, the client will be able to hear for themselves how their irrational thinking sounds when it is said aloud by someone else. It also allows the client to take responsibility for some aspects of their behaviour because they will be offering solutions to the ‘client’, which of course will help them because they are that person, simply being impersonated by the therapist.
Imagery
Whilst undoubtedly an effective technique, this can be distressing for clients to engage with at first because it involves them imagining a situation, which, in real life, would provoke very strong negative emotions. Let’s take someone who is afraid of heights as an example. In this CBT strategy the therapist will ask them, whilst in the safe confines of the therapy office, to imagine that they are walking across an extremely high bridge, for example. Initially, a client may be reluctant to do this but hopefully they will be able to create the image and feel the subsequent negative feelings they associate with it. Once this happens, they will be encouraged to change the negative feelings for more positive ones whilst they are safe in the office.
Application of this technique is useful for homework because here the imagined scenario can be gradually swapped for a real one – here the client might start by looking out of a high floor window, before going out on to the balcony etc., before eventually working their way up to actually walking across the high bride in the initial imagery session.
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