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TitleCBT - A Practical Guide to Helping People to Take Control
TagsSocial Stigma Mental Disorder Cognitive Behavioral Therapy Mental Health
File Size1.2 MB
Total Pages255
Table of Contents
                            Book Cover
Title
Copyright
Dedication
Contents
About the author
Foreword: Cognitive behaviour therapy: counteracting the poison of stigma and prejudice
Preface
Acknowledgements
A personal experience by Danny C. K. Lam
Part I: Societal perspective
	Chapter 1 Mental illness stigma
	Chapter 2 Biological and genetic explanations of 'mental illness'
	Chapter 3 Prejudice, discrimination and 'mental illness'
Part II: Therapist's perspective
	Chapter 4 Cognitive behaviour therapy theory of emotional upset
	Chapter 5 Components in cognitive behaviour therapy
	Chapter 6 A shared responsibility approach in the change process
	Chapter 7 Dealing with negative thoughts
	Chapter 8 Dealing with unhelpful behaviour
	Chapter 9 Homework assignments
	Chapter 10 Drug treatments
Part III: Client's perspective
	Chapter 11 Approval and approval-seeking behaviour
	Chapter 12 Perfectionism and competitiveness
	Chapter 13 Healthy and unhealthy negative emotions
	Chapter 14 Fear of failure and procrastination
	Chapter 15 Self-criticism
	Chapter 16 Setback and relapse
Part IV: Client's perspective
	Chapter 17 Others' criticism
	Chapter 18 Good and bad communication
	Chapter 19 Developing effective communication skills
Part V: Therapeutic approach
	Chapter 20 Assessment skills
	Chapter 21 Disputing approach and techniques
Part VI: Taking control
	Chapter 22 Control and choice in mental health
	Chapter 23 An illustration of the cognitive behaviour therapy approach to panic disorder: A case example
References
Index
                        
Document Text Contents
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Cognitive Behaviour Therapy: A Practical
Guide to Helping People Take Control

Cognitive Behaviour Therapy: A Practical Guide to Helping People Take Control

explores the premise that negative beliefs play an important role in the development

and continuation of mental health problems. The book offers a new integrative

model of causality for instigating change, based on giving clients control and choice

over these beliefs, and therefore over their mood and behaviour.

This practical guide also focuses on the stigmas often attached to people with `mental

illness'. Danny C. K. Lam suggests that by providing both the client and the general

public with a more accurate understanding of the nature and causes of mental health

problems it is possible to de-stigmatise the `mental illness' label. This will help the

client improve self-esteem and the ability to manage personal and interpersonal

dif®culties and to take control of their problems and responsibility for recovery.

Divided into six parts, this book covers:

· stigma, prejudice and discrimination from societal perspectives
· the nature and cause of emotional upsets
· a therapeutic framework for change
· self-prejudice, personal and interpersonal issues
· good and bad methods of communication
· practical approaches to assessing problems
· methods of taking control.

This cognitive behavioural approach to mental health problems is an innovative

contribution to the ®eld. Illustrated throughout with clinical examples and practical

advice, the book is essential reading for all of those involved in mental health, from

nurses to counsellors, and from medical practitioners and social workers to

ministers of religion.

Danny C. K. Lam is a Principal Lecturer at Kingston University, St George's,

University of London, a CBT trainer and supervisor and a frequent contributor to the

literature and CBT conferences. He is passionate about developing an effective prac-

tical approach in the treatment of mental health problems, including psychological

assessment, cognitive case formulation, CBT techniques and relapse prevention.

Page 127

the recognition and praise that she had received. Naturally, I added my voice

to the congratulations.

She was tearful, upset and depressed when she came for the next session,

saying that she had done another presentation after the last successful one.

But hardly any people went to her to say anything nice about what she did.

She said that she had put a lot of effort into it and felt that it had gone well.

Not getting the recognition and praise that she craved for had driven her

mood down, so much so that she did not go out or do anything except drink

heavily over the weekend and feel sorry for herself.

Her unhelpful assumption about approval was that `If people did not come

to congratulate me or appreciate my work, this meant that I was not good

enough and I couldn't feel good about myself as a person'.

Cognitive behaviour therapy approach to approval and
approval-seeking behaviour

In CBT terms, not getting people's approval is not the cause of emotional
upset. It doesn't make sense, as not everybody in a similar situation would
end up feeling upset, tearful or depressed. Some would feel upset (e.g., hurt,
anxious or worried), whereas others would feel ®ne with it. We are all
different and therefore our responses to it are likely to be different. Not
getting approval is just a situation (the A of the ABC, see the ABC model
in Chapter 1, pp. 8±12), in a way that is similar to not getting a job
following an interview or not being invited to a wedding. The underlying
problem really lies with the person's thoughts and beliefs about approval
and disapproval and with the way he or she copes with disapproval.

The client often overlooks the fact that it is only his thoughts and beliefs
which have the power either to lift up or lower his spirits. Another person's
approval or disapproval has no control over his mood unless the client
believes what the other person says is valid (e.g. you are no good). If the
client believes the compliment is well earned, it is his belief which makes
him feel good. Similarly, if the client believes the disapproval is terrible, it is
his belief which makes him feel bad.

In working with the client on the issue of approval, the CBT message
is that:

· It is pleasant to have other people's approval or recognition, but it is
not a necessity.

· Self-approval or self-acceptance is the key to developing a stable self-
esteem.

· It is the client's thoughts and beliefs about approval and disapproval
which largely determine his or her spirits.

106 Self-prejudice and personal issues

Page 128

· It is the client's approval-seeking behaviour that causes him or her to
be extremely vulnerable to people's opinions.

· Self-worth does not depend on approval and disapproval.

Technique: Assumption

Rationale and focus

Clients often do not question the assumptions they make about approval
and their need for approval. Their assumption is that they will be `all right'
as a person if they are loved, accepted, praised and recognised. Such an
assumption is problematic on the grounds that nobody can be liked,
accepted, loved or recognised all the time and by everybody, irrespective of
their wealth and social status. By the same token, nobody can be disliked,
rejected, unloved or unrecognised all the time and by everybody.

Such an assumption can be challenged with another `assumption', the
therapist can say: `assuming that you have the approval of everybody today,
what about tomorrow, the day after, next week, next month . . . ?'

Process

Therapist: How important is it to be approved of by people in terms of

acceptance, love and recognition, on a scale of 1 to 100?

Emma: Very important. I will say 95.

Therapist: Because of?

Emma: Oh, I don't know. I suppose it is about rejection: not good enough

and unlovable.

Therapist: So you assume that if people approve of you, you are okay as a

person.

Emma: Yes, in a way.

Therapist: So your self-worth and self-esteem are dependent on people's

approval.

Emma: Oh, yeah.

Therapist: Assuming that you are approved by practically everybody today,

how much effort do you have to make in order to get their

approval?

Emma: A lot. I please people all the time and say what they want to hear.

I often feel tired and exhausted afterwards. It's hard work.

Therapist: Suppose you do not mind putting in the hard work. What

guarantee do you have that you will still have their approval

tomorrow, next week, next month, next year, and for the rest of

your life?

Approval and approval-seeking behaviour 107

Page 254

relapse 146–52, 207, 221; of panic
attacks 217

resentment 167, 181; expression of 183
responsibility 65; client lack of 60–2;

diary 65
Rewriting assumptions technique 12, 49,

74, 81, 98, 108–10, 145, 152, 162,
219

ritualistic checking 76
rivalry 181
role expectations 5
role-play 78, 165, 170

sadness 174, 180–1; normal 120
safety-seeking 79
SANE, UK 16
sarcasm 176; in communication 169
scanning 219
scapegoating, in communication 169
schizophrenia 91, 99, 129, 164, 172
Seeing the event from the other side

technique 118, 137, 151–2, 162
self as agent 208–9
self-acceptance 106
self-approval 106
self-belief 85
self-blame 188; in communication 169
self-confidence 129, 172, 174, 208, 210;

and communication 164–5; and
criticism 138–9, 155–6; and drug
treatments 93; and perfectionism
113; reduction in 92; and self-
criticism 140–2

self-criticism 69, 86, 121, 138–45, 208;
diary 144, 151; and self-confidence
140–2

self-esteem 5–6, 129, 172, 174, 207–8;
and approval 107–8, 110; and
communication 163–5; and criticism
138–9; and drug treatments 93; high
70; low 60, 85, 111, 132, 141, 178,
210; and negative thoughts 69–70;
and perception 93; and setbacks
147–8; stable 70, 106, 155, 210

self-fulfilling prophecy 5, 31
self-harm 18, 92, 208
self-image 172, 210; negative 69; and

perfectionism 113
self-labelling 156
self-perception 207
self-perfection 77
self-prejudice 37, 165

self-stigmatisation 37, 92, 120–1, 129,
172

self-worth 107–8, 110, 132, 158, 160,
162; and perfectionism 113

setback 146–52; normality of 149; in
panic attacks 217

shame 129, 157–8, 180, 208; and
emotional awareness 174; and
perfectionism 113; and self-criticism
141

shared responsibility, in change process
59–66

shared understanding 53
‘sick role’ 31, 84, 129, 140, 207
side-effects, of drugs 92
skills training 76, 78, 165, 170
sleeplessness 21, 24–5
social anxiety 200
social exclusion 3–4
Socrates, on knowledge 209
Socratic questioning technique 188–93,

193, 197, 222
staying better 83, 92, 147, 149, 219
stereotypes 29–30
stigma 207, 209, 222; and CBT 8–13;

common factors in 19; and drug
treatments 91–2; enacted 4–5; of
mental illness 3–13; notes for
therapists on 12–13; perceived 4–5

stress 35, 174, 191, 210, 216; and
communication 166; diary 36, 216,
218–19

structure, and CBT 55–6
suicide 18–19, 92, 94
summary, of CBT sessions 56
Sun and rain technique 126–8
Survey technique 110, 122–6, 219
Swimming analogue technique 78–80,

90
symptoms 19; physical 53–4; reasons for

24

team work 59–60, 64
techniques: ABC model 8–12, 9, 27, 38,

56–7, 216; Acceptance 49, 98, 118,
137, 149–51, 162; Active listening
175–7; An athlete and a sports
coach 64–5; Assumption 107–8;
Balloon 34–6, 216; Benefits of being
fallible and infallible 116–18; Best
friend 110, 128, 137, 197–8, 200–3,
219; The brain 12, 27, 38, 95–8, 216;

Index 233

Page 255

Bricklaying 87±8, 219; cognitive
behaviour 57; Cognitive continuum
12, 49, 74, 81, 118, 128, 135±7, 145,
152, 160±2; Con®rmation 37±8;
Costs and bene®ts analysis 26±7, 38,
48±9, 90, 110, 216; Daughter 49, 66,
90, 98, 100, 110, 118, 128, 145, 198,
201±3, 219; De®ne the term 115±16,
133±5, 219; Developing an
alternative explanation 24±6, 38,
216; Disarming 177±8; Disputing
197±203, 199; Education 62±4, 66,
90; Empathy 178±80; Follow your
son around 143±4; 100 people 10,
46±9, 128, 137, 196, 198, 200, 219; `I
. . .' statements technique 183;
Inquiry 181±2; Judge 49, 71±2; The
law 158±60; Law in the universe
72±4; Prediction 27, 38, 80±1,
88±90, 137, 219; Read it out loud
74, 81, 98, 141±2, 152; Rewriting
assumptions 12, 49, 74, 81, 98,
108±10, 145, 152, 162, 219; Seeing
the event from the other side 118,
137, 151±2, 162; Socratic
questioning 188±93, 197, 222; Sun
and rain 126±8; Survey 110, 122±6,
219; Swimming analogue 78±80, 90;
Territory model 194±7, 195; Turn
the table round 166±7

Territory model technique 194±7, 195

therapists, notes for see notes for
therapists

thinking, and emotional state 189
thought empathy 179±80
thoughts: assessment of 189; Beck's

classi®cation of 195; connection
with emotion and behaviour 192;
unhelpful 198, 218

treatment strategy, for panic attacks 216
truth, in communication 168
Turn the table round technique 166±7

underlying assumptions 68, 107±8; as a
clinical issue 68±70; negative 68±9,
74; positive 68±9, 74; rewriting of
108±10

understanding 209±11
unhealthy emotions 119±28
unhelpful behaviour 86; dealing with

75±82
unhelpful thoughts 198, 218
unpredictability: ratings of 16±17; as

stigmatising factor 8, 19, 30

violence, as stigmatising factor 8, 19, 30

worry 76, 85, 113, 129±30, 165, 216;
about worry 121; normal 119, 223

`You . . .' statements, in communication
183

234 Index

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