NUR COUNSELING LLC

Role of Your Therapist:

Therapy is a collaborative relationship based on trust and accountability. Good fit between the patient and the skills and personality of the therapist is important. The counselor serves like a magnifying glass on your true self, pulling the light out of you and paves the way for you to achieve fulfillment. I will never tell you to do anything of which you’re not comfortable or ready. My role is to stretch you to your limit, but not beyond it. My therapeutic environment is nonjudgmental, supportive, compassionate, collaborative, interactive, goal oriented and empowering. Sessions focus on here and now however, we also take a journey to your past and your future concerns as needed. Together we will explore your emotional obstacles, behavioral patterns and perceptions that no longer serve you. I will make suggestions to help you avoid repetitive patterns that don’t serve in your best interest and how to make adjustments in how you think, feel, act and communicate.

How Aynur Fox Can Help with CBT:

When a person feels depressed or anxious, his/her perceptions and interpretations become distorted. A distorted view can make someone more susceptible to a negative mindset, jumping to conclusions, mistakenly seeing situations as catastrophic, seeing things as either good or bad with nothing in between. Fear is at the root of anxiety, and so discovering the core fear that drives anxiety is important in cognitive therapy. If people learn fearful or negative ways of thinking, they can start to think in this way automatically. CBT focuses on challenging these automatic thoughts and comparing them with reality. If  people can change their way of thinking, their distress decreases and they can function in a way that is more likely to benefit them and those around them. As the individual acquires new skills, it becomes easier for them to solve problems in a constructive way. This can reduce stress, help them to feel more in control, and reduce the risk of a negative mood. CBT helps patients with:

Identify problems more clearly; Develop an awareness of automatic thoughts; Challenge underlying assumptions that may be wrong; Distinguish between facts and irrational thoughts; Understand how past experience can affect present feelings and beliefs; Stop fearing the worst and face their fears rather than avoid them; See a situation from a different perspective; Better understand other people’s actions and motivations; Develop a more positive way of thinking and seeing situations; Become more aware of mood and overreactions; Establish attainable goals, eliminate task interfering cognitions that results lack of motivation and procrastination; Avoid generalizations, all-or-nothing thinking and cognitive distortions; Stop taking the blame for everything; Focus on how things are rather than how they think they should be; Describe, accept, and understand rather than judge themselves or others.

There are three phases to treatment:
1) Assessment: The first session or two focuses on assessing the nature of your anxiety or depression. The therapist will ask lots of questions about the history of your anxiety/depression, its symptoms, your everyday experiences with it, and how you’ve tried to cope. The goal of the assessment is to understand the nature of your anxiety/depression and develop a treatment plan that will work for you.

2) Intervention: This is the main part of cognitive therapy, which focuses on identifying the problematic thinking that is making you anxious/depressed, correcting these thoughts, helping you discover a new perspective on anxiety, and structuring action plans that will alter how you deal with episodes of anxiety. To understand anxiety you need to know its symptoms or how it is expressed in the physical, cognitive, behavioral, and emotional domains. The basic idea of the CBT therapy is as follows: 

          Life Situation, Event (Trigger) → Thought (perception, interpretation) → Feeling (tense, anxious)

3) Termination: The final few sessions occur less frequently and focus on skills necessary for dealing with the occasional return of anxiety/depression. Therapists refer to this as relapse prevention, and its goal is to ensure the person has the ability to cope with future experiences of anxiety/depression without therapist assistance.

Structure of a Typical Cognitive Therapy Session

1. Weekly review and anxiety/depression check: Each session begins with the patient providing a brief report on any anxiety/depression-relevant experiences during the week as well as a rating of the frequency and intensity of anxiety/depression episodes. (5–10 minutes).
2. Set session agenda: The therapist and patient together set an agenda of issues for the therapy session. (5 minutes).
3. Evaluate previous session action plan: The results or outcome of the last session action plan are discussed and evaluated. What has the client learned from doing this between-sessions task? How can this be incorporated into a strategy for reducing anxiety/depression? (5 - 10 minutes).
4. Primary session topic(s):The main part of the session focuses on identifying, evaluating, and modifying specific problematic thoughts, beliefs, and behaviors that maintain anxiety. (15 minutes).
5. Develop action plan: An action plan is developed that the patient does as homework between sessions. The action plan is based on the outcome of the “primary session topic.” (5 - 10 minutes).
6. Session summary and feedback: The patient provides a summary of the main points of the session and feedback on what patient found most and least helpful. (5 minutes).

Therapeutic Style of CBT

• Education: Learning is a fundamental feature of cognitive therapy. The therapist assumes the role of consultant or teacher, who provides guidance and instruction on how to learn to overcome anxiety/depression.
• Collaboration: The patient is an active participant in the therapy process. Together the therapist and patient set the goals and direction for therapy and work together to discover the best cognitive and behavioral strategies for reducing anxiety/depression.
• Socratic questioning: The CBT therapist poses a series of questions and then summarizes patients’ answers to emphasize how certain thoughts, beliefs, perceptions, and behaviors are responsible for anxiety and its relief. (“What did you think was the worst possible outcome in that situation?” “How likely was this to happen?” “What were the chances you could have coped successfully with this situation?”
• Guided discovery: The CBT therapist relies on probing questions to help individuals discover for themselves the root causes of their anxiety and how best to overcome it. The therapist avoids directly telling patients what is wrong or what to do but instead uses systematic questioning to guide individuals toward their own “cognitive self-discovery.”
• Collaborative experimentation: Together the patient and therapist develop action plans or behavioral assignments that determine the best strategies to reduce fear and anxiety. It is well known that change comes best through experience.

If you are engaged in another form of psychotherapy, and it primarily concerns some other problem (such as family or relationship difficulties), you should have no problem simultaneously undergoing cognitive therapy for anxiety. But it’s not a good idea to be engaged in two different therapies for anxiety, because the effectiveness of each is likely to be reduced significantly. In our experience it’s best to commit exclusively to cognitive therapy for anxiety over a 3-to 6-month period, either with or without medication.

Patient Responsibility:

Each session is designed to provide you the tools and teach you techniques to help you manage your challenges outside of the session that will make you feel confident, safe, and stay focused on your goals. I offer you readings, worksheets, behavioral experiments, reflection questions, relaxation techniques, mindfulness concepts, audios and videos based on your unique needs. Completing homework assignments in between sessions is essential for progress and good therapeutic outcome. All the discussions, tools, exercises, and wisdom shared during sessions are irrelevant if you don’t act upon it. 

Suggested Readings and Self- Help Books: 

Psychoeducation/Coping Skills/Articles: www.facebook.com/www.nurcounseling.org 

Click here to download the list of Book Suggestions