Therapeutic change requires the client’s motivation and perseverance, but it can be the path to a new narrative and to more satisfying work and personal relationships. Negative thoughts and emotions have historically been construed as parts of our personality to avoid, deny, hide, or escape. However, thoughts which create disturbing emotions, such as shame, guilt, disappointment, anger, frustration, and fear can be transformed into more rational, empowering, and managed thoughts through a process of acknowledging them as both real and valid but also as often counterproductive to completing daily tasks and as damaging to one’s interpersonal relationships. In this blog we will explore aspects involved in Therapeutic change, including identifying cognitive distortions. to increase cognitive awareness and emotional awareness.
I am currently using a structured 5-phase approach toward helping my clients to develop and utilize more effective coping thoughts and behaviors. These phases can occur in order or may require a “revisiting” when the client encounters new problems or when the client is having difficulty in progressing through one or more of these phases.
Phase 1: Cognitive and Emotional Awareness
The Cognitive Awareness phase consists of an exercise during which I ask the client to rate on a scale of 1 to 5 how often one experiences different cognitive distortions. This phase also consists of an emotional awareness exercise which requires the client to identify dominant emotions, their sources, and current triggering situations which bring out these emotions. This process can take a few sessions or longer, depending upon the client’s motivation to elicit therapeutic change to increase emotional awareness as well as cognitive awareness.
Learning how to identify and to “own” self-doubting, irrational, fear-perpetuating, and, otherwise, unproductive thoughts is the first crucial step toward gaining emotional awareness over such thought patterns. This phase also includes helping the client to identify triggers which can cause disturbing emotions and dysfunctional behavioral responses. Finally, the client is guided in identifying strengths and challenges in managing one’s daily tasks and relationships. This phase must be completed prior to developing the client’s emotional awareness towards their therapeutic plan, but it may be revisited when the client encounters new challenges or is having difficulty with existing challenges.
Phase 2: Cognitive Restructuring
Therapeutic Change begins with the Cognitive Restructuring phase consists of prompting the client to verbalize at least 3 specific and frequent “I” statements which relate to EACH of the cognitive distortions with the higher ratings on the 1 to 5 scale, as identified during Phase 1. This phase also focuses on helping the client to track the accuracy and validity of each of these cognitive distortions, as well as prompting the client to verbalize at least 3 memories or experiences which have created each of the cognitive distortions with the higher ratings. The main purpose of this phase is to help the client to dissect one’s cognitive distortions. Cognitive changes can only occur after the client has attained a full understanding of the roots of the cognitive distortions.
The Cognitive Restructuring phase involves exploring how past experiences and messages are creating current emotional and behavioral responses. I then guide the client in identifying revised, healthier emotional and behavioral responses. This phase also includes weekly monitoring of the client’s reactions to triggering thoughts and experiences, particularly regarding significant people in one’s life. After helping the client to clarify negative self-statements and ruminating thoughts, we can then develop a therapeutic plan consisting of cognitive and behavioral changes to benefit therapeutic change.
Phase 3: Mindfulness Training and Monitoring
The Mindfulness Training and Monitoring phase focuses on three specific areas of the client’s daily functioning: (1) physical activities, (2) sensations and feelings, and (3) mental activities. Physical activities include social interactions, nutrition habits, exercise, and career-focused and/or academic-focused behaviors. Sensations and feelings include past and present emotions, which are both inspiring and challenging. Mindfulness skills are taught to the client and are particularly important in helping the client to truly identify and process emotions as they occur and not to push them aside. Mental activities include the client’s specific thoughts, perceptions about daily experiences and interactions, emotional triggers, and memories. The Mindfulness Training and Monitoring phase is key to increasing the client’s self-awareness and self-control. This phase also teaches the client to embrace all emotions as they are and not how others think that they “should” be.
During this phase, the client must be willing to move out of one’s comfort zone and to try hard to start viewing situations with no self-judgment and no impulsive pushing down of any emotional responses to these situations. This skill is the first step toward moving from being out of control to achieving emotional, cognitive, and behavioral control. Mindful awareness can create a continuous sense of empowerment, patience, and self-compassion in all situations. Most importantly, the client can develop an excellent and valuable introspective ability to carry throughout the remainder of one’s life. When the client can learn to accept what has happened and what is happening in one’s life path, then regrets, insecurities, and pain can gradually dissipate.
Phase 4: Action Plan for Creating your Ideal Narrative
The Action phase is the true test of the client’s motivation to apply the coping behaviors and revised thoughts which have been identified in one’s therapeutic plan. This phase is focused upon taking action in each moment of each day, with the intention of living as one’s true higher self. During this phase, the client will follow a structured and proactive plan for acknowledging disturbing and unproductive thoughts, using thought-stopping strategies when these thoughts create too much emotional pain, using thought-replacement strategies to refocus on the present moment, committing to writing one’s thoughts and feelings in a daily journal, and implementing more effective coping behaviors which have been discussed during the therapy sessions. During the Action phase, I prompt the client to process and to better understand how one’s thoughts can lead to dysfunctional behaviors and debilitating emotions.
The main goal of the Action phase is to promote the client’s movement toward more confident and balanced thoughts, which will then result in healthier behaviors in relation to external events. Revising one’s thoughts and beliefs can greatly decrease the client’s anxiety, depression, and other symptoms. During this phase, the client utilizes actions which lead to a decrease in the intensity of the emotions which the client has been experiencing in response to painful memories or anxiety-provoking situations. Most importantly, the Action phase is about viewing oneself as a strong and wise “warrior” and not as a helpless victim.
Phase 5: Evaluation of Accomplishments and Challenges
During the Evaluation phase, the client identifies daily tasks which were accomplished and any tasks which caused difficulty. This task identification process pushes the client to honestly explore how certain behaviors can either positively or negatively impact the achievement of one’s most important life goals. During this phase, I prompt the client to identify accomplishments within the areas of work, school, social situations, and significant relationships. When the client can constructively process and learn from negative thought and behavioral patterns, then the fears and insecurities of life’s events will gradually decrease. I also prompt the client to openly discuss any setbacks in implementing coping behaviors or in managing one’s emotional triggers.
Personal growth and transformation will gradually occur as the client navigates through new coping skills and continues learning from difficult situations or painful emotions. Through this process, the client creates a resilience, or a buffer, when facing any life event. I continuously guide the client in using introspection as a tool for clarifying one’s accomplishments and setbacks with the goals in one’s therapeutic plan. I encourage the client to remain committed to a new perspective toward external circumstances. This new perspective is “being the master of one’s fate.”
What do the 5 phases mean to me?
These 5 phases contain much personal meaning to me, in that I have practiced them in varying orders for the past 10 years. These 5 phases represent my true purpose as a therapist. The desired outcome of these 5 phases is the client’s emotional well-being and interpersonal well-being. Emotional well-being is created by confidence in your ability to practice effective thinking patterns and satisfying behavioral coping strategies. Furthermore, when you have emotional well-being, you accept all moods and emotional states as catalysts for increased and unconditional self-acceptance. Interpersonal well-being is experienced after you deeply explore and commit to your core values and to your most important personal goals in life. This well-being also results from using authentic and mindful words and actions in your romantic relationships, work relationships, peer relationships, and family relationships.
In sum, there will be situations which cause self-doubt, sadness, and anxiety, but you must continue to refocus on YOUR actions and YOUR thoughts, which are separate from what you believe that others want or how you perceived yourself in the past. Doing your best each day can be simply completing your work, personal, and parental tasks. You will make progress and will have setbacks, but the point is to stay focused on the genuine and complete acceptance of yourself and on taking action in any circumstance. You will generate positive emotions through a willingness to learn from your negative emotions, as opposed to hiding them. Finally, if you keep trying to be mindful of your daily actions and accomplishments, you can gradually learn how to accept negative circumstances as part of the therapeutic process and not as obstacles to your mental stability and strength.
Interested? Keep reading to learn about Neuroplasticity!
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