Acceptance and commitment therapy (ACT) is an action-oriented approach to psychotherapy that stems from traditional behaviour therapy and cognitive behavioural therapy. Clients learn to stop avoiding, denying, and struggling with their inner emotions and, instead, accept that these deeper feelings are appropriate responses to certain situations that should not prevent them from moving forward in their lives. With this understanding, clients begin to accept their hardships and commit to making necessary changes in their behaviour, regardless of what is going on in their lives and how they feel about it.

ACT was developed in the 1980s by psychologist Steven C. Hayes, a professor at the University of Nevada. The ideas that coalesced into ACT emerged from Hayes’s own experience, particularly his history of panic attacks. Eventually, he vowed that he would no longer run from himself—he would accept himself and his experiences.

"We as a culture seem to be dedicated to the idea that ‘negative’ human emotions need to be fixed, managed, or changed—not experienced as part of a whole life. We are treating our own lives as problems to be solved as if we can sort through our experiences for the ones we like and throw out the rest," Hayes writes in a Psychology Today post. "Acceptance, mindfulness, and values are key psychological tools needed for that transformative shift."

When It's Used

ACT can help treat many mental and physical conditions. These include:

• Anxiety disorders

• Depression

• Obsessive-compulsive disorder

• Psychosis

• Eating disorders

• Substance use disorders

• Workplace stress

• Chronic pain

What to Expect

Working with a therapist, you will learn to listen to your own self-talk or the way you talk to yourself specifically about traumatic events, problematic relationships, physical limitations, or other challenges. You can then decide if a problem requires immediate action and change or if it can, or must, be accepted for what it is while you learn to make behavioural changes that can modify the situation. You may look at what hasn’t worked for you in the past, and the therapist can help you stop repeating thought patterns and behaviours that can cause you more problems in the long run. Once you have faced and accepted your current challenges, you can make a commitment to stop fighting your past and your emotions and, instead, start practising more confident and optimistic behaviour, based on your personal values and goals.

ACT aims to develop and expand psychological flexibility. Psychological flexibility encompasses emotional openness and the ability to adapt your thoughts and behaviours to better align with your values and goals.

The six core processes that promote psychological flexibility are:

1. Acceptance

Acceptance involves acknowledging and embracing the full range of your thoughts and emotions rather than trying to avoid, deny, or alter them.

2. Cognitive Defusion

Cognitive defusion involves distancing yourself from and changing the way you react to distressing thoughts and feelings, which will mitigate their harmful effects. Techniques for cognitive defusion include observing a thought without judgement, singing the thought, and labelling the automatic response that you have.

3. Being Present

Being present involves being mindful in the present moment and observing your thoughts and feelings without judging them or trying to change them; experiencing events clearly and directly can help promote behaviour change.

4. Self as Context

Self as context is an idea that expands the notion of self and identity; it purports that people are more than their thoughts, feelings, and experiences.

5. Values

Values encompass choosing personal values in different domains and striving to live according to those principles. This stands in contrast to actions driven by the desire to avoid distress or adhere to other people’s expectations, for example.

6. Committed Action

Committed action involves taking concrete steps to incorporate changes that will align with your values and lead to positive change. This may involve goal setting, exposure to difficult thoughts or experiences, and skill development.

How It Works

The theory behind ACT is that it is counterproductive to try to control painful emotions or psychological experiences; suppression of these feelings ultimately leads to more distress. ACT adopts the view that there are valid alternatives to trying to change the way you think, and these include mindful behaviour, attention to personal values, and commitment to action. By taking steps to change their behaviour while, at the same time, learning to accept their psychological experiences, clients can eventually change their attitudes and emotional states.

What to Look for in an Acceptance and Commitment Therapist

Look for a licensed, experienced therapist, social worker, professional counsellor or other mental health professional with additional training in ACT. There is no special certification for ACT practitioners. Skills are acquired through peer counselling, workshops, and other training programs. In addition to these credentials, it is important to find a therapist with whom you feel comfortable.

References

Forman EM, Herbert JD, Moitra E, Yeomans PD, Geller PA. A randomised controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behaviour Modification. November 2007;31(6):772-799      

Hayes, S. About ACT. Association for Contextual Behavioural Science. Accessed Feb 6 2017.

Dewane, C. The ABCs of ACT. Social Work Today. Sept/Oct 2008;8(5):34.

Long, D. ACT Certification. Assoc for Contextual Behavioural Science. Accessed feb 6, 2017.

Last updated: 03/21/2022

Psychological coaching is a process that aims to help clients achieve concrete goals, identify and overcome obstacles to well-being and performance, and build skills that may be interfering with their success. Coaching is specific, goal-oriented, and can be conducted one-on-one or in a group. Like sports coaching, psychological coaching concentrates on individual or group strengths and abilities and how they might be used in new and different ways to enhance performance, feel better about the self, ensure smooth life transitions, strengthen relationships, deal with challenges, achieve goals, become more successful, or improve the overall quality of one’s personal and professional life.

In general, coaching does not deal extensively with the negative, irrational, or pathological aspects of life; it also tends to be present- and future-oriented, rather than dwelling on the past. In these ways and others, coaching is distinct from therapy, as therapists are trained to directly address mental health concerns and may explore a patient’s emotions, childhood, or other past experiences in a way a coach would not. Therapy is also much more strictly regulated than coaching and coaches may not have the same academic or professional credentials that therapists hold. However, some practitioners who call themselves coaches may also be licensed psychologists, and coaches and therapists may at times help clients work through very similar challenges.

Coaching can be effective for certain individuals or organisations, and some studies and meta-analyses have concluded that it tends to have an overall positive effect in areas like performance, well-being, coping skills, attitudes toward work, and goal-directed self-regulation. However, because the term “coaching” is loosely defined and the industry is largely unregulated, it may not be a positive experience for everyone. It’s important that clients take the time to vet potential coaches and identify one who is experienced and knowledgeable about their particular concerns.

When It's Used

There are several different types of coaches, including executive or career coaches, health coaches, and personal life coaches, who aim to help clients overcome day-to-day issues that may be interfering with their career, relationships, or general happiness. Life coaching, in particular, has grown in popularity in recent years; this is thought to be in part due to the ongoing shortage of therapists and lingering stigma surrounding mental health care. While many life coaches take a broad approach and then tailor their practice to each client’s specific needs, others specialise in one particular area, like relationships or self-esteem, that is especially likely to cause individuals stress.

Coaching can be used in schools, business organisations, performance venues, and individual counselling programs. A health coach at a worksite wellness program, for instance, may provide individual and group weight control counselling to employees or provide them with the skills and motivation they need to improve their health and set goals to maintain a healthier lifestyle. A career coach, on the other hand, may work with clients one-on-one to help them identify fulfilling career paths, strengthen their resume or interviewing skills, and take any other steps needed to secure a job in their chosen field. Career coaches usually aim to make use of positive resources, such as hope, resilience, and optimism, all of which can help clients improve job satisfaction, performance, and dedication in the workplace.

In general, coaching should not be used to treat diagnosable mental health conditions, as coaches are not required to have training in these areas and are not subject to the same ethical codes or medical privacy laws that therapists are. However, many coaches do assist clients who struggle with subclinical anxiety or depression; others may offer sobriety support to someone who has already been treated for substance abuse and is in recovery.

What to Expect

Most coaching is short-term and consists of straightforward, supportive, solution-based counselling. Depending on the client’s specific needs, the coach and client may explore techniques to alleviate stress, cope with specific challenges, successfully navigate upcoming transitions, and make more positive choices in the client’s personal or professional life.

Coaching is largely client-directed; often, the client will come in with specific issues or concerns they wish to address, and the coach will guide them toward identifying possible solutions and developing strategies to attain them. Coaches may also encourage clients to practice visualisation, mindfulness, or other calming techniques to help promote positive emotions as the client works toward his or her goals.

Coaching styles may vary, depending on the type of coaching required or whether the client is involved in private or group coaching. For instance, a worksite coaching program may include both individual counselling and group activities that emphasise the needs of the organisation as well as those of the individual within the group.

Coaches may meet with their clients in person, on the phone, or via video chat platforms such as Skype or Zoom. Because U.S.-based coaches are not subject to state licensing like therapists are, they can meet virtually with clients anywhere in the country. Sessions usually occur on a regular schedule over a set period of time, though some individual practitioners may take a more informal or open-ended approach.

How It Works

Coaching is based on fairly straightforward principles—notably, that many people need help overcoming common obstacles to personal and professional success, and getting support from a third party who has expertise in a particular area can be helpful toward that end. Many coaches, no matter their specialty, aim to identify and bolster a client’s inherent strengths in order to help them lead a more authentic, motivated, and successful life.

A systematic review of studies, published in the International Coaching Psychology Review, identified five key factors that help determine the effectiveness of a positive coaching relationship. These include:

1. Establishing and maintaining trust

2. The coach’s understanding and ability to manage a client’s emotional responses and problems with empathy

3. Two-way communication

4. The coach’s ability to facilitate and help the client’s learning and development to reach goals

5. A clear contract and transparent process

What to Look For in a Coach

Because coaching is an unregulated field—meaning there are no official minimum requirements to become a coach and no certification or licensing requirements—anyone can use the title and practice coaching. Some people who call themselves coaches but have no specific training or degrees base their practice and advice largely on their own personal experience or past experiences assisting others.

At the same time, many licensed therapists, clinical social workers, and licensed professional counsellors are now involved in executive coaching, health coaching, performance coaching, and life coaching, as well as in training other mental health professionals through various methods to become coaches in specific fields. A trained mental health professional has the advantage of an education in, and broad understanding of, human behaviour as well as the clinical experience required by the profession.

Coaches with various educational and experiential backgrounds may be certified at the associate, professional, and master levels by the International Coach Federation. Coaches may also be licensed by the American Counselling Association. Some clients feel more comfortable working with coaches who have attained such certifications, but they are not required.

Coaching works best when the client feels heard, understood, and as if they can be their authentic self. Thus, as with a therapist, in addition to finding someone with the credentials and experience relevant to your needs, it is important to find someone who provides a counselling environment in which you feel safe and comfortable.

References

Tim Theeboom, Bianca Beersma & Annelies E.M. van Vianen (2014) Does coaching work? A meta-analysis on the effects of coaching on individual level outcomes in an organisational context, The Journal of Positive Psychology, 9:1, 1-18, DOI: 10.1080/17439760.2013.837499

Lai Y-L and McDowall A. A systematic review (SR) of coaching psychology: focusing on the attributes of effective coaching psychologists. International Coaching Psychology Review. September 2014.    

Clark MM, Bradley KL, Jenkins SM, et al. Improvements in health behaviours, eating self-efficacy, and goal-setting following participation in wellness coaching. American Journal of Health Promotion. 25 August 2015.

International Coach Federation

Avey JB, Richard RJ, Luthans F, Mhatre KH. Meta-analysis of the impact of positive psychological capital on employee attitudes, behaviours, and performance. 10 June 2011;22(2):127-152.

DeAngelis, T. First Class Coaching. American Psychological Association Monitor on Psychology. November 2010;41(10):48.

Govindji R, Linley PA, Strengths use, self-concordance and well-being: implications for strengths coaching and coaching psychologists. International Coaching Psychology Review. 2 July 2007;2(2)

Last updated: 07/27/2022

Cognitive behavioural therapy (CBT) is a short-term form of psychotherapy based on the idea that the way someone thinks and feels affects the way he or she behaves. CBT aims to help clients resolve present-day challenges like depression or anxiety, relationship problems, anger issues, stress, or other common concerns that negatively affect mental health and quality of life. The goal of treatment is to help clients identify, challenge, and change maladaptive thought patterns in order to change their responses to difficult situations.

Originally called simply “cognitive therapy,” what is now CBT was developed in the 1960s and 1970s by psychiatrist Aaron Beck, who found that helping depressed patients recognize and challenge their automatic negative thoughts had a positive impact on their symptoms. Beck drew on theories developed by psychologist Albert Ellis, the creator of rational emotive behaviour therapy (REBT), among others, to develop an approach that was short-term and goal-oriented, in contrast to the dominant modalities of the time. Though it was originally designed to treat depression, since its inception CBT has been found to be effective for a wide range of mental health conditions and day-to-day psychological challenges, and is recommended as the first-line treatment for disorders including depression, anxiety, and insomnia.

When It's Used

CBT is appropriate for children, adolescents, and adults and for individuals, families, and couples. A large body of research has found it to be either highly or moderately effective in the treatment of depression, generalised anxiety disorder, post-traumatic stress disorder, general stress, anger issues, panic disorders, agoraphobia, social phobia, eating disorders, marital difficulties, obsessive-compulsive disorder, and childhood anxiety and depressive disorders. CBT may also be effective as an intervention for chronic pain conditions and associated distress. CBT can be used alone or in conjunction with psychiatric medication. Some studies have found that CBT and medication are equally effective in treating depression.

Specialised forms of CBT may also be used to treat specific conditions. For example, cognitive behavioural therapy for insomnia, or CBT-I, has been found to be a highly effective short-term treatment for chronic insomnia; it is now the recommended first-line treatment for individuals struggling with insomnia. Another example is enhanced cognitive behavioural therapy, or CBT-E, a form of CBT specifically designed to treat eating disorders. Brief cognitive behavioural therapy, or BCBT, is a shortened form of CBT used in situations where the client is not able to undergo a longer course of therapy.

What to Expect

CBT is a structured form of psychotherapy that can occur in a relatively short period of time—often between 5 and 20 weekly sessions, generally around 45 to 50 minutes each. CBT usually starts with one or two sessions focused on assessment, during which the therapist will help the client identify the symptoms or behaviour patterns that are causing them the most problems and set goals for treatment. In subsequent sessions, the client will identify the negative or maladaptive thoughts they have about their current problems and determine whether or not these thoughts are realistic. If these thoughts are deemed unrealistic, the client will learn skills that help them challenge and ultimately change their thinking patterns so they are more accurate with respect to a given situation. Once the client’s perspective is more realistic, the therapist can help them determine an appropriate course of action.

CBT usually concludes with a session or two of recapping, reassessing, and reinforcing what was learned. If necessary, someone may return to therapy for periodic maintenance sessions. Along the way, clients will most likely be given “homework” to do between sessions. That work will typically include exercises that will help them learn to apply the skills and solutions they came up with in therapy to real-world situations in their day-to-day life.

While cognitive behavioral therapy may sound simple—CBT therapist Seth Gillihan writes that he tells clients that the things he’ll ask them to do are “stupidly obvious”—it can be quite challenging in practice. Our patterns of thinking are often deeply entrenched and habitual—and as with any long-standing habit, it can be an arduous process to replace one thought pattern with a new, healthier one. And while clients undergoing CBT will likely not spend a large amount of time exploring their childhood or past, they may still be asked to examine thoughts and behaviour patterns that they may find embarrassing or shameful. As in all types of therapy, it is important to work with a therapist with whom one can be open and candid.

How It Works

CBT integrates behavioural theories and cognitive theories to conclude that the way people perceive a situation determines their reaction more than the actual reality of the situation does. When a person is distressed or discouraged, his or her view of an experience may not be realistic. Changing the way clients think and see the world can change their responses to circumstances.

CBT often targets cognitive distortions, or irrational patterns of thought that can negatively affect behaviour. Common cognitive distortions include all-or-nothing thinking (seeing everything in black-and-white terms and ignoring nuance), catastrophizing (always assuming the worst will happen), and personalization (believing that the individual is responsible for everything that happens around them, whether good or bad).

For example, someone who is prone to catastrophizing may assume that a friend who doesn't text them back right away is angry at them, potentially leading them to withdraw socially, lash out at the friend, ruminate, or otherwise behave in a non-productive way. Using CBT, they may learn to recognize their tendency to jump to the worst possible conclusion—and the next time their friend does not return their text, they can remind themselves that the friend has always returned texts in the past and may simply be busy. Such reframing can help someone refrain from engaging in counterproductive behaviour.

CBT is rooted in the present, so the therapist will initially ask clients to identify life situations, thoughts, and feelings that cause acute or chronic distress. The therapist will then explore whether or not these thoughts and feelings are productive or even valid. The goal of CBT is to get clients actively involved in their own treatment plan so that they understand that the way to improve their lives is to adjust their thinking and their approach to everyday situations.

What to Look for in a Cognitive Behavioural Therapist

CBT is among the most widely-utilised therapeutic approaches, so many people are able to locate a therapist in their area who practices it, but CBT has also been found to be effective when delivered online. There is no particular certification or licence required to practice CBT, but clients are advised to look for a credentialed mental health professional with specialised training and experience in cognitive behavioural therapy. In addition to confirming these credentials, it is important to find a therapist with whom one feels comfortable, as CBT is a collaborative process and a strong therapeutic alliance is critical to its success.

References

Beck, J. S., & Fleming, S. (2021). A Brief History of Aaron T. Beck, MD, and Cognitive Behaviour Therapy. Clinical Psychology in Europe, 3(2), 1-7. https://doi.org/10.32872/cpe.6701

Beck Institute of Cognitive-Behavioural Therapy.

Hupp SDA, Reitman D, Jewell JD. Cognitive-Behavioural Theory. Handbook of Clinical Psychology. Vol. 2. Children and Adolescents. 2008 John Wiley & Sons, Inc.

Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioural therapy: a review of meta-analyses. Clinical Psychology Review. January 2006;26(1):17-31. [Abstract]

Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A. The efficacy of cognitive-behavioural therapy: a review of meta-analyses. Cognitive Therapy and Research. October 2012;36(5):427-440.

Wood J, Piacentini JC, Southam-Gerow M, Chu BC, Sigman M. Family cognitive behavioural therapy for child anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry. March 2006;45(3):314-321.

Wood J, Piacentini JC, Southam-Gerow M, Chu BC, Sigman M. Family cognitive behavioural therapy for child anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry. March 2006;45(3):314-321.

Last updated: 06/17/2022

Dialectical behaviour therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.

When It's Used

DBT was originally developed to treat borderline personality disorder. However, research shows that DBT has also been used successfully to treat people experiencing depression, bulimia, binge-eating, bipolar disorder, post-traumatic-stress disorder, and substance abuse. DBT skills are thought to have the capability of helping those who wish to improve their ability to regulate emotions, tolerate distress and negative emotion, be mindful and present in the given moment, and communicate and interact effectively with others.

What to Expect

DBT treatment typically consists of individual therapy sessions and DBT skills groups. Individual therapy sessions consist of one-on-one contact with a trained therapist, ensuring that all therapeutic needs are being addressed. The individual therapist will help the patient stay motivated, apply the DBT skills within daily life, and address obstacles that might arise over the course of treatment.

DBT skills group participants learn and practice skills alongside others. Members of the group are encouraged to share their experiences and provide mutual support. Groups are led by one trained therapist teaching skills and leading exercises. The group members are then assigned homework, such as practising mindfulness exercises. Each group session lasts approximately two hours, and groups typically meet weekly for six months. Groups can be shorter or longer, depending on the needs of the group members. DBT can be delivered by therapists in many ways. For instance, some people complete the one-on-one therapy sessions without attending the weekly skills group. Others might choose the group without regular one-on-one sessions.

How It Works

DBT is a cognitive-behavioural treatment developed by Marsha Linehan, Ph.D., in the 1980s to treat people with borderline personality disorder. Those diagnosed with BPD often experience extremely intense negative emotions that are difficult to manage. These intense and seemingly uncontrollable negative emotions are often experienced when the individual is interacting with others—friends, romantic partners, family members. People with borderline often experience a great deal of conflict in their relationships.

As its name suggests, DBT is influenced by the philosophical perspective of dialectics: balancing opposites. The therapist consistently works with the individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white—the all-or-nothing styles of thinking. In service of this balance, DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change.

What to Look for in a Dialectical Behaviour Therapist

DBT assumes that effective treatment, including group skills training, must pay as much attention to the behaviour and experience of providers working with clients as it does to clients’ behaviour and experience. Thus, treatment of the providers is an important part of any DBT program, and therapists should practice the skills themselves. They need to know basic behaviour therapy techniques and DBT treatment strategies. Look for a mental health professional with specialised training and experience in DBT. The Linehan Board of Certification, a non-profit organisation, has developed certification standards for clinicians. In addition, it is important to find a therapist with whom you feel comfortable working.

References

Chapman AL. Dialectical Behaviour Therapy: Current Indications and Unique Elements. Psychiatry. Sep 2006;3(9):62-68

Panos PT, Jackson JW, Hasan O, Panos A. Meta-analysis and systematic review assessing the efficacy of Dialectical Behavior Therapy (DBT). Research on Social Work Practice. 2014;24(2).

Valentine S, BankoffSM, Poulin RM, Reidler EB, Pantalone DW. The use of dialectical behaviour therapy skills training as stand-alone treatment: A systematic review of the treatment outcome literature. Journal of Clinical Psychology. Jan 2015;71(1):1-20.

Trauma-focused cognitive behavioural therapy (TF-CBT) addresses the mental health needs of children, adolescents, and families suffering from the destructive effects of early trauma. The treatment is particularly sensitive to the unique problems of youth with post-traumatic stress and mood disorders resulting from sexual abuse, as well as from physical abuse, violence, or grief. Because the client is usually a child, TF-CBT often brings non-offending parents or other caregivers into treatment and incorporates principles of family therapy.

The trauma-focused approach to therapy was first developed in the 1990s by psychiatrist Judith Cohen and psychologists Esther Deblinger and Anthony Mannarino, whose original intent was to better serve children and adolescents who had experienced sexual abuse. TF-CBT has expanded over the years to include services for youths who have experienced many forms of severe trauma or abuse.

When It’s Used

TF-CBT was originally geared toward helping children who were the victims of sexual abuse, but its scope has widened to include children and adolescents who have experienced a single or repeated experience of sexual, physical, or mental abuse or who have developed post-traumatic symptoms, depression, or anxiety.

If a child or adolescent also exhibits serious behavioural, substance abuse, or suicidal ideation, other forms of treatment, such as dialectical behaviour therapy, may be more appropriate as an initial intervention and can be followed up with a trauma-sensitive approach.

What to Expect

TF-CBT is a short-term intervention that generally lasts anywhere from eight to 25 sessions and can take place in an outpatient mental health clinic, group home, community centre, hospital, school, or in-home setting. Treatment takes place with a non-offending parent or caregiver. Often, the treatment will begin where the child and non-offending caregiver have separate therapy sessions and advance to engaging in joint sessions.

Cognitive behavioural techniques are used to help modify distorted or unhelpful thinking and negative reactions and behaviours. Learning to challenge intrusive thoughts of guilt and fear can help a patient to reorganise their thinking in a healthier and happier way.

The family therapy aspect of trauma-focused CBT attends to the problems family members may have in dealing with the trauma suffered by the child, including the use of various stress management, communication, and parenting skills.

Research comparing TF-CBT to other treatment models shows significantly greater gains in well-being for children and parents.

How It Works

Early trauma can lead to guilt, anger, feelings of powerlessness, self-harm, acting out, depression, and anxiety. Post-traumatic stress disorder, which affects children and adults, can manifest in a number of ways, such as negative recurring thoughts about the traumatic experience, emotional numbness, sleep problems, difficulty concentrating, and extreme physical and emotional responses to anything that triggers a memory of the trauma.

By integrating the theories and techniques of several therapeutic interventions, TF-CBT can address and improve the symptoms of post-traumatic stress in youth. Core features of TF-CBT treatment include:

• Psychoeducation, which teaches the victim about the normal reactions to traumatic experiences. This can help them reduce feelings of guilt or culpability for what happened.

• Coping skills, including relaxation exercises like deep breathing, mindfulness, acceptance, identifying and redirecting thoughts, and other methods.

• Gradual exposure, which involves gradually introducing the patient to memories of their traumatic experience, with the goal of reconditioning their response to triggers and easing emotional distress.

• Cognitive processing, which can include developing skills to recontextualize unhelpful feelings and thoughts, and regulate emotions.

• Caregiver involvement, which may include rebuilding trusting adult relationships for the child and training the caregiver in how to best be a resource for the child.

The goal of the treatment is to help the patient develop a sense of safety and security, to repair or develop healthy social skills, and for the caregiver to feel more confident in their ability to help the child in a productive manner.

What to Look for in a Trauma-Focused Cognitive Behavioural Therapist

There is no official accreditation for trauma-focused cognitive behavioural therapy, though supplemental training and courses exist. It’s most important to look for someone with experience in the practice and someone with whom you feel comfortable discussing personal problems.

Some helpful questions to ask a TF-CBT therapist include:

• The extent of their experience with trauma-focused CBT treatment.

• Whether there is an assessment process to track the functioning of the patient and family, in order to monitor the progress of the treatment.

• Whether there will be joint therapy sessions with the child and parent, and to what degree.

References

U.S. Department of Health and Human Services. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. August 2012.

Gillies D, Taylor F, Grey C, O’Brien L, D’Abrew N. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (review). Evidence-Based Child Health. May 2013;8(3):1004–1116.

Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews. 2013;12.

Trauma-Focused Cognitive Behavioural Therapy National Therapist Certification Program website

de Arellano, M. A. R., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Huang, L., & Delphin-Rittmon, M. E. (2014). Trauma-Focused Cognitive-Behavioural Therapy for Children and Adolescents: Assessing the Evidence. Psychiatric Services, 65(5), 591–602. https://doi.org/10.1176/appi.ps.201300255

Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma-focused cognitive behavioural therapy for children: impact of the trauma narrative and treatment length. Depression and anxiety, 28(1), 67–75. https://doi.org/10.1002/da.20744

Last updated: 06/21/2022

Motivational interviewing is a counselling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behaviour. It is a practical, empathetic, and short-term process that takes into consideration how difficult it is to make life changes.

Motivational interviewing evolved from Carl Rogers' person-centred, or client-centred, approach to counselling and therapy, as a method to help people commit to the difficult process of change. It was introduced by psychologist William R. Miller in 1983 and further developed by Miller and psychologist Stephen Rollnick. “The more you try to insert information and advice into others, the more they tend to back off and resist. This was the original insight that generated our search for a more satisfying and effective approach,” Rollnick writes. “Put simply, this involves coming alongside the person and helping them to say why and how they might change for themselves.”

When It's Used

Motivational interviewing is often used to address addiction and the management of physical health conditions such as diabetes, heart disease, and asthma. This intervention helps people become motivated to change the behaviours that are preventing them from making healthier choices. It can also prepare individuals for further, more specific types of therapies. Research has shown that this intervention works well with individuals who start off unmotivated or unprepared for change. It is less useful for those who are already motivated to change. Motivational interviewing is also appropriate for people who are angry or hostile. They may not be ready to commit to change, but motivational interviewing can help them move through the emotional stages of change necessary to find their motivation.

Research shows that motivational interviewing is effective in many contexts, including:

• Substance use disorder

• Smoking

• Weight loss

• Medication adherence

• Cancer care

• Diabetes care

• Health behaviours among children

What to Expect

In a supportive manner, a motivational interviewer encourages clients to talk about their need for change and their own reasons for wanting to change. The role of the interviewer is mainly to evoke a conversation about change and commitment. The interviewer listens and reflects back the client’s thoughts so that the client can hear their reasons and motivations expressed back to them. Motivational interviewing is generally short-term counselling that requires just one or two sessions, though it can also be included as an intervention along with other, longer-term therapies.

Motivational Interviewing is guided by four key principles. These are:

1. Express Empathy

Empathy is a key component of motivational interviewing. The therapist listens carefully to the patient and conveys that they understand the patient’s feelings, beliefs, and experiences.

2. Support Self-Efficacy

Motivational interviewing posits that clients possess the strength and ability to grow and change—even if past attempts at change have failed. The therapist supports the patient’s belief in themselves that they can change. The therapist may do this by calling attention to the patient’s skills, strengths, or past successes.

3. Roll with Resistance

If the patient is struggling to change, they may resist potential solutions or the therapist’s guidance. In motivational interviewing, the therapist avoids becoming defensive or argumentative if they encounter resistance. Instead, they help the patient identify the problem and solution themself. The therapist doesn’t impose their viewpoint on the patient but helps the patient consider multiple viewpoints.

4. Develop Discrepancy

The therapist helps the patient identify discrepancies between their present circumstances and their future goals. What thoughts and behaviours do they need to change to achieve those goals? The therapist guides the patient in spotting this discrepancy and solutions to reduce it.

Several skills help therapists employ these principles. Open-ended questions encourage patients to think deeply or differently about a given problem. Affirmations are statements that recognize a client’s strengths, which can instil confidence, or self-efficacy, in their ability to change. Reflections involve listening to the patient and reflecting back a response, which can demonstrate empathy as well as point out discrepancies between their current behaviours and goals. Summaries refer to recapping at the end of a session. (These four skills may be referred to by the acronym OARS: open-ended questions, affirmations, reflections, summaries.)

How It Works

The process is twofold. The first goal is to increase the person’s motivation and the second is for the person to make the commitment to change. As opposed to simply stating a need or desire to change, hearing themselves express a commitment out loud has been shown to help improve a client’s ability to actually make those changes. The role of the therapist is more about listening than intervening. Motivational interviewing is often combined or followed up with other interventions, such as cognitive therapy, support groups, and stress management training.

What to Look for in a Motivational Interviewer

Look for a licensed mental health professional who is empathetic and supportive as well as a good listener. Since motivational interviewing is a skill that improves with time, look for an interviewer with both formal training and experience. In addition to finding someone with the appropriate educational background and relevant experience, look for a motivational interviewer with whom you feel comfortable working.

References

Hettema J, Steel, J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;1:91-111.

Treatment Improvement Protocols. Enhancing Motivation for Change in Substance Abuse Treatment. Chapter 3—Motivational Interviewing as a Counselling Style. SAMHSA. (1999, Rockville, MD)

SAMHSA-HRSA Centre for Integrated Health Solutions website. Motivational Interviewing.

Last updated: 06/06/2022