A Therapist’s Manual for Cognitive Behavior Therapy in Groups

259 Pages·1984·3.675 MB·English

by  Lawrence I. Sank, Carolyn S. Shaffer (auth.)

A THERAPIST'S
MANUAL FOR
COGNITIVE BEHAVIOR
THERAPY IN GROUPS
A THERAPIST'S
MANUAL FOR
COGNITIVE BEHAVIOR
THERAPY IN GROUPS
Lawrence I. Sank and
Carolyn S. Shaffer
Center for Cognitive Therapy
Bethesda, Maryland
The George Washington University Medical Center
Washington, D.C.
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Sank, Lawrence, I., date-
A therapist's manual for cognitive behavior therapy in groups.
Bibliography: p.
Includes index.
1. Behavior therapy-Handbooks, manuals, etc. 2. Cognitive therapy-Handbooks,
manuals, etc. 3. Group psychotherapy-Handbooks, manuals, etc. I. Shaffer, Carolyn
S., 1946- . II. Title. [DNLM: 1. Behavior therapy-Methods. 2. Cognition. 3.
Psychotherapy, Group-Methods. WM 430 S277t]
RC489.B4S175 1983 616.89'152 83·13652
ISBN-13: 978-1-4615-8332-5 e-ISBN-13: 978-1-4615-8330-1
001: 10.1007/978-1-4615-8330-1
© 1984 Plenum Press, New York
Softcover reprint of the hardcover 1s t edition 1984
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical. photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
We dedicate this volume to
those who have so patiently supported us
throughout the development of this program and
the writing of this book:
Jim, Linda, Jessica, Benjamin, and David.
FOREWORD
One of the great advantages of rational-emotive therapy (RET) and cog
nitive behavior therapy (CBT) is that they frequently employ psycho
educational methods-including bibliotherapy, workshops, lectures,
courses, recordings, and films. I created RET at the beginning of 1955
after I had abandoned the practice of psychoanalysis because I found it
to be highly inefficient and philosophically superficial. Being almost
addicted to one-to-one therapy as a result of my analytic training and
experience, I at first did RET only with individual clients and found this
pioneering form of CBT considerably more effective than the other ther
apies with which I had experimented.
By 1957, however, I realized that RET could be taught to large num
bers of persons through self-help books and articles and that RET -ori
ented writings could not only prove valuable to the general public but
that they could also be successfully employed to hasten and intensify the
therapy of my individual clients. I therefore wrote a number of RET self
help books-especially How to Live with a Neurotic (1957), Sex without Guilt
(1958), A New Guide to Rational Living (with Robert A. Harper; original
edition, 1961), and A Guide to Successful Marriage (with Robert A. Harper,
1961). The effectiveness of these books has surpassed my wildest expec
tations-since they have sold millions of copies (notably in the paper
back editions published by Wilshire Book Company, North Hollywood,
California), have been recommended to clients by hundreds of thera-
vii
viii FOREWORD
pists, have been translated into more than twenty foreign languages,
have brought to my mailbox and to my face thousands of enthusiastic
testimonials, and have encouraged the publication of many other CBT
oriented self-help books, such as Robert Alberti and Michael Emmons's
Your Perfect Right, Wayne Dyer's Your Erroneous Zones, and David Burns's
Feeling Good.
Spurred on by the psychoeducational success of How to Live with a
Neurotic and A New Guide to Rational Living, I began in 1959 to apply RET
to group therapy and to large-scale workshops. Again, it seemed to work
significantly better than conventional therapies do when used in group
form. I have now seen about 2,500 regular group-therapy clients during
the last 24 years (since I lead 6 groups every week, each of which has a
maximum of 13 clients) and have given over a thousand RET workshops
to well over one hundred thousand people during this same period. Fol
lowing my lead, the Institute for Rational-Emotive Therapy in New York,
which I direct, and its allied branches and groups throughout the world
now give hundreds of other RET workshops every year, and many other
CBT therapists and centers (such as the Center for Cognitive Therapy in
Philadelphia and in Bethesda, Maryland) give innumerable other CBT
oriented talks, workshops, and other public presentations.
All of which indicates-what? Presumably, that RET and CBT are
not merely effective therapies on a one-to-one basis, but that they also
have important group and psychoeducational applications. That is why
this book by Lawrence I. Sank and Carolyn S. Shaffer, A Therapist's Man
ual for Cognitive Behavior Therapy in Groups, is such a valuable volume. It
takes four of the major aspects of CBT -relaxation training, cognitive
restructuring, assertion training, and problem solving-and it shows in
great detail how these methods can be used in a brief group-therapy for
mat. It tells the therapist who would employ these modes of CBT exactly
how to do so over a period of 15 weekly sessions. And it provides suitable
handouts, bibliotherapy suggestions, and other materials that therapists
of CBT groups can use to help themselves and their group members. It
is remarkably complete in these aspects, and it is written in such a clear
and simple manner, with a minimum of technical jargon, that virtually
all therapists or counselors who want to use group CBT techniques can
distinctly follow its procedures and add to their knowledge and their
skills.
Is A Therapist's Manual for Cognitive Behavior Therapy in Groups thor
oughly comprehensive and flawless? Of course not. It only briefly men
tions, for example, several important cognitive methods-such as mod
eling, philosophical analysis, and the use of humor. It is skimpy in its
employment of emotive-evocative techniques, such as rational-emotive
FOREWORD ix
imagery, forceful self-statements, and RET's famous shame-attacking
exercises. But since cognitive behavior therapy now includes literally
hundreds of possible methods, and since no book is likely to be truly
comprehensive in explaining all of them, Drs. Sank and Shaffer cannot
legitimately be faulted for not being all things to all readers.
What the book does contain is distinctly good. It is hard-headed,
practical, and right down to earth. It presents a CBT program that can be
easily understood and utilized. It can be selectively used and discrimi
natingly modified by those therapists who want to experiment with and
add to or subtract from it. Like RET and CBT themselves, it presents no
dogmas or unfalsifiable assumptions. Sank and Shaffer's book is a wel
come addition to the CBT literature. I predict good results for the thera
pists and clients who work at using it.
ALBERT ELLIS, PH.D.
Executive Director
Institute for Rational-Emotive Therapy
45 East 65th Street
New York, New York 10021
CONTENTS
FOREWORD ............................................... . vii
Albert Ellis
INTRODUCTION ........................................... 1
Chapter 1
COPING SKILLS TRAINING AND COGNITIVE BEHAVIOR
THERAPy.................................................. 9
Thomas L. McKain
Chapter 2
THE SCREENING PROCEDURE 25
Chapter 3
THE RELAXATION MODULE ............................... . 41
Session 1 .............................................. . 41
Session 2 .............................................. . 49
Chapter 4
THE COGNITIVE RESTRUCTURING MODULE 63
Session 3 ................................. . 63
xi
xii CONTENTS
Chapter 5
ENHANCING COGNITIVE RESTRUCTURING SKILLS. . . . . . . . . . 77
Session 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Session 5 91
Session 6 99
Chapter 6
INDIVIDUAL SESSION/MIDWAY EVALUATION .............. 107
Session 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 107
Chapter 7
THE ASSERTION-TRAINING MODULE................. 113
Session 8 ......................... . 113
Session 9 .............................................. . 125
Session 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 133
Session 11 141
Chapter 8
THE PROBLEM-SOLVING MODULE ......................... . 149
Session 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 149
Session 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 157
Chapter 9
CLOSING SESSIONS 165
Session 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 167
Session 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 171
Chapter 10
BOOSTER SESSIONS 177
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 181
APPENDIXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 187
1. Pretreatment Questionnaire (PTQ) . . . . . . . . . . . . . . . . . . . .. 187
2. Pregroup Screening Description of the Coping Skills
Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 199
3. List of Symptoms Common to Patients Referred to the
Coping Skills Group ................................. 201
4. Potential Goals for Each Module. . . . . . . . . . . . . . . . . . . . . .. 203
CONTENTS xiii
5. Coping Skills Group Screening Form-Individual Goal
Sheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
6. Coping Skills Group Attendance/Performance Record
and Contract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 207
7. Example of Completed Coping Skills Group Screening
Form-Individual Goal Sheet. . . . . . . . . . . . . . . . . . . . . . . .. 209
8. Relaxation Practice Log. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 211
9. List of Required and Suggested Readings. . . . . . . . . . . . . .. 213
10. Personal Reminder Form ............................. 215
11. Example of Completed Personal Reminder Form ........ 217
12. Relaxation Sequence ................................. 219
13. Cognitive Distortions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 221
14. Dispute Handles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 223
15. Homework Sheet for Cognitive Restructuring. . . . . . . . . .. 225
16. Advanced Homework Sheet for Cognitive Restructuring 227
17. Therapist's Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
18. Basic Irrational Ideas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 231
19. Homework Sheet for Cognitive Restructuring. . . . . . . . . .. 233
20. CBT Homework Sheet: Example Originally Prepared for
Nondisclosure to Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 235
21. CBT Homework Sheet: Example Done at Home That
Prompted Self-Disclosure in the Group. . . . . . . . . . . . . . . .. 239
22. Components of Assertive Behavior. . . . . . . . . . . . . . . . . . . .. 241
23. Scripted Assertive Scenes. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 243
24. Vignettes for Assertiveness Training . . . . . . . . . . . . . . . . . .. 245
25. Assertive Behavior Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 249
26. Problem-Solving Homework Sheet. . . . . . . . . . . . . . . . . . . .. 251
27. Completed Problem-Solving Homework Sheet. . . . . . . . .. 253
28. Example of Completed Goal Sheet for Final Interview. . .. 255
29. Worksheet for Remaining Problems. . . . . . . . . . . . . . . . . . .. 257
30. Individual Goal Sheet for Final Interview. . . . . . . . . . . . . .. 259
31. Log of Problem Situations and Skills Employed ......... 261
INDEX .................................................... . 263