Practice Management
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DIDACTIC
CEU TRAINING: Cognitive Interventions
DATE: 08/31/2022
TIME: 11:00 AM-1:00 PM CT
OUTSIDE STUDY: 1.5 Hours (reading & video)
DIDACTIC PRESENTATION: 2 Hours
EDUCATOR: Tara Riggs MT #3969 FL
Introduction
As experiential therapists who are more concerned with process than content, we also know that too much psycho-ed is not helpful. Insight alone does not create change, and in fact can add to a client’s shame that might say, “What’s wrong with me? I know what to do but I just can’t do it?!” We are after second-order, permanent change that shifts how our clients view themselves, others, and the world through relational corrective emotional experiences. We want limbic revision for internal working models, known as “playbooks” in NICC, in ways that allow our clients to experience life from a more positive, expansive, flexible way of being. However, when we are new to experiential work, and even when we are not new, we don’t always know how to get to these deeper places.
Psycho-education, also known as cognitive intervention, is an important part of the work we do as therapists. It helps clients get buy-in to the work we do in session, appeals to their left-brain logic where many clients are most comfortable, and provides insight and tools that can help them outside of session. This is the place some of us are also most comfortable and where we go when we lose our balance or aren’t sure what to do. That is also valuable! Feeling confident and competent is important. But as we well know, we cannot stay where we are comfortable, and instead must begin navigating the new and unfamiliar terrain of experiential therapy where we focus on process instead of content, emotion instead of cognition, and glimmers of transformance instead of pathology.
As my high school basketball coach used to say, “don’t throw the baby out with the bath water!” In other words, it is not our intent to do away with psycho-ed altogether, but instead we want to use it well. What does it mean to use psycho-ed well? I’m glad you asked. This is what we will be diving into in this didactic. Below I will offer a few guiding principles for using cognitive interventions so you can help determine appropriate use for yourself and learn to lean into the tension of holding two realities (both cognitive and experiential interventions are important, but they are not of equal value).
Principle # 1: Use psycho-ed in service to your client, not in service of yourself.
As previously stated, for many of us, psycho-ed is an easy place for us to go and where we are most comfortable. However, staying here is often a block/defense for us as therapists. We started to feel wobbly in our session, unsure of ourselves, uncertain of what to do next, and we pop out of process, and into content in our heads. We try to show others our value by what we know, perhaps because we aren’t entirely certain that our presence and care are enough to bring transformation. This is where we get it wrong. You are indeed enough. Just as you are. Right now. Yes, you. Not when you know the protocol, not when you’ve taken that training, or read that book. Relationship is one of the essential elements for positive neuroplasticity (aka how we rewire the brain), and you already know how to do that. Stay connected to yourself, your emotions, and your experience and your body will guide you like a compass into the stream of flow. Let go and trust the process, dear ones. It will hold.
However, psycho-ed can be used in many ways for the sake of your clients. It can be used to normalize a trauma-response and validate a protective action or defense against emotion, thereby neutralizing shame, guilt, and judgment about the response, and instead making a way for self-compassion, kindness, and curiosity. It is easy after having been in grad school and sitting with so many clients, to forget all the things that we know that are helpful in this way to our clients, but the options are endless. When you notice shame in the room, grab one and love your client with it, shining light in the dark place where shame lurks.
Principle # 2- Use cognitive interventions in service of future experiential interventions.
Some clients will not be able to lean in to the experience until they understand what you are going to have them do and why. They NEED the left-brained buy in BEFORE they can trust the process and we want to meet them where they are. For example, discussing why and how we do portrayals is necessary for some clients before they can fully engage the intervention. Another example, is discussing how emotions are embodied to get buy in for somatic interventions such as, “What are you noticing in your body as we talk about this?”
This might also look like slicing the experience thinner (taking baby steps) until they can more fully lean into the intervention. This might sound like, “what would you say to her if she were still here?” rather than setting up a portrayal using all 5 senses or reprocessing a traumatic memory. Another example might be seeding parts language (i.e. part of you wants , but part of you wants ) before introducing the concept of younger parts. These interventions are on the midline between cognitive and experiential interventions and are a helpful segue between the two.
Some concepts are larger and require more teaching and explanation since they lay a foundation for the work going forward. For example, most of us teach The Change Triangle to help our clients understand how they have and continue to deal (or not deal) with their emotions and to get some buy-in about what therapy will look like, and how this well help them to achieve the goal they presented with. Another example might be teaching about Boundaries when working with a client harmed by self-abandonment and people pleasing, or caught in an emotionally-destructive relationship. Trauma and sex therapy also require a fair amount of front-loaded psycho-ed in order for clients to lean into and trust what can be a long, painful, and arduous process.
Principle # 3- With left-brained interventions, less is more and short is sweet.
Learning how to explain difficult concepts with clarity and simplicity is no easy task, but is very valuable. Ideally, left-brained interventions are still somewhat “bottom up”, meaning they are done while the client is in the process, and are not taken out of it with the learning. This can really only be done if the explanation is short, sweet, and to the point. To this end, I would encourage everyone to borrow and steal from each other! If you are in triad, case consult or office hours or are watching recordings from someone on the Leadership team, and you like how a concept is present, write it down and use it! Imitation is the highest form of flattery🙂 I remember that when I first read It’s Not Always Depression, I highlighted, underlined, and wrote, “say this!” in the margin throughout the entire book. Sometimes we just aren’t sure how to word what we are trying to get across and this is one of the many cases when we are better together! Use this wonderful learning community to your advantage and borrow and steal from each other! You don’t have to recreate the wheel.
We want to give you some language to borrow and examples to learn from from the Leadership Team in how to apply these concepts. None of these are perfect, as we are all therapists dedicated to learning and growing, but we want to offer you what we have, know, and do. Below, you will view a video of some of our Certified and Advanced Practice clinicians in Leadership using psycho-ed in their sessions.
Didactic
During the didactic next week, you will have access to a panel of the Clinical Leadership Team who will be available for Q & A specifically regarding the use of cognitive interventions in session. This is not a time for case consult, but instead is a great place to bring your questions about how to get left-brained buy in or offer psycho-ed explanations in a more efficient way. Spend some time this week assessing some of your own gaps in understanding or holes in knowledge, and bring your questions for this rare opportunity for Q & A with our most seasoned therapists. We fully recognize that asking questions and expressing needs is vulnerable, but that is what this space is created for. Check your armor at the door of your office, and bring your curiosity, your wonder, and your hunger to learn and grow (and your paper and pen to take notes!). Every question is valuable, and I can almost guarantee that you aren’t the only one asking it. We look forward to growing together and sharpening one another.
Additional Resource
The Leading Edge in EFT Podcast- Psych-Ed in the EFT Process (from 2/19/21)
MCO - CEU Tracker
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