Reflections on Cognitive-Behavior Therapy in Clinical Practice - Essay Example

Cognitive behaviour therapy in clinical practice: Reflective journal Introduction The paper focuses on the use of reflective journal in nursing, especially emphasising on cognitive behaviour therapy in clinical practice. Such a journal helps a nursing professional in maintaining a written and objective record of the experiences gained by the professional over a period of time. In this module the student is expected to keep a regular journal and recording various events, emotions, dialogues and behaviours. Thereafter, these entries need to be analysed in detail to find out the automatic thinking and response style adopted by the student while conducting cognitive behaviour therapy. The paper aims to develop self-awareness and self-regulation among the students in a clinical setting. The nursing students were asked to keep a reflective diary for a period of time during a cognitive behaivour therapy setting. A systematic method was used to analyse the diary entries to find out the elements affecting the students during the clinical practice. Some of the central issues that the paper focused on were helping the student to find out about his or her behaivour during the clinical practice, what were the conscious beliefs the student commonly used to interpret events and actions, what were the cognitive distortions and irrational beliefs that were operative and how they influenced the student’s behaviour, whether the student was able to challenge and replace any cognitive distortions or irrational beliefs or not, whether the student was able to detect any cognitive distortions or irrational beliefs in others and suggestions on how to assist clients to challenge such beliefs in the future, or in the current clinical practice of the student. Reflection Reflection study has been accepted widely as a means to learn in the higher education. This form of study has also been used in various fields of medical education, even in nursing education. Reflection is considered to be important for conducting professional nursing practice. It is important to form a connection between experiences, observations and judgment while taking a decision in a clinical study and reflection helps in taking such decisions. Reflection also helps in analysing experiences and promoting learning, as it enhances the analytical thinking in nursing students to understand and find solutions for an issue. It helps the students to analyse their assumptions about a situation and try to understand it by identifying various perspectives to the situation (Sutton et al, 2007). Reflection also helps in developing learning in the nursing students by making them identify the gap areas in their study and fulfilling them through their learning needs. Reflection is especially important in nursing practice, as it is an evidence-based study. Further it is client-centric and need the nurse to understand and find out the best possible solution for assessing a situation. For this, the nurse needs to analyse the situation by assessing his or her assumptions and values with the beliefs and value systems of the patient. Thus, such a study helps the nurse to recognise his or her own assumptions and find out how these assumptions would affect the therapeutic relationship and their decisions. This type of study aids in developing a questioning attitude among the nurses. They are able to constantly upgrade their knowledge base and skills and make them at par with the current health care set up (Sugerman et al, 2000). Thus, reflection is not just thinking about a problem and finding out the best possible solution for it or creating a well-developed future plan based on the existing knowledge of the nurse, it is also about questioning a particular situation and process in a critical manner and trying to analyse the problem through past experiences. It is a though process that is being done consciously and in a systematic order. There are three main factors in reflection, which are process, content and context. The use of all these factors would result in changing in the behaviour of the nurses. This in turn reflects that the value system, attitude and the beliefs of the nurses have also changed to become more professional in outlook (Hawton et al, 2003). Self-discovery through reflective journal Nurses practicing in the area of cognitive behaviour therapy just not required to analyse their clinical practice but also determine their personal behaivour and its impact on their practice. In order to manage the therapeutic relationships in an effective manner, it is important for the nurses to analyse their personal reactions about a mode of a treatment by observing their own beliefs and thoughts. This can be best done through analysing the reflective journal (Burns, 2000). As a part of the module, I have also kept a detailed journal recording my beliefs and thoughts over a period of time about the various treatments used during cognitive behaivour therapy. It helped me in finding out my beliefs and value system about the therapy and understanding the gap areas as well. As propagated by Haarhof and Kalantzis (2007), my reflective journal also established that therapists often prefer to undertake a particular treatment due to their own deep-seeded beliefs. My journal helped me in identifying my personal beliefs, attitudes and reactions towards a particular situation and treatment. I found that I have been biased towards a few approaches and considered to follow theoretical method in many cases. For instance, while treating a patient who was suffering from drug abuse, I had my own biases about the case. I though the patient, a 21-year old girl named Lucy, took drugs due to family problems. I had a general outlook towards all such drug abuse cases and always thought that family or some other personal problems are to be blamed for the patient to take up drugs. I started to treat the patient based on this bias. But soon I realised that the patient’s drug abuse was not a product of her family problem. Instead, she came from a well-to-do family which was well-bonded. It was her friends who got her into the habit of abusing drugs in parties. This knowledge helped me re-thinking about my care strategies and showcasing the fact that a nurse need to curb his or her biasness while finding out a suitable treatment for a patient. A reflective journal also helps a person to identify his or her skills and talents (Bennett-Levy et al, 2001). Through my journal I was able to identify my skills as well. While reading through my cases, I understood that I was a good listener, which helped me in documenting even little details about the patient. This comes very handy at times, especially treating patients suffering from depression. In one such case, a patient, a 16-year old boy named Tim, suffering from depression talked about multiple problems, but it became tough to pinpoint to one issue that was actually bothering the patient the most. My listening skills helped in documenting everything that the patient said that thereafter analysing the case in retrospect it was found that the patient had repeatedly talked about being feeling out of place during his school years. Although, the patient made this statement as a passing remark once a while during the sessions, it was also the most consistent remark the patient made so far. On probing this issue further, it was found that the patient was not able to cope up with the pressure of high school and constantly feared about failing grades. Therefore, my reflective journal helped me in analysing problems by segregating my own beliefs and biases about a situation. Further, it also brought forth my skills and talents while treating a CBT patient. Conscious beliefs used to interpret events and actions While analysing a reflective journal, a conscious process is being used to interpret the events and actions recording in the journal. This later on becomes a guide for the nurse to follow (Mertes, 1991). This process requires the understanding the impact of the assumptions made by the nurse about the situation. Further, it also helps in realising why and how certain decisions were taken. Such a process requires conducting critical self-reflection that questions the underlying assumptions of the nurses and tries to find out how such assumptions were developed. For this module, I have critically analysed my journal entries and sorted out the incidents and actions wherein I have used my conscious beliefs. I did this through critical thinking and adopting various problem-solving strategies. While selecting the events and actions, I focused on incidents that could be considered the most important during the entire process. I have not only analysed the positive actions, but also found negative decisions as well. I also kept a detailed analysis on various conflicts and confusions occurring during a particular situation. Therefore, after each day, I used to apply critical thinking to analyse the activities of the entire day and create entries based on this analysis. My entries were not merely a record of the day’s events but a detailed analysis of the decisions made and the observations conducted during the session. For instance, while undertaking a session with a patient suffering from depression due to pressure at school, I consciously made an effort to record the various physical anomalies and discomfort shown by the patient every time his school’s name was mentioned. Such a conscious effort helped me in establishing the fact that the problem is related to the school that the patient was attending. Further, I used the techniques of questioning and probing the patient about issues that caused remarkable discomfort, as I believed that gentle probing about the issue would help the patient to talk about the problem easily. Again, this was a conscious effort on my part to be attentive towards the body language of the patient and find out about the issues that might be causing physical discomfort to him or her. Once I was able to pin point on the issue, I used the technique of questioning the patient in a gentle manner to help the patient to talk about the issue easily. Influence of cognitive distortions and irrational beliefs on behaviour In the field of cognitive behaviour therapy it has been found that often erroneous reasoning known as cognitive distortions leads to wrong prognosis and treatment (Kaplan, Sallis, & Patterson, 1993). Some of the common forms of cognitive distortions include generalising events, giving emotional reasoning, jumping to conclusions, using statements with should or must, only taking selective information, minimising or maximising the facts, aggravating the situation etc. While studying the journal, I found that cognitive distortions also influenced my line of therapy as well. I found that I had a habit of generalising events and give emotional reasoning to situations. For instance, in the case of Lucy, I generalised the event and thought that Lucy was suffering from some family problem which has resulted in her drug abuse, as in most drug abuse cases, such were the underlying problem. Such an emotional reasoning resulted in providing a wrong analysis of the situation. However, my skill for being a good listener saved the day and I could rectify my mistake in time. Although our perceptions are based on our belief system, it has often been found that these beliefs might be illogical and does not have a rational basis (Corey, 2009). In this journal as well, I found that I had certain irrational belief systems as well. For instance, I believed that a bad childhood and parenting is the sole reason for a child to take up drugs, seldom realising that drug abuse can also be a result of lifestyle change and peer pressure. Thus, the journal helped me in detecting my cognitive distortions and irrational beliefs that influenced my behaviour towards the patients. However, once I was able to identify them, I took care to address these behavioural issues and undertake the sessions in an unbiased manner. I stopped generalising the situations and kept my biases away from my analysis. I took every situation as unique and leveraged my listening skills to understand the patient’s problem. I did not jump at conclusions based on my emotional reasoning, instead thought about the entire issue in totality and logically arrived at a conclusion. Further, I tired to come out of my irrational belief system by using logic and analysing each and every situation by giving reasoning rather than accepting it as established belief (Beck & Butler, 2005). Detecting cognitive distortions and irrational beliefs in others The journal also helped me in identifying the cognitive distortions and irrational beliefs in others as well. While undertaking a through analysis of the journal, I found that the two patients that I was handling at that time showed clear signs of cognitive distortion and irrational beliefs (Armstrong & Feeston, 2006). For instance, in case of Lucy, she thought that it is a must for her to take drugs during parties to be a part of the crowd. As all her friends were drug abusers and used to take drugs during parties, it developed a cognitive distortion in Lucy that in order to be a part of the party circle she needs to take up drugs. She kept on using statements with need to and must have drugs during parties. The analysis of her statements clearly stated that she was suffering from cognitive distortions. Similarly, in the other case, Tim showed signs of irrational beliefs whenever we talked about his performance in school. His grades in school were failing constantly and he was suffering from depression due to his failing grades. However, he also talked about other problems such as inability to excel in sports or other extra-curricular activities. Further, he talked about low self confidence and inability to talk to girls in his school. He was clearly facing too much of trouble coping at school but it was tough to point to one single trigger point. However, whenever the mention about his performance at school and his parents’ expectation about his grades came up, he showed remarkable physical discomfort. On probing the issue, it was found that Tim was suffering from irrational belief. He believed that in order to become successful he needs to be an all-rounder in school and should get good grades along with being good at sports and other extra curricular activities. This belief was installed in him by his parents, who were ambitious for their son’s future, as he was their only child. The expectations on Tim added pressure on the boy to excel in all the fields. This resulted in his failing grades in exams as well as poor performance in sports. Further, this also affected his self-confidence and he started becoming aloof from his friends and peers. He also thought that girls preferred boys who were successful in terms of studies as well as sports and started withdrawing himself from them. Therefore, it was this irrational belief about being successful that was the central problem dogging Tim. Assisting patients with cognitive distortions and irrational beliefs It was found that in cognitive behaviour therapy, most of the problems in the patients occur due to cognitive distortions and irrational beliefs. Therefore, it is important to find out about these beliefs and treat the patients accordingly. In this case as well, I was able to find out about the cognitive distortions and irrational beliefs in the patients I was studying during the period that I kept the journal. It was through this journal that I was able to identify these beliefs in the patients and could advise them on how to overcome such situations. In case of Lucy, I had to take a lot of sessions with her to make her understand that parties are not synonyms to drug abuse. Instead parties are events where one goes to relax and network. Further, I had to make her realise that she was not keeping good company and her friends were not right for her. This was a rather difficult task as she came from a higher class society and was very stubborn in her beliefs (Leahy, 2001). She was often rude and did not want to listen to any of my reasoning. Therefore, I asked my seniors to help me out and they also took some counseling session with her. Further, I also asked her parents to help their daughter by attending the separate sessions, wherein they were told how to behave with her. We asked them not to be stern with her and listen to her carefully without losing patience. We asked them to provide her with their support and time to come out of such a difficult phase of life (Marlatt & Donovan, 2005). In case of Tim, I had to install self-confidence in him by providing him with lots of instances where a person achieved success even without being popular or studious at school. I told him about the value of knowledge rather than the importance of getting grades. I took the help of a career counselor who took separate sessions with Tim to guide him to choose a suitable career for himself (Holdaway & Connolly, 2004). Further, I also took sessions with Tim’s parents and told them not to preasurise Tim about his studies or other activities and instead should support him to undertake a career of his liking. Conclusion A reflective journal undoubtedly helped me not only in understanding my point of views about a situation or treatment, but also aided me in identifying the issues in my patients and providing the best possible solution to such issues. While writing the journal, I did not merely wrote an account of the day’s activity, instead, analysed all the events that took place during the day and wrote them in detail so that it could be interpreted properly at a later stage. While reflecting upon this written journal, I was able to identify my own behaviour during therapy sessions and how it influenced my decisions to treat a patient. I found that I had biasness towards certain issues and often indulged in generalising a situation. However, I also discovered that I am a good listener, which helped me in identifying the core problem in my patients. The most important aspect of the reflective journal was to identify cognitive distortions and irrational beliefs that I followed and over rule them by using logical thinking and unbiased analysis. Further, this journal also helped me in understanding cognitive distortions and irrational beliefs in others and how to tackle them in a best-possible manner. References: Armstrong, P. 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