Clinician's Guide to Mind Over Mood (35 page)

Many nontherapist professionals can use
Mind Over Mood
to enhance their work. For example, physicians can recommend
Mind Over Mood
to patients taking psychotropic medications. Employee assistance counselors may not be allowed to offer therapy to employees and yet may recognize clear indicators of depression, anxiety, or other problems addressed by
Mind Over Mood.
Ministers, priests, and rabbis often are called on to help people with more serious problems than their training prepares them to handle. Self-help group leaders may find the structure of the treatment manual helpful in organizing group discussion and learning.

Patients treated by a physician may not be willing or able to go to a psychotherapist. Many people who go to a primary care physician complain of fatigue, poor appetite, agitation, or other symptoms indicative of depression or anxiety once a medical condition has been ruled out. Further, many patients are depressed or anxious secondary to a medical condition. For these patients,
Mind Over Mood
enables the physician to provide more than medical treatment.

Mind Over Mood
provides a step-by-step guide to treatment that can be followed by physicians and nurses even if they have not had extensive training in cognitive therapy. By recommending
Mind Over Mood
along with indicated medication, physicians can help their patients develop new coping skills that often lower the risk of relapse better than medication alone. Physicians or nurses can encourage and review patient use of the treatment manual at follow-up medical appointments following the principles offered in this clinician’s guide.

Nurses are responsible for ensuring that patients follow medical treatment plans in hospitals, home care nursing programs, and outpatient treatment programs. In addition to monitoring medication compliance, nurses often counsel patients on changes in life style (e.g., nutrition, exercise) and self-care procedures.
Mind Over Mood
can help nurses identify patient emotions and beliefs that may interfere with treatment compliance. For example, many patients have interfering beliefs such as “I need to take this medication only when I’m feeling bad,” “If I’m tired, I shouldn’t exercise,” “Since I’m probably going to die anyway, it doesn’t matter if I eat properly.” These types of beliefs can be identified and tested using
Mind Over Mood
worksheets.

Employee assistance programs (EAPS) have become an important source of assessment, treatment, and referral for millions of workers.
Mind Over Mood
can enhance the brief treatment offered by EAP professionals by providing structured therapy to supplement EAP services. Further, if an EAP counselor refers the client for longer-term therapy to a therapist who also uses
Mind Over Mood,
the treatments provided by both professionals are consistent and synergistic.

Many EAP counselors lead groups or classes that are preventive in nature or help people who do not require more intensive treatment.
Mind Over Mood
can be text or resource book for these groups following the guidelines in
Chapter 9
of this therapist guide. The client treatment manual can be used to teach stress or mood management, to identify and test beliefs that lead to conflict in the workplace, or to help implement workplace changes that an EAP counselor anticipates will spark emotional reactions and challenge existing employee beliefs.

Many members of the clergy spend a large portion of their time counseling people with psychological or relationship problems. As an adjunct to spiritual advice,
Mind Over Mood
can help religious leaders address the cognitive, emotional and behavioral dimensions of human problems in a comprehensive, formalized way. People who are depressed or anxious frequently have idiosyncratic perceptions or interpretations of religious writings and teachings. In treating depression or anxiety directly, misinterpretation of religious messages often changes as well.

Self-help or support groups can use
Mind Over Mood
to help members achieve goals. Overeaters Anonymous, Alcoholics Anonymous, Rational Recovery, S.M.A.R.T Recovery, TERRAP, and a host of other groups can use
Mind Over Mood
to help their members develop and use new tools to improve their lives. In these settings,
Mind Over Mood
can be used informally as a source for discussion and learning.

Some colleagues or students are reluctant to learn a new approach or accept guidance. Other therapists are blind or belligerent regarding problems identified by a supervisor. These circumstances tap all a supervisor’s skills for developing and maintaining a collaborative relationship. In fact, maintaining a collaborative rather than critical tone in supervision is one of the best strategies a supervisor can follow under these conditions.

Supervisors are recommended to take a curious and investigative attitude with a reluctant supervisee, following the principles described in
Chapter 7
of this guide regarding maintenance of collaboration under challenging therapy circumstances. If therapist emotional reactions and beliefs in problem situations are inquired about neutrally, a reluctant supervisee may be more willing to discuss difficulties. The structured worksheets of
Mind Over Mood
can help therapists identify thoughts and emotions during therapy and also during supervision.

Identifying emotions and beliefs triggered by supervision can help identify reasons for supervisee reluctance. For example, a supervisee may think he or she is too experienced to require supervision or new training. When an agency institutes a new program (e.g., cognitive therapy groups to replace former forms of group therapy), experienced therapists may resent intrusions on independence of practice. By identifying emotional and cognitive reactions to supervision or training with
Mind Over Mood,
supervisor and supervisee are in a better position to evaluate and problem solve these concerns.

At times, a supervisor may have only marginally more experience than a supervisee. Therapists who are new supervisors or new to cognitive therapy often feel somewhat awkward supervising others because of uncertainty about their own expertise. In these cases, we encourage the supervisor to be honest about experience limitations and form collaborative supervisory relationships that rely on mutual coinvestigation of therapy method and process based on reading, clinical trial, discussion, and occasional consultation with more experienced therapists on or off site.

The numerous primary cognitive therapy texts referred to throughout this guide should be read and digested by both supervisor and supervisee. For example, treatment of a depressed client should follow the treatment protocol detailed in Beck, Rush, Shaw, and Emery (1979), as recommended in
Chapter 4
; treatment of a client with panic disorder should follow the Clark (1989) protocol mentioned in
Chapter 5
. Treatment planning for each client will require learning by the novice supervisor and supervisee. Fortunately, most treatment models rely on teaching clients the skills highlighted in
Mind Over Mood,
so supervisor and supervisee should quickly develop a core repertoire of therapy procedures.

Novice supervisors and supervisees benefit from reviewing audio or video tapes of therapy sessions. Taped sessions can be dissected and discussed on many levels: helpfulness to the client, structure, implementation of a clear treatment plan, collaboration achieved, and focus on central client problems. Session tapes can be rated according to the Competency Checklist for Cognitive Therapists reprinted in the Appendix of Beck, Rush, Shaw and Emery (1979). This checklist summarizes the main process and content goals of a cognitive therapy session. It can be used in supervision to help both parties identify therapist strengths, weaknesses, and areas in need of additional supervisorial help.

Some therapists do not have the benefit of regular supervision and training because their practice is geographically isolated. Other clinicians are the sole cognitive therapy practitioners in their groups or areas. Practitioners working alone often recognize a need for additional training, yet the means to obtain it seem remote. For these providers, we hope
Mind Over Mood
and this clinician’s guide provide guidance. Many of the troubleshooting guides throughout both books address problems commonly encountered along with recommended remedies.
Mind Over Mood
addresses many of the common roadblocks encountered by clients along with suggestions for solving them.

Isolated practitioners also can avail themselves of supervision by phone or mail. Most of the training centers for cognitive therapy throughout the world offer long-distance telephone supervision. The senior author of this guide can be asked for training center contacts in different parts of the world. Professional books, audio tapes of workshops, and occasional travel to workshops and conferences can be used for continuing education.

In addition, self-supervision can be very valuable. Practitioners are encouraged to tape and review their own sessions. As described in the “Supervision” section this chapter, a competency checklist can be used to identify areas of practice that require continued learning. Client dialogues from relevant chapters in this guide can be used as models for therapy interventions.
Mind Over Mood
can be used with clients to emphasize development of key skills.

It is usually best to target one or two areas of improvement at a time. For example, one month a therapist may choose to improve her skill at helping clients identify automatic thoughts; another month she may choose to improve her understanding of couples treatment. Once initial goals have been met, additional goals can be set. The goal-setting chapter in this guide (
Chapter 3
) can help establish and prioritize goals for self-supervision.

Finally, we offer encouragement and a caution against perfectionism. Self-supervision is generally the most demanding you will ever receive. Most therapists are highly motivated to improve practice skills. It is important to be collaborative and curious with oneself in supervision. Self-supervision ideally emphasizes observation and problem solving over critique and judgment. And, of course, whenever a therapist in training becomes discouraged or impatient with progress made, the exercises in
Mind Over Mood
can be used to evaluate thoughts and modify learning plans. Just as for clients, irritants and problems experienced by the therapists can become the seeds for valuable learning.

Padesky, C. (1996). Developing cognitive therapist competency: Teaching and supervision models. In P. Salkovskis (Ed.),
Frontiers of cognitive therapy
(pp. 266–292). New York: Guilford Press.

A catalog of training materials in CD and DVD formats as well as information on workshops, conferences, and other training resources is available from
www.padesky.com,
a cognitive therapy website for mental health professionals. A website for the public,
www.MindOverMood.com,
offers links to help find a cognitive therapist and additional information on
Mind Over Mood.

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