Session Five - Cognitive Behavioral Counseling (Challenge the Lies We Tell Ourselves)

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Mary arrived ten minutes late today. Joan cannot and will not add an extra ten minutes on the other side. This would not be fair to the next client and Mary needs to learn that there are consequences to not being punctual.

Mid Session Five

Joan: “Mary we’ve done the exercise 'The Ten Things I Like About Me' and you’ve just said you agree with these. And yet you continue to say awful things about yourself. I want you to think what your best friend would think if you said these kinds of things to her…”

Mary: (Stays silent.)

Joan: “She’d be really upset with you – in fact, she might never speak to you again. She’d be crushed and it would take her some time to get over this. And yet you say these things to yourself day after day.”

Mary: “But they are true.”

Joan: “I’m going to challenge you on this with a little exercise called The Lies We Tell Ourselves (based on Cognitive Behavioral Counseling or Therapy – because so often that is what we are doing. So Mary, tell me five things you don’t like about yourself – and only five so make them good.”

Mary: “That’s easy enough.

1. I’m nasty to my mother

2. I’m a lousy student

3. I’m a slob of a housekeeper

4. I’m fat and out of shape

5. And my nose is too big!”

Joan repeats these back to her…

Joan: “OK, #1. So how are you nasty to your mother?”

Mary: “I get really impatient with her on the phone.”

Joan: “Every call? Every minute of every call? Be more specific.”

Mary: “OK, not every call – but lately I’ve been getting edgy. I’m behind on essays.”

Joan: “So a more accurate description might be, ‘When my mother calls and I’m trying to write an essay I can be short with her.’”

Mary: “That’s true.”

Joan: “You and I can take some time and work out a strategy for dealing with this – but you see what’s going on here? You’re lying to yourself. You say you’re nasty all the time and in fact you get short occasionally. Very big difference and easily fixable.”

Mary: Nods…

Joan: “#2. I’m a lousy student. What is the evidence for this?”

Mary: “I’m not getting straight A’s and part of me could care less.”

Joan: “We’ve reviewed your marks. It was only in one course you failed a test and you now have a tutor for that.” Mary: “I’m not getting straight A’s.”

Joan: “Welcome to the majority of students. You normally don’t get less that a B and you’ve said you don’t even have to work that hard to get B’s.”

Mary: “Yeah well.”

Joan: “And you said ‘could care less’? Last session you told me you were worried about your debt situation on graduation – that’s care.”

Mary: “It feels hopeless.”

Joan: “Just because you feel something doesn’t mean it’s right. Have you heard of the book ‘Mind Over Mood’ by David Burns?”

Mary: “I’m a history major, not a psyche major.”

Joan: “His basic premise is that you can change the way you feel by changing the way you think. When a person is feeling down, the thoughts become negative. Which makes us more down, and so it goes. But if we say ‘No!’ to these exaggerated negative thoughts and ‘Yes!’ to productive positive thoughts – we can improve our mood and work to change situations.”

Mary: “So if I think happy thoughts, my loan will vanish?”

Joan: “If you think, ‘Hmm, I’m worried about my loans and need to take some steps. I know, I’ll get some ideas and strategies from Joan…’ – then, yes, you’ll have happier thoughts and a strategy for paying off your loan. In fact in our next session how about you and develop a strategy for paying off this loan and getting a job in your field."

Mary: "Let me guess, you've written a book called 'Great Jobs for Artsies!"

Joan: "Not quite, but I'm working on a power-point for it..."

Mary: “Hey Mary Poppins! #3 I’m a lousy housekeeper.”

Joan: “What does that look like?”

Mary: “I do the minimum.”

Joan: “What does that mean?”

Mary: “I let dishes pile in the sink, garbage flow over the top of the pails. The bathroom is disgusting, and there are dust bunnies – no, kangaroos!”

Joan: “I’m glad you still have a sense of humor. So your partner Andy has two broken arms and legs?”

Mary: “No, but it’s a downward spiral.”

Joan: “If the two of you were to take an hour on a Saturday morning – working together – how much of it could you clean up?”

Mary: “All of it. It’s a small apartment.”

Joan: “So this is a lifestyle choice – you could fix this, but at this time you are deciding not to.”

Mary: “I guess, if you put it that way. But I don’t feel it’s a choice. I feel absolutely flat about it…”

Joan: “What would motivate Andy and you to go on a cleaning spree?”

Mary: “Having company over - Andy’s an amazing chef, you know. But we don’t have company over because the place is a sty.”

Joan: “May I humbly suggest that you take the hour, do it, and then reward yourselves with a nice breakfast out of the apartment.”

Mary: “That might work actually…”

Joan: “#4 You say you are fat and out of shape. How many pounds overweight are you according to the chart at the health office, and what does ‘out of shape’ mean?”

Mary: “Twenty pounds and a flight of stairs winds me.”

Joan: “So I will agree with part of what you said then – you are overweight – but not obese – and you are out of shape – but you can get around campus easily enough. This is a situation that is easily fixable if you decide to do it.”

Mary: “Why am I not feeling happier!” Joan: “Cognitive Behavioral Counseling or Therapy or ‘Challenging The Lies We Tell Ourselves’ is not about pretending problems don't exist. Rather, it’s about being more accurate and then making the necessary changes – rather than feeling defeated and being disempowered.”

Mary: “Let me guess – you’re going to tell me my nose is biggish but not big, and fixable if I really want to…”

Joan: “Who tells you your nose is too big?”

Mary: “The mirror.”

Joan: “So in fact YOU are saying that. Anyone else?”

Mary: “They’re too polite and I really truly am embarrassed about my nose.”

Joan: “So what are your options?”

Mary: “Plastic surgery – eventually.”

Joan: (Wants to roll her eyes, but…) “That’s one option. Isn’t there one that is less expensive and more immediate?”

Mary: “If I knew, I’d be doing it.”

Joan: “Let’s try something. (Types into computer ‘how to make nose look smaller’). Look at this! Dozens of sites called ‘How to Make Your Nose Look Smaller.’ I’ll email this link to you. Guess you aren’t alone, huh?! And by the way, I don’t think you nose is too big either!” Mary: “I haven’t liked this session at all. Instead of listening to me and agreeing with me, you’ve been abrupt and disagreed with everything I’ve said!”

Joan: “I have absolutely listened to you – but I disagree with the lies you tell yourself. I’m going to give you an info sheet called ‘Common Thinking Errors’ - and it’s a really good lie-detector. It highlights the ten most common distorted thinking patterns and how to break out of them. Also, one on ‘Positive Thinking and Self Talk’ and, my favorite, ‘How to Be Your Own Best Friend.’

Mary: (Rolls her eyes.) “Let me guess, for homework you want me to do some charting.”

Joan: “You know I’m just itching to give you a ‘week sheet’. But I know you like journaling better. On your info sheet there is a handy little chart called ‘The ABCs of Cognitive Behavioral Counseling (Therapy).’

A. Activating Event – the actual event and the client’s immediate interpretations of the event

B. Beliefs about the Event – this evaluation can be rational or irrational

C. Consequences – how you feel and what you do or other thoughts

So how about you journal when you say a nasty thing to yourself (Belief about the event) and how that makes you feel or think or how you behave (Consequence). Next I want you to also write down what triggered this (Activating Event). Then I want you to think of and write down what might be a more helpful perspective (Belief about the event) and how you might then feel, think or do (Consequences.)”

Mary: “Sounds like physics to me!”

Joan: “It isn’t. Here’s an example.

Situation One – Distorted Thinking

A - Mary is walking down the street, and her friend Sarah walks right on by.

B – Mary thinks, “Oh Sarah is such a jerk.”

C – Next time, Mary ignores Sarah.

The ‘B’ may or may not be true. Here is another possibility.

Situation Two – Positive Thinking

A - Mary is walking down the street, and her friend Sarah walks right on by.

B – Mary thinks, “Oh that Sarah, always distracted.”

C – Mary calls out, Sarah apologizes for missing her, and they go for coffee!”

Mary: “OMG! That first example happened. So I resolved not to call Sarah. She called me and asked ‘What’s up!?’ So I told her how hurt I was. Sarah was stunned. So we both apologized and went for coffee!”

Joan: “Awesome! A testimony from a satisfied customer!”

Mary: “You know – you’re starting to grow on me!”

Joan: (Grins) “I’m glad to hear that because I’d really like you to come back for a session on Holistic Health also known as the Biopsychosocial Model. This is where we do a whole health review – physical, social, emotional, spiritual, vocational and intellectual.”

Mary: “Good grief. Should I bring crystals?”

Joan: “No, this is going to be more like ‘Grandma’s Rules.’”

Sample Session Five - Cognitive Behavioral Counseling (Therapy) continues...

If you want to get somewhere, you have to know where you want to go and how to get there. Then never, never, never give up. — Dr. Norman Vincent Peale

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