SIX STEPS TO FACILITATE COGNITIVE CHANGE

CBT focuses on changing a person’s thoughts and actions. In turn, this changes their
feelings and behaviours. There are generally six phases in CBT:

1. Assessment: Evaluate what’s wrong and what the client’s current cognitive process is.

CBT is a goal orientated goal of therapy which means evaluating what’s ‘wrong’ isn’t about
allowing your clients to think they’re ‘wrong’, but instead asking your client to identify what’s
wrong with the way they’re approaching their current goals and what they believe is ‘wrong’
with how they’re feeling and behaving. There’s always a reason someone is coming to you for
CBT treatment, so this is what we need to establish at the very beginning.

There are some people who will be in denial about certain parts of themselves which need
addressing, but that you can see clearly are working as a major contributing factor to why
they feel ‘wrong’. Your role as a CBT practitioner is to help them not feel ashamed or defensive
about these parts of themselves but make them know that they will never be free from a self-
destructive loop-hole unless they address and acknowledge this part of themselves and the
role it’s playing in their ‘wrongness’. During this stage, we also help clients identify whether or
not the goals they’re pursuing are in line with their values.

2. Re-conceptualisation: Work with client and encourage them to explore their experience
differently

Many clients come to CBT practitioners with a focus on the negative. Once a client has
become aware of their issues, they become more aware of the personal consequences of
their habits and attitudes and spend time thinking about our problem. During this step, CBT
practitioners need to help clients manage their indecisiveness and mixed emotions about
them and consider the possibility of changing. The role of a CBT practitioner is not to make
the negative emotions go away, but to help them look at their circumstances, identity, goals
and situation from an alternative perspective to reevaluate themselves.

3. Skills Acquisition: Help client learn to deal with issues, for example: examine thoughts
and beliefs, exploring which ones are logical and which are fear-based (‘thought
monitoring’)

We as CBT practitioners want our clients to be able to take away the tools they need to
help themselves in the future which means we must teach them what techniques we are
employing when working with them whilst we work with them. This means sharing details
about how someone can monitor their thoughts, ask themselves meaningful questions, how
to improve their communication and challenge their own perceptions. Whilst this means
they’ll start to need you less and less, it would be dishonourable of a CBT practitioner to leave
their client in a disempowered position for their own financial benefit.

4. Skills Consolidation: This is where the rubber hits the road and the principles are applied.

Making a move towards that which we have been preparing requires boldness and an
enormous commitment of energy. This stage requires clients to leave their comfort zone
behind and embrace the uncertainty that accompanies a step into the unknown. Deciding
to change is one thing, and it’s another thing taking action steps towards making change
happen. Needless to say, this stage is always determined by the client, not by us.
 SIX STEPS TO FACILITATE COGNITIVE CHANGE
5. Maintenance: Working with the client until the new skills become habit and routine.

This is where the new processing skills we’ve been teaching them (such as the ABC model)
become habitual to them, This part of the process that demands grit, patience, perseverance,
persistence and hard work. This character developing stage of change is likely to fail
unless the client is taking charge of the process and is willing to accept relapses, setbacks
and successes equally. Whilst taking action is an incredible first step, old habits will find a
way back into their lives if our client isn’t committed to ongoing improvement, growth and
development.

Newly acquired change is a fragile thing; the temptation to quit can seem overwhelming at
this stage. Therefore, much planning and preparation can be required to see this stage to
completion. Our clients need to set goals, do their homework, action plan and establish their
priorities.

6. Follow-up: Address any issues that arise and evaluate for growth/progress/regression

Around a month after their final session, give your client a phone call to check in on them and
see how they’re progressing on their own. You may find that your client has been successful in
applying the skills and techniques you taught them to the original area of their life which they
came to you for help with but not other aspects of their life. In this case, another session or
two may be appropriate.

In cases of relapse, we may want to bring our clients back to another series of sessions to
bring them back to the re-conceptualisation stage to allow them time to reflect, adapt, adjust,
figure out what went wrong before re-entering the action stage once again. Effective ‘self-
changers’ can go through these six stages multiple times before they complete the cycle of
change without any relapse.

Change can be a complicated process and committing to positive changes can be laborious
and stress-inducing, but we have to remember that the pain of change is still less than the
pain of remaining the same and the potential benefits can be huge. If we plan carefully and
build a solid foundation for change, implementing change can be far more comfortable with
increased chances of success.

Change is an inevitable part of life. Understanding these six stages of change can help us to
help ourselves and others better. Whether we want to facilitate change in others, a sense of
urgency, a compelling vision for what change looks like and a commitment to hard work will
spur the momentum that makes change part of everyday life.