In Consultation

In Consultation

Avoiding Clinical Drift: Learning how to use CARE with your clients

By David Bricker, Mark Glat, and Sherri Stover

January/February 2007

Q: Lately, some of my therapy sessions are feeling less focused--more like friendly conversations and reviews of the week's events. How can I better organize my work and keep therapy moving toward objective, recognizable goals?

A: Getting unstuck in your therapy requires a good "clinical toolbox"--a set of useful, empirically informed ideas about therapy and human behavior that are easy to remember, easy to access, and foster "clinical mindfulness." Being an effective therapist requires not only being empathic, but having concrete skills that help make a difference in the lives of our clients.

The toolbox we use has four compartments that correspond to the areas most clients must address in therapy:

* Cognitions--all the words, ideas, and concepts that shape a client's way of seeing the world;

* Actions--behaviors and activities that structure experiences inside and outside of the consulting room;

* Relaxation--that's shorthand for the importance of managing bodily responses, especially anxiety, in clinical work;

* Emotional Expression--the role that feelings play in all forms of psychotherapy.

Keeping the acronym of CARE in mind (as both an idea and a mantra) will help your practice become more focused and effective.


Since identifying clinical drift isn't always easy, a good strategy is to periodically ask yourself whether your treatment is working on…

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