Psychoeducation and Impact Statement Assignment
In the first session of cognitive processing therapy (CPT), psychoeducation is a crucial component, coupled with the assignment of an impact statement. The term “practice assignments” is preferred over “homework” due to potential negative connotations associated with the latter. It’s important to clarify that effective treatment requires both in-session activities and continued practice at home.
The patient’s experiences, particularly regarding their trauma, needed consistent practice beyond the weekly 45 to 50-minute sessions. The impact statement should reflect the patient’s understanding of why the trauma occurred and its effects on their self-perception, relationships, and worldview. This included their thoughts on safety, trust, power and control, esteem, and intimacy. These areas were emphasized as they would be focal points later in treatment. Therapists should look for “stuck points” in these statements and plan to review them in subsequent sessions.
Session 1: Responsibilities and Resources
CPT includes practice assignments and various handouts. These resources cover topics such as recovery and non-recovery symptoms post-trauma, and the definition and identification of stuck points.
Sessions 2 and 3: Identifying Stuck Points
Focus on Stuck Points
In the following sessions, the therapist and patient worked together to identify stuck points, essentially unhelpful beliefs stemming from the trauma. This process leveraged the psychoeducation provided in the first session.
Routine Assessments and Expectation Setting
The PTSD Checklist (PCL-5) should be administered in every session. Initially, it focuses on symptoms over the past month, shifting to a weekly perspective as regular CPT sessions proceed. It’s crucial to inform patients that symptoms may intensify before improvement is noticed, using metaphors like the “shaken soda bottle” to illustrate this.
Addressing Non-Completion of Assignments
Non-completion of assignments must be addressed promptly, as they are integral to successful treatment. If a patient fails to complete their impact statement, therapists might dedicate session time to this task or even end the session early, emphasizing its importance. Establishing early in the therapy that practice assignments are as crucial as the sessions themselves is vital.
Introducing the ABC Worksheet
In sessions 2 and 3, therapists introduce the ABC worksheet. This tool helps patients track activating events, their beliefs about these events, and the resulting consequences. This tracking aids in connecting current reactions to trauma-related stuck points.