Low-intensity CBT Skills and Interventions. Группа авторов

      Figure 2.1 Funnelling technique (adapted from Richards and Whyte, 2011)

      Top of the Funnel

      Adopting this approach, the LICBT practitioner will start with general, open questions to help the patient start talking about their difficulties (e.g. ‘What problems are you experiencing that have led you to seek help?'). The ‘Four W’ questions can be used as open questions to represent the top of the questioning funnel.

      Key Point

      The ‘four Ws’ questions:

      Moving down the Funnel

      When funnelling, ask open questions to request more specific information and begin to move down the funnel (e.g. ‘Can you tell me a bit more about how your anxiety is affecting you on a day-to-day basis?'; ‘Can you say a bit more about how your low mood has been affecting you?'). Following this approach, the patient chooses the focus of the answers and the practitioner encourages the patient to provide more detail.

      Bottom of the Funnel

      Closed questions obtain more specific detail (e.g. ‘How often do you have problems getting off to sleep at night?'; ‘Have you noticed particular situations where you are more likely to experience a panic attack?'). By doing this, the patient is helped to focus on providing a clearer picture of how their problems are affecting them with the LICBT practitioner getting a sense of the frequency, intensity and duration associated with the problem (e.g. ‘How often do you experience panic attacks in an average week?'; ‘Using a scale of 0–10, where 10 is the most intense and 0 is no symptoms, how severe is your anxiety when you get panicky?'; ‘How long do your panic attacks tend to last?').

      Problem Formulation Assessment Structure

      Within LICBT, completing assessment sessions and deriving a problem formulation typically take 35–40 minutes (Richards and Whyte, 2011) and are delivered using a specific structure comprising a clear beginning, middle and end across six separate but interdependent sections (Table 2.1).

Table 2.1

      Adopting common factor skills (Chapter 5) and working collaboratively throughout the assessment session will help develop a strong therapeutic alliance to build upon during treatment sessions. It is therefore essential that the assessment is appropriately paced to gain an accurate understanding of the patient's difficulties. When new to this way of working there can be a tendency to become overly focused on a list of questions. However, this can hinder active listening and responsiveness to what the patient is saying. A degree of flexibility to enable a better flow to the session whilst facilitating a specific focus on areas of importance that may arise, in particular risk, is therefore important. When working more flexibly however, consideration should always be given to fundamental characteristics of the LICBT clinical method (Chapter 1).

      Introduction to Assessment Session

      The importance of making a good introduction to an assessment session can sometimes be overlooked. However, getting off to the right start means it is important to establish realistic patient expectations about the competency of the LICBT practitioner and potential benefits of LICBT. This helps the LICBT practitioner gauge the potential practitioner–patient interaction and determine appropriate common factors (Chapter 5). The benefits of establishing a good introduction is further enhanced given the importance of establishing a relationship with patients that represent some form of diversity (Chapters 18 and 19). For example, when assessing a patient who needs an interpreter, it is important to establish the ground rule that everything that everyone says in the room will be translated. This statement makes it clear that everyone will be included in all communication at all times. This is important so that patients do not ever feel excluded.

      Introductions

      Whether in person, by telephone or other support modalities, it is essential to establish that the assessment session is being undertaken with the right person. Practitioners should therefore introduce themselves and ascertain the patient's full name and how they would like to be addressed.

      Clinical Example

      Introduction

      ‘Hello, I'm Delaney Hasbrook but please call me Del. Can I please check your full name?’ Followed up with: ‘What would you like me to call you?’

      Brief Clear Explanation of LICBT Practitioner Role

      Once preferred names have been established it is important to orientate the patient to the session, providing a brief description of the role and job title.

      Clinical Example

      Introducing Role

      I'm a low-intensity practitioner here at Busbrook House. What this means is that I help people who are experiencing difficulties such as anxiety and low mood by working together using tried and tested evidence-based interventions that are likely to help the problem. I'll explain later in our session what kinds of interventions I can offer that may be helpful for you. How does that sound?

      Overview and Agree Session Agenda

      Consistent with high-intensity CBT (HICBT; Beck et al., 1987) it is important to provide an overview of the aims of the session, collaboratively developing an agenda and specifying session length.

      Clinical Example

      Overviewing Session

      Our session will last up to 45 minutes during which time I hope to get an understanding of what brings you here today, which means I will ask you questions about your problem and how it is affecting different areas of your life. There will be lots of opportunities for you to ask questions and by the end of the session, together we will work out next steps. How does that sound?

      It is a good idea to find out if this is what the patient is expecting and whether this meets their needs.

      Confidentiality and Informed Consent

      It is imperative from the outset that confidentiality is accurately explained, with the end of the introductions an ideal time to explain the remits of confidentiality. It is not true to say that the session is completely confidential. The following use of patient information should therefore be highlighted.

      Clinical Practice

      Confidentiality