Over the years, I have developed a certain pragmatic sequence in teaching students how to conduct effective cognitive behavior therapy. First, we start with CBT theory, history, and research and the basics of how to conduct a thorough diagnostic evaluation. This natural starting point provides an important foundation in their learning CBT.
Next we turn to how to treat depressed patients. Initially, I focus on two critical elements: conceptualization and the therapeutic relationship. Among other activities, I ask students to monitor their own mood and behavior and to look for their own automatic thoughts when they notice they are feeling distressed and/or behaving in a way that isn't consistent with their goals. In this way, I try to get them to see their own experience through the cognitive model. I also have them create "coping cards," with important reminders such as, "I should treat this patient the way I would like to be treated." To reduce their anxiety, I might have them make a coping card that says, "My goal in this session is not to cure the patient. It is to develop a good therapeutic alliance and do some work on at least one problem." When their anxiety lessens, students can pay better attention to the emotional experience of their clients rather than focusing on their own.
Next I'll ask a student who has already started treating a patient to present the case. I guide the class in conceptualizing the patient. Then I ask them, "If this patient were a family member or friend, what would you suggest?" I find that this helps students verbalize fairly standard cognitive, behavioral, and problem-solving techniques. It also helps them gain confidence in their ability to use their own good common sense to help patients with their problems.
I also teach students how to set goals, structure sessions, and elicit and respond to feedback.
My final emphasis is on learning basic cognitive and behavioral techniques. I find that an initial emphasis on conceptualization and common sense reasoning teaches students how to conduct therapy based on their understanding of the individual patient, instead of just employing techniques in rote, cookbook fashion.