This week we explored the use of cognitive approaches in practice as an occupational therapist. The first thing that came to my mind was that "CBT is for psychologists and psychiatrists". However, I was quick to learn that OTs don't necessarily engage in CBT, and that cognitive strategies are slightly different. So I was very interested to learn how to integrate them into my practice!
We began by exploring 'what are cognitive approaches', and 'who could this be relevant for'. The conclusion around the classroom was that it would be relevant for people who have a disorder in which thinking is part of the problem. If cognition is our perceptual lens, anyone who has the ability to think about thinking could benefit from this. Notably, the people who might not benefit from cognitive approaches might be children, people with intellectual disabilities, or people with dementia.
Application to OT
In differing from CBT, cognitive approaches to treatment from an OT lens is unique because we focus on health education, guidance/support, engage in a less emotionally intense interaction, and is less formal. This information is specified on the COTO website at: www.coto.org/pdf/COTO_standards_Psychotherapy.pdf
In the class, we were able to practice different cognitive approaches:
Socratic Questioning
Pros: I liked Socratic questioning because I was able to help my partner come to her own conclusions about her problems by gently guiding her with my questions. The technique was helpful because I really think she was able to think about what was stressing her out from a different perspective. Hopefully I helped her a bit!
Cons: While this method was successful with my partner, I can imagine that there might be situations in which Socratic questioning might not help. For example, if someone was having a life problem in which 'changing the way in which they think about it' wouldn't help, Socratic questioning would be useless. I suppose the most important thing is to be sure that the problem is one of cognition before using the Socratic method on them. It also may be hard to do when your client is talking about something that I have no understanding of. Does the person who is using the Socratic questioning technique on a client have to know what the ultimate goal of the conversation is? These were some of my questions.
TIC TOC Technique
TIC stands for "Task-Interfering Cognitions" and TOC stands for "Task-Oriented Cognitions". In this method the person must objectively examine a cognition that may be task-interfering (ie. "People are going to laugh at me over what I write in this blog"), identify the though distortion (all or nothing thinking), and state a way to think that is task-oriented ("We were instructed to write and reflect our innermost thoughts, the readers will respect my opinion").
Pros: I like that you have to digest what you said and analyze it. I think this would be a good way to train yourself to change the way in which you think.
Cons: I found it hard sometimes to classify what my thought distortions were. Are there a finite amount of thought distortions? I also wondered if there was a "right" or "wrong" way to write your TOC's.
Overall, I found this class very helpful to examine cognitive strategies that to be used by OTs. I also understand the scope in which we operate in. I think this will be very helpful to use in my clinical practice because much of the time, a persons cognition can hinder change. Having negative self-thought is something that should be addressed by OTs because that can sometimes be the first step in the therapeutic relationship.
In my search online for the use of cognitive approaches in day to day life, I came across this webpage that would be very relevant to me.
http://www.marksschwartzphd.com/procrastination.aspx
In this article, Dr. Mark Schwartz discusses how the TIC TOC technique can be used to work on other cognitions and behaviours, such as procrastination. He writes that unrealistic beliefs can contribute to procrastination, and can be used in the same way that we practiced in class with negative self image. This resource helped me to realize that the TIC TOC technique can be used more widely than just for negative thoughts.
