CYOA Mock Therapy

You are sitting across from your new client, John(He/Him/His). According to the intake information, John is 28 years old, White, and identifies as a male. John sits forward in his seat, his body curled in on itself defensively. He looks to be pale, his eyes are sunken, and he has a few days' growth of facial hair. [["Hello, John my name is $name, I understand you were referred here by your general practitioner because you've been feeling down recently."->Encounter #2 Optimal]] [["Hello, John my name is $name, why are you here?"->Encounter #2 Suboptimal]]

John looks at you, and then looks to the floor. "Yeah, I've been feeling kind of low lately, and it is hurting... hurting more than I'd like." [["You've been feeling down."->Explanation #1]]

(set: $name to (prompt: "Please enter a name: ", "")) Choose Your Own Therapy Adventure Therapist Exercise #3: Text-Based Adventure, Choosing the Better CBT Intervention In this text-based choose your own adventure exercise, you will be playing the role of a therapist who uses core counseling skills and Cognitive Behavior Therapy (CBT) skills to help the client explore the difficulty that is bringing them into therapy. At each step, you'll be presented with two response options (i.e., intervention options). Your task is to choose the better of the two response options--the one you believe will help the session move in a more productive direction. When you select the more optimal intervention the dialogue will proceed. When you select the less optimal intervention, you'll be asked to return to the prior screen to try out the more optimal intervention. (The designation of "more/less optimal" is not intended to suggest that a given intervention option represents the best possible option or that we are always correct in designating the choice as being more/less optimal. Rather, these designations are based on our subjective understanding of counseling best practices.) Good luck on your adventure! [[Begin->First Encounter]]

John looks down, "I've been having trouble." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->First Encounter]]

John furrows his brow, considering, then shakes his head. "No, I haven't heard of that before." [["Okay, you just identified what we call an automatic thought. Everyone has them. They are thoughts that just seem to pop into our heads. We're not deliberately trying to think about them; that's why we call them automatic. Most of the time, they're very quick and we're much more aware of the emotion-in this case, sadness-than we are of the thoughts. Lots of times the thoughts are distorted in some way. But we react as if they're true. Through therapy, you’ll learn to identify your automatic thoughts, and then evaluate them to see just how accurate they are."->Explanation #2]]

Your client gives you a confused look. "Mm-mm." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #11 Optimal]]

Reflections of feeling: "You've been feeling down." This statement is a reflection of feeling. A reflection of feelings is a statement that explicitly labels the client’s feelings. The feelings may have been stated by the client (in either the same or similar words), or the helper may infer the feelings from the client’s non-verbal behavior or from the content of the client’s message. The reflection may be phrased either tentatively (e.g., “I wonder if you’re feeling angry?”) or more directly (e.g., “It sounds to me like you’re feeling angry”). The emphasis can bejust on the feeling (e.g., “You feel upset”) or on both the feeling and the reasonfor the feeling. ((text-style:"underline")[Helping Skills: Facilitating Exploration, Insight, and Action] 4th Ed, Clara Hill 2014) [["Continue"->Encounter #3 Optimal]]

John nods his head in small movements, "Yeah, I'm ready for change." [["Have you tried talking to your friends about this?"->Encounter #4 Suboptimal]] [["How long has this been going on?"->Encounter #4 Optimal]]

John looks up, some confusion on his face. "No, I don't think they'd be right to talk about this sort of thing," he says. [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #3 Optimal]]

John briefly considers his answer. "It started a few months after I moved here from the other side of the country." John hesitates a moment before continuing, "It's been building, and just has become too much." [["How did you feel before this started?"->Encounter #5 Suboptimal]] [["This low feeling has been going on quite some time, and it's gotten pretty bad lately."->Encounter #5 Optimal]]

"Yeah, it started with a down feeling, but now I just don't have the drive to do things, sometimes to even get out of bed. I just... want to, I need to do something to make this stop." [["You seem to be putting yourself under some pressure to feel better."->Encounter #6 Optimal]] [["You say you are feeling very unmotivated. Do you accomplish what you are delegated at work? Do you think the way you are feeling is affecting your performance?."->Encounter #6 Suboptimal]]

John smiles weakly, "It was better, I felt happier and didn't have this cloud hanging over me." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #4 Optimal]]

John makes prolonged eye contact for the first time as he adds some force to his voice. "Of course, it's my mind." He deflates somewhat as he adds, "It's just hard because I don't have anyone to talk about this with, and I don't know what to do. So I stay by myself and try to stay distracted from thinking about it." [["What sort of things have been effective at helping you stay distracted?"->Encounter #7 Suboptimal]] [["You've been feeling very isolated."->Encounter #7 Optimal]]

John thinks for a moment. "No, I don't finish everything, especially when this feeling is dominating my thoughts." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #5 Optimal]]

"I don't have anyone to talk to, to share with. My friends and family are scattered all over the country, and I can't call them about this." John says, resigned. [["You're separated from your friends and family, and you can't reach out to them."->Encounter #8 Optimal]] [["I'd like to get to know you a little better. You're a systems engineer that moved pretty far to come here for your work?"->Encounter #8 Suboptimal]]

John looks away. "Music and Netflix, things to get my mind off this." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #6 Optimal]]

"Yeah. I don't want to just throw my problems on him." [["It seems like you may be having what we call an "Automatic Thought". Have you ever heard of that term before?"->Encounter #12 Optimal]] [["You know, sometimes I wonder if when I'm sharing or asking for advice, I'm causing an issue or being an inconvenience. So that's something that's called automatic thoughts. Have you heard of that before?"->Encounter #12 Suboptimal]]

"Yeah," John says, "I followed the money and here I am." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #7 Optimal]]

"Yeah, even when I want to call them, I can't." [["Can you think of a time recently when you wanted to reach out, but couldn't?"->Encounter #9 Optimal]] [["Why not?"->Encounter #9 Suboptimal]]

"Last weekend, I was thinking of calling my dad. I knew he'd be home watching the game, and I went to pick up the phone to call him. I just started feeling terrible and couldn't do it." [["You started feeling bad, and couldn't go through with it. [John nods] Can we focus on that moment, those few seconds as you're going to the phone, [John nods again] what's going through your mind at that moment?"->Encounter #10 Optimal]] [["Do you think that that terrible feeling should stop you from calling you dad?"->Encounter #10 Suboptimal]]

"I'm thinking that I'm going to ruin his nice day. Instead of enjoying the game, he'll be dealing with me." [["What is your relationship with your father like?"->Encounter #11 Suboptimal]] [["You think you're a burden."->Encounter #11 Optimal]]

John shakes his head wearily, "No." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #9 Optimal]]

"Uh, pretty good. Nothing to complain about." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #10 Optimal]]

Automatic Thoughts: Automatic thoughts are the stream of momentary thoughts that coexists with your overt thought processes. All people experience automatic thoughts, not only those under a form of psychologcial distress. The majority of the time, we are barely aware of automatic thoughts, though they are just under the surface of conscious awareness. With a small amount of training we can readily bring these thoughts to the foreground. [[Continue->Encounter #14 Optimal]]

"I've got you, I'll keep that in mind." John says. [["Do you get what I'm saying?"->Encounter #15 Suboptimal]] [["How does that explanation fit for you?"->Encounter #15 Optimal]]

John considers for a moment, "I mean I get behind it. I understand, how you said, I think at first it's just my emotion, feeling bad before reaching out. But, then I can see my emotion is caused because of that thought. I definetly agree with that." [["So, you've been a burden on your family for a while now?"->Encounter #18 Suboptimal]] [["Has this reticence to reach out, this burdensome feeling, happened before?"->Encounter #18 Optimal]]

"Well," John thinks back, "A few years back, I was having relationship trouble and I was thinking about asking my friend, Zion, for advice when we were hanging out. But, I got the same feeling, and tried not to bother him." [["Can you think of any ATs here?"->Encounter #19 Suboptimal]] [["What thoughts came up for you in that moment?"->Encounter #19 Optimal]]

"Yeah, it feels like it." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #15 Optimal]]

"I was thinking that he wouldn't want to deal with my problems. I don't want to add to anything he might be dealing with. He must've sensed something though, because he asked me if something was the matter." John takes a breath before continuing, he gets a grin on his face as he thinks of his friend. "I told him not to worry about it, you know, I didn't want to put it on him. But, he said that's why we are here, for each other." [["How did it feel for your friend to challenge those thoughts?"->Encounter #20 Optimal]] [["How long have you known this friend, Zion."->Encounter #20 Suboptimal]]

"Yeah, I think so." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #14 Optimal]]

"Umm, no. I can't." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #18 Optimal]]

"It felt good. It lifted a weight off my shoulders to know I wasn't being a burden. That my friend was there for me and wanted to help." [["That is a great feeling, isn't it. And if you had a friend who came to you and said, 'I have a problem but I think I'll be a burden', what would you say to that friend?"->Explanation #3]]

"Forever, or close enough. We met in grade school." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #19 Optimal]]

Socratic Questioning: Socratic questioning is another tool that mental healthcare providers may use. The practitioner will use their expertise to decide when and where to apply evaluative questions to a belief. There are several types of questions designed to discover the validity and/or utility of the thought being considered. These questions are not intended for the therapist to directly challenge the thought, but to allow the client to evaluate the thought themselves. [[Continue->Encounter #21 Optimal]]

John leans forward, "I'd tell them that I'm their friend and I //want// to help them." After a slight pause he continues, "Ok, I see. But, it is easier when you are right there with them." [["It is, isn't it. How has it been trying to make friends here?" ->Encounter #22 Optimal]] [["Why is that the case? That doesn't seem logical to me." ->Encounter #22 Suboptimal]]

John looks down, some sadness coming back into his face. "I haven't met anybody I'd call a friend, not since I moved here. It's been... a bit lonely." [["You haven't met anyone here, but you do have supportive friends that live further away."->Encounter #23 Suboptimal]] [["That sounds hard. What has it been like, sitting with that loneliness?" ->Encounter #23 Optimal]]

"It feels pretty bad, I just get down whenever I think of it and I wonder if I'll live alone the rest of my time here. I tried to start conversations with a some of my coworkers, just wanting to get to know them and I got shut down. Now, I just sit at home. I only go out for work, food and church." [["That's a rough feeling, to believe you're alone and it isn't going to get better." ->Encounter #24 Optimal]] [["Why did you give up on talking to them?" ->Encounter #24 Suboptimal]]

"Yeah, I don't want to feel like this." John says forlornly. "I just don't see a way out." [["Yeah. Coming to this new place, with no friends. Have you ever been in a situation like this before? New place and new faces."->Encounter #25 Optimal]] [["Well, we're here to work on that, together."->Encounter #25 Suboptimal]]

"Uh, because they are present with you. On the phone it just feels so distant." John says. [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #21 Optimal]]

"Yeah, I do have those friends out there." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #22 Optimal]]

John quick responds, "Well, yeah, when I went to college; I didn't know anyone there." [["So you have been in this position before."->Encounter #26 Suboptimal]] [["What happened there?"->Encounter #26 Optimal]]

"Yeah, ok." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #24 Optimal]]

John looks off, remembering back to his school days. "Well, after a little bit I met a friend here and there. I slowly built up some relationships." [["So, why aren't you able to do that in this situation?"->Encounter #27 Suboptimal]] [["Yeah, you seem like a good guy, someone the right people would want to be friends with. Finding those right people can be tough. Especially as we get a little older and aren't thrown together like when we're younger."->Encounter #27 Optimal]]

"Yeah, not a fun place to be." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #25 Optimal]]

"Mm-hm. Like in university, you have to meet and work with a lot of people in your classes, and meet your roommates and the people who live in your dorm." John lightens up as he describes part of the college experience, then becomes a little crestfallen as he comes back to the present. "But, I don't have that now." [["Just because you don't have it now, doesn't mean you can't get that back."->Encounter #28 Suboptimal]] [["I wonder if there are some places or groups in your life that could provide you with an opportunity to connect with other people."->Encounter #28 Optimal]]

"I don't know." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #26 Optimal]]

"Well, my church does have a few opportunities. There is a men's group and an adult continuing study." [["Great. I'm going to present a question, you don't have to answer now, and I certainly don't expect you to do it now. But, I'd like you to consider how you might feel about trying an experiment. Joining one of these groups, meeting the people there in something of a structured environment. How do you feel about trying that out as an experiment?"->Explanation #4]]

"I definitely wish I could." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #27 Optimal]]

Behavioral Experiments: A behavioral experiment is a planned real world activity that can test the validity of a belief. It is a powerful tool to confirm or challenge a the thought which is being experimentally tested. Behavioral experiments are designed with a specific thought or belief to be tested, and are not only a method for encouraging activity. [[Continue.->Encounter #29 Optimal]]

"Uh, I'll think about it. I'm not sure how I feel about it yet." John says as he considers the proposal. [["All right. Thank you for considering it. As our session winds down, I'd like to ask you how you feel about our session today? For example, the degree to which you feel I heard and understood your concerns and gave you what you needed?"->Encounter #30 Optimal]] [["Great, thank you. We're getting close to the end of our time today. Is there anything else you need to talk about?"->Encounter #30 Suboptimal]]

"It felt okay. You mostly got me, and you gave me some good things to chew on. We also talked about what I'm here for, so that's good. Yeah, thanks, Doc." [["No. Thank you, John. I'll see you next week."->Finish #1]]

"It felt nice." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #29 Optimal]]

$name, thank you for participating in this choose-your-own-therapy adventure experience. We hope this was a thought provoking exercise, which helped you think more about the careful thought that must go into making intervention choices when working with clients. For further resources related to therapy, counseling psychology, graduate school, and more, check out (link: "http://drjosephhammer.com/")[(goto-url:'http://drjosephhammer.com/')] - Created by Andrew, Kelsey, and Dr. Hammer [[Glossary->Finish #2]] (link: "Exit Game")[(goto-url:'http://textadventures.co.uk/games/view/omeqcwicpkwtycctlyyuxw/cyoa-therapy-session')]

Glossary: [[Restatement->Gloss #1]] [[Automatic Thoughts->Gloss #2]] [[Socratic Questioning->Gloss #3]] [[Behavioral Experiment->Gloss #4]] (link: "Exit Game")[<script>window.close()</script>] [[Start over->First Encounter]]

Reflection of feeling: A reflection of feelings is a statement that explicitly labels the client’s feelings. The feelings may have been stated by the client (in either the same or similar words), or the helper may infer the feelings from the client’s non-verbal behavior or from the content of the client’s message. The reflection may be phrased either tentatively (e.g., “I wonder if you’re feeling angry?”) or more directly (e.g., “It sounds to me like you’re feeling angry”). The emphasis can bejust on the feeling (e.g., “You feel upset”) or on both the feeling and the reasonfor the feeling. ((text-style:"underline")[Helping Skills: Facilitating Exploration, Insight, and Action] 4th Ed, Clara Hill 2014) [[Glossary->Finish #2]] (link: "Exit Game")[<script>window.close()</script>]

Socratic Questioning: Socratic questioning is another tool that mental healthcare providers may use. The practitioner will use their expertise to decide when and where to apply evaluative questions to a belief. There are several types of questions designed to discover the validity and/or utility of the thought being considered. These questions are not intended to directly challenge the thought, but to allow the client, in a structured setting and in collaboration with an expert, to gain insight. [[Glossary->Finish #2]] (link: "Exit Game")[<script>window.close()</script>]

"I don't know, I just can't do it." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #8 Optimal]]

"I didn't want to push myself on them." [[Please go back one step and try the other intervention option, which may help the therapeutic dialogue move in a more productive direction.->Encounter #23 Optimal]]