English for Psychotherapy and Counselling: Handbook for Practitioners. Английский для психотерапии и консультирования: практическое руководство

7. Our termination session _______ (take place) on December 15th.

8. This relapse prevention plan _______ (help) you maintain your progress.

Exercise 2: Will vs. Going to

Decide if each sentence should use “will” or “going to”:

1. A: I haven’t decided which intervention to use yet.

B: I _______ (recommend) trying cognitive restructuring first.

2. We _______ (start) working on your social anxiety in today’s session. (This was planned last week)

3. A: The client seems very distressed.

B: Don’t worry. I _______ (check in) with him right away. (spontaneous decision)

4. According to the treatment plan, therapy _______ (last) for 16 weeks.

5. I can see you’re making great progress. You _______ (reach) your goals very soon. (based on evidence)

Exercise 3: Complete the treatment plan discussion

Complete this dialogue between a therapist and client using appropriate future forms:

Therapist: So, we _______ (work) together for approximately 12 sessions. In our first few sessions, we _______ (focus) on assessment and goal-setting.

Client: That sounds good. What _______ (happen) in the later sessions?

Therapist: We _______ (use) various CBT techniques to help you manage your anxiety. I _______ (teach) you relaxation skills and cognitive restructuring.

Client: _______ (I / have) homework?

Therapist: Yes, I _______ (assign) practice exercises between sessions. This _______ (help) you apply what we learn in therapy to your daily life.

Client: When _______ (we / meet)?

Therapist: We _______ (meet) every Thursday at 2 PM. Does that work for you?

Client: Perfect. I _______ (see) you next Thursday, then!

Exercise 4: Correct the mistakes

Find and correct the mistakes in these sentences:

1. We will meeting for our session tomorrow at 3 PM.

2. I think the client is going achieve their goals soon.

3. The therapist going to assign homework next week.

4. Our final session will taking place in June.

5. What we are going to work on today?

6. The treatment plan are going to include relaxation techniques.

7. I meet my supervisor next Monday to discuss this case.

8. Will the client going to attend group therapy?

COMMUNICATION:

A Therapeutic Session: Setting Goals and Creating a Treatment Plan

Context: This is session 3. The client, James, is a 37-year-old professional who came to therapy for anxiety and sleep problems. He has been in therapy for three weeks. The therapist is Dr. Roberts.

Dr. Roberts: Good morning, James. How have you been since we last met?

James: Hi, Dr. Roberts. I’ve been… okay, I guess. Better than before I started therapy, but I still have difficult days.

Dr. Roberts: I’m glad to hear there’s been some improvement. Can you tell me a bit more about the difficult days? What makes them challenging?

James: Well, I still feel overwhelmed at work quite often. And I’m having trouble sleeping – my mind just won’t switch off at night.

Dr. Roberts: I understand. These seem like important things to address. Today, I’d like us to work on something specific – creating clear treatment goals and developing a plan for our work together. Does that sound good to you?

James: Yes, definitely. I think I need that. Sometimes I’m not sure what we’re working towards.

Dr. Roberts: That’s very honest of you, and it’s exactly why setting goals is so important. Let’s start with what you’d like to change. If our therapy together is successful, what would be different in your life?

James: I want to feel less anxious, especially at work. And I want to sleep better. Also… I’d like to feel more confident in general.

Dr. Roberts: Those are great starting points. Let’s work on making them more specific so we can track your progress. You mentioned feeling less anxious at work – can you describe what that would look like in practical terms?

James: I suppose… I’d be able to present at team meetings without my heart racing. And I wouldn’t spend my lunch breaks worrying about what might go wrong in the afternoon.

Dr. Roberts: Excellent. So, one goal could be about managing anxiety in specific work situations. Let’s make it even more concrete. How often do you present at meetings currently?

James: About once a week, usually on Fridays.

Dr. Roberts: And how would you rate your anxiety level during these presentations right now, from 0 to 10, where 0 means no anxiety at all and 10 means extreme anxiety?

James: Probably an 8 or 9. It’s really high.

Dr. Roberts: Okay. So, let’s create a SMART goal – that means it’s Specific, Measurable, Achievable, Relevant, and Time-bound. How does this sound: “Within 10 weeks, I will present at weekly team meetings and reduce my anxiety level from 8/10 to 4/10, measured before and during the presentation.”

James: That sounds… challenging but possible, I think.

Dr. Roberts: Good. It should feel like a stretch but not impossible. Now, what about sleep? What would better sleep look like for you?

James: Falling asleep within 30 minutes instead of lying awake for two hours. And maybe waking up feeling rested, not exhausted.

Dr. Roberts: How many nights per week are you having trouble sleeping currently?

James: Five or six nights. It’s pretty consistent.

Dr. Roberts: Alright. Here’s a possible goal: “Within 8 weeks, I will fall asleep within 30 minutes on at least 5 nights per week by practicing sleep hygiene techniques and relaxation exercises.”

James: That would make such a difference to my life.

Dr. Roberts: I believe it will. Now, you also mentioned confidence. That’s a bit broader. Can you give me an example of a situation where you’d like to feel more confident?

James: Social situations, I think. I avoid going out with friends because I worry I’ll say something stupid or that people won’t like me.

Dr. Roberts: How often are you declining social invitations right now?

James: Almost always. I probably say no nine times out of ten.

Dr. Roberts: And realistically, how often would you like to be able to say yes?

James: Maybe… half the time? At least at first.

Dr. Roberts: That’s a realistic target. So, our third goal might be: “Within 12 weeks, I will accept and attend at least 50% of social invitations I receive, with a minimum of two social events per month.”

James: Okay. These goals make it all feel more… real. More manageable.

Dr. Roberts: That’s exactly the purpose. Now let’s talk about how we’re going to help you achieve these goals. Based on what you’ve told me over our sessions, I think Cognitive behavioural Therapy would be very effective for you. Do you know anything about CBT?

James: Not really. What does it involve?

Dr. Roberts: CBT focuses on the connection between your thoughts, feelings, and behaviours. We’ll identify unhelpful thinking patterns that increase your anxiety and work on developing more balanced, realistic thoughts. We’ll also use exposure exercises to gradually help you face situations you’re avoiding.

James: Exposure exercises? That sounds scary.

Dr. Roberts: It will be gradual and at your pace. For example, we might start with smaller social situations before working up to bigger ones. And we’ll teach you coping strategies first – like relaxation techniques and thought challenging – so you have tools to manage the anxiety.

James: Okay. That sounds more manageable.

Dr. Roberts: Good. So, here’s our treatment plan: We’ll meet weekly for approximately 12—14 sessions. Each session, we’ll check on your progress, review any homework exercises, learn and practice new skills, and plan what to work on between sessions. For your work anxiety, we’ll use thought records to identify and challenge anxious thoughts. For sleep, we’ll implement a sleep hygiene plan and teach you progressive muscle relaxation. And for social confidence, we’ll create an exposure hierarchy – starting with less anxiety-provoking situations and gradually building up.

James: And the homework you mentioned – what would that involve?

Dr. Roberts: Between sessions, you’ll practice the skills we work on here. For example, keeping thought records, practicing relaxation exercises daily, or gradually completing exposure tasks. The homework is where most of the change happens – our sessions are for learning and planning, but you’ll do the real work outside this room.

James: That makes sense. I’m nervous but I’m ready to try.

Dr. Roberts: That’s a great attitude. Remember, we’ll review your progress regularly. Every few sessions, we’ll check whether these goals still feel relevant and whether we need to adjust them. This plan isn’t set in stone – it’s a working document we’ll adapt as needed. How are you feeling about everything we’ve discussed?

James: Honestly? A bit overwhelmed, but also relieved. It’s good to have a clear direction.

Dr. Roberts: That’s a very normal reaction. For next week, I’d like you to start monitoring your anxiety and sleep patterns. I’m going to give you a simple diary sheet where you can record your anxiety levels in different situations and note what time you go to bed and fall asleep each night. This will give us baseline data and help you become more aware of patterns.

James: Okay, I can do that.

Dr. Roberts: Excellent. Let’s summarize what we’ve agreed today. We’ve set three main goals: reducing your anxiety at work presentations to 4/10 within 10 weeks, improving your sleep by falling asleep within 30 minutes at least 5 nights per week within 8 weeks, and accepting 50% of social invitations within 12 weeks. We’ll use CBT techniques including thought records, relaxation exercises, and gradual exposure. Does that sound right?

James: Yes, that covers it.

Dr. Roberts: How helpful was today’s session for you?

James: Very helpful. I feel like I understand what we’re doing now and where we’re headed.

Dr. Roberts: I’m glad to hear that. I’ll see you next week, at the same time. And remember to bring your anxiety and sleep diary.

TASK 1: True / False / Not Mentioned

Read the statements below about the therapeutic session. Decide if each statement is:

• TRUE – the statement agrees with the information

• FALSE – the statement contradicts the information

• NOT MENTIONED – the information is not given

Statements:

1. This is James’s first therapy session with Dr. Roberts.

2. James is having difficulty sleeping because his mind won’t switch off at night.

3. Dr. Roberts plans to use Cognitive behavioural Therapy with James.

4. James currently rates his anxiety during presentations as 8 or 9 out of 10.

5. James has been diagnosed with panic disorder.

6. James accepts most social invitations he receives.

7. The treatment plan includes approximately 12—14 weekly sessions.

8. Dr. Roberts will adjust the treatment plan if needed as therapy progresses.

9. James needs to practice relaxation exercises twice a day.

10. Dr. Roberts assigns James an anxiety and sleep diary for homework.

ㅤ

TASK 2: Answer the Questions

1. How is James feeling compared to before he started therapy?

2. What are the three main issues James wants to address in therapy?

3. What does SMART stand for in goal-setting?

4. What is James’s first SMART goal about work presentations?

5. How often is James currently having trouble sleeping?

6. What percentage of social invitations does James want to be able to accept?

7. What three main techniques will Dr. Roberts use to help James?

8. What is James’s homework assignment for next week?

ㅤ

TASK 3: Personal Response

Discuss:

1. James feels “overwhelmed but also relieved” after setting goals. Why do you think clear goals can create both feelings at the same time?

2. Dr. Roberts says, “The homework is where most of the change happens.” Do you agree that practice outside therapy sessions is more important than the sessions themselves? Why or why not?

3. One of James’s goals is to attend at least two social events per month. Do you think this is realistic for someone with social anxiety? Would you set the goal higher or lower?

TASK 4: Role Play

Work in pairs. One person is a psychotherapist, the other is a client.

The client presents with:

• Chronic stress from work overload

• Frequent headaches and muscle tension

• Difficulty saying “no” to additional responsibilities

• Feeling burned out and exhausted

The psychotherapist should:

• Ask questions to understand the client’s difficulties

• Help the client formulate 2—3 SMART goals

• Suggest appropriate interventions (e.g., stress management techniques, assertiveness training, relaxation exercises)

• Assign homework for the coming week

• Summarize the treatment plan

Time: 10—15 minutes

After the role play, discuss:

• Was it easy or difficult to create SMART goals?

• Did the goals feel realistic and achievable?

• What interventions seemed most appropriate for this client’s problems?

PROFESSIONAL PRACTICE:

Creating Effective Treatment Plans

Sample Treatment Plans

Treatment Plan 1: Depression

Client: 32-year-old female with major depressive disorder

Presenting Problems: Low mood, loss of interest in activities, difficulty concentrating, sleep disturbance

Treatment Approach: Cognitive-behavioural Therapy

Goal: Reduce depressive symptoms and improve daily functioning within 12 weeks

SMART Objectives:

1. Within 4 weeks, client will identify and challenge 3 negative automatic thoughts daily using thought records

2. By week 6, client will engage in 3 pleasurable activities per week (behavioural activation)

3. By week 12, client will score below 10 on PHQ-9* (currently 18)

Interventions:

• Cognitive restructuring

• behavioural activation

• Sleep hygiene psychoeducation

• Homework assignments (thought records, activity scheduling)

Outcome Measures: PHQ-9 administered every 3 sessions

Planned Duration: 12—16 weekly sessions

Relapse Prevention: Identify warning signs, maintain activity schedule, know when to seek additional support

* PHQ-9 (Patient Health Questionnaire-9) – Опросник здоровья пациента-9

Treatment Plan 2: Social Anxiety

Client: 25-year-old male with social anxiety disorder

Presenting Problems: Fear of judgment, avoidance of social situations, physical anxiety symptoms

Treatment Approach: Cognitive-behavioural therapy with exposure

Goal: Decrease social anxiety and increase participation in social activities within 16 weeks

SMART Objectives:

1. Within 4 weeks, learn and practise relaxation techniques with 80% success rate

2. By week 8, attend one low-anxiety social situation per week using coping strategies

3. By week 12, give a presentation at work (previously avoided)

4. By week 16, report anxiety in social situations decreased from 8/10 to 3/10

Interventions:

• Cognitive restructuring of social anxiety thoughts

• Progressive muscle relaxation training

• Graduated exposure hierarchy

• Social skills practice

• Homework: weekly exposure exercises

Outcome Measures: GAD-7*, subjective anxiety ratings, behavioural tracking

Planned Duration: 16 weekly sessions

Relapse Prevention: Continued gradual exposures, recognition of anxiety warning signs, maintenance of coping strategies

*GAD-7 (Generalized Anxiety Disorder-7) – стандартизированный опросник из 7 вопросов для скрининга и оценки тяжести генерализованного тревожного расстройства

Useful Phrases for Treatment Planning

Describing Presenting Problems:

• The client presents with…

• Primary concerns include…

• The client reports experiencing…

• Main difficulties are…

Setting Goals:

• The overall goal of treatment is to…

• The client aims to…

• We will work toward…

• Treatment will focus on…

Writing SMART Objectives:

• Within [timeframe], the client will…

• By [date], the client will be able to…

• The client will demonstrate… [number] times per [period]

• By the end of treatment, the client will achieve…

Describing Interventions:

• Treatment will include…

• Therapeutic techniques will consist of…

• We will utilize…

• The approach combines…

• Sessions will incorporate…

Measuring Outcomes:

• Progress will be measured using…

• We will track…

• Outcome measures include…

• Success will be indicated by…

Planning Termination:

• Termination is planned for…

• Treatment will conclude when…

• We will begin discussing termination…

• Relapse prevention will include…

Practice Exercises

Exercise 1: Identify SMART Elements

Look at these goals and identify which SMART criteria each one meets or lacks:

1. “Client will feel better”

2. “Within 8 weeks, client will practise relaxation exercises 5 times per week”

3. “Client will reduce panic attacks from 5 per week to 1 per week within 10 weeks as measured by daily tracking”

Exercise 2: Convert Vague Goals to SMART Goals

Rewrite these vague goals as SMART goals:

1. Vague: Client will have less anxiety

SMART: _________________________________

2. Vague: Client will improve relationships

SMART: _________________________________

3. Vague: Client will cope better with stress

SMART: _________________________________

Exercise 3: Match Interventions to Goals

Match each goal with the most appropriate intervention:

Goals:

1. Reduce frequency of panic attacks

2. Improve communication with a partner

3. Decrease depressive symptoms

4. Manage anger more effectively

Interventions:

a) behavioural activation and cognitive restructuring

b) Couples therapy and active listening skills training

c) Interoceptive exposure and breathing techniques

d) Anger management techniques and cognitive reappraisal

Exercise 4: Create a Session Structure

You are meeting a client for the third time. They have been practising thought records as homework. Create an outline for today’s session including:

• Check-in: _________________________________

• Agenda setting: _________________________________

• Working section: _________________________________

• Summary: _________________________________

• Homework: _________________________________

Exercise 5: Write a Mini Treatment Plan

Create a brief treatment plan for this scenario:

Client: 28-year-old female experiencing work-related stress, sleep problems, and difficulty saying “no” to extra responsibilities

Your treatment plan should include:

• One overall goal

• Two SMART objectives

• Three specific interventions

• One outcome measure

• Planned duration

Exercise 6: Relapse Prevention Planning

A client with depression has achieved their treatment goals and will terminate therapy in two sessions. List 5 elements you would include in their relapse prevention plan:

1. _________________________________

2. _________________________________

3. _________________________________

4. _________________________________

5. _________________________________

Vocabulary and Collocations for Unit 4

check-in – проверка состояния, начальное обсуждение

agenda setting – установление повестки дня

treatment plan – план лечения

SMART goals – СМАРТ-цели

intervention – вмешательство/интервенция

termination – завершение терапии

relapse prevention – профилактика рецидива

homework – домашнее задание

building rapport – выстраивание раппорта

gathering history – сбор анамнеза

setting initial goals – постановка начальных целей

therapeutic process – терапевтический процесс

regular sessions – регулярные сессии

homework review – обзор домашнего задания

reviewing progress – обзор прогресса

relapse prevention planning – планирование профилактики рецидива

measuring progress – измерение прогресса

therapeutic frame – терапевтические рамки (сеттинг)

session structure – структура сессии

consistent boundaries – устойчивые границы

confidentiality agreements – соглашения о конфиденциальности

current state – текущее состояние

experiences since the last meeting – переживания после последней встречи

significant events – значимые события

present moment – настоящий момент

immediate emotional state – непосредственное эмоциональное состояние

urgent issue – срочная проблема

immediate attention – первоочередное внимание

collaborative process – совместный процесс

most pressing concerns – самые актуальные проблемы

working section – рабочая секция

therapeutic techniques – терапевтические техники

negative automatic thoughts – негативные автоматические мысли

unconscious patterns – бессознательные паттерны

transference – перенос

closing and summary – завершение и резюме

key insights – ключевые инсайты

homework assignment – назначение домашнего задания

therapeutic tasks – терапевтические задачи

thought diary – дневник мыслей

relaxation techniques – техники релаксации

real-life situation – реальная жизненная ситуация

complete homework assignments – выполнять домашние задания

make faster progress – ускорить прогресс

achieve better outcomes – достигать лучших результатов

comprehensive treatment planning – всестороннее планирование лечения

presenting problems – предъявляемые проблемы

diagnosis – диагноз

therapeutic goals – терапевтические цели

specific objectives – конкретные цели

planned interventions – запланированные вмешательства/интервенции

measuring progress – измерение прогресса