u/Miserable-Case3526

Had an interesting moment with a client recently where they were expressing an interest in CBT, but shared they don’t have an internal monologue. Instead, they think in abstracts. How would you guys approach this when there is no “thought” to reframe? This client stated that there aren’t any identifiable automatic thoughts that run through their mind, rather just the immediate negative emotions. This definitely made me stop and think as I have an internal monologue and never really considered how modalities are received completely differently (or maybe even just don’t work at all) for like ~50% of the population. In this case, would you abandon CBT altogether for this client, or is there a creative way you would use the principle but modify it in a way that is helpful for those that can’t just simply challenge their own thoughts? I realized in retrospect that I could possibly try to explore what is coming up in those moments — if it’s imagery for example, what does it look like — that kind of thing. However, from there how would I alter what that imagery looks like? I actually feel quite stupid now reflecting on this that it hasn’t come up for me yet in any previous client or wasn’t discussed in school.

For context I’m graduating from my MHC program in May and I’m finishing up my internship. The frequency of my clients emailing to reschedule to a different time in the the week definitely surprised me and perhaps I wasn’t prepared well enough for this before starting clinical work. I definitely find myself getting frustrated sometimes at the constant changing of my schedule and clients always assuming (even expecting) that I will be flexible and able to accommodate this kind of rescheduling. However, my frustration about this is not the point. I’m aware that this kind of thing is part of the work so I will not complain. Since I’ll be starting my full-time job this summer I just don’t know how it will be even remotely possible to accommodate clients like this. Unless I would be willing to work outside my designated shifts, having a full caseload would surely not allow clients to reschedule this often.. right? How do you all generally handle this? Try your best to accommodate, only offer another slot if there was some other cancellation? Or, do you typically find that most efforts to reschedule end up being a cancellation?