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CBT Coaching Techniques
Rabbi Joshua Ritchie MD • November 16, 2014
CBT Coaching Techniques
Ritchie: Thank you, so beautifully said and Connie is great, she’s a really great, capable person. She’s one of our practicum supervisors. Part of our program, probably the most important part of our program, is the practicums. Besides the weekly lectures, the other major half of our program is the practice sessions that you can join. They’re offered five or six times a week, and you don’t have to do, obviously, five or six a week, the minimum is ten during the year, but there are people who do more than fifty during the year. You can pick the time, you can pick the practicum supervisor that you work with, and you can work with several of them. Those are where you get to practice your coaching skills and observe others practicing their coaching skills, and you get to play both coach and/or client, and you, obviously, also play observer and provide feedback to the other students and you’re working with a supervisor, who’s giving you feedback and leading discussions and answering questions. There are about half a dozen very skillful practicum supervisors besides myself, Yashai Gordon, who’s on our faculty and helping with the technical side, Hashi Rechmen, who I think introduced himself earlier is one of our practicum supervisors, there’s half a dozen very great, capable, skilled people who have been through a couple of years of our training that do a wonderful job helping training our people.
Woman 3: Hello?
Woman 3: Hi, this is Sara LaBode.
Ritchie: Ah, Sara! How are you?
Sara: Very good to hear your voice again. I’d just like to second Connie’s comments and also, the practicums are one of the best things, really. I gained a lot out of it, and every once in awhile I miss them too.
Ritchie: You know what we’ve done, Sara? We’re allowing our graduates to rejoin the practicums every now and then, if you would like. If some time you want to jump in on a practicum, please give it a shot some time.
Sara: It’s more with the clients I’m sometimes a little stuck with – I’d like to play them and be coach and see where others might take them.
Ritchie: You can do that with me or one of the other practicum supervisors, if the time works out for you. Sure. I did that the other day with one of our practicum supervisors – role-played one – and I think we all learned from it.
Woman 4: Hello? I’m sorry. I didn’t mean to interrupt.
Ritchie: Go ahead.
Woman 4: I wanted to ask a question, please. This is Dana Reuben calling from Atlanta. I definitely believe in the strength perspective, even as a social worker, so all of this, I feel very strongly about it, I support everything that you’ve said 100%. I wanted to know, what do you consider the limitations of this kind of coaching. In other words, you talked about depression and while I can see situational depression responding to this type of coaching or to this approach, what about clinical depression?
Ritchie: Those are labels and made up words. Let me just briefly say something about that – the work of Burns, who is a professor, I think he’s now retired at Stanford , a psychiatrist – wrote Feeling Good Handbook and Feeling Good Therapy as well as hundreds of journal articles and wrote several other books, Ten Days to Self Esteem and so on and so forth, so David Burns wrote these books and they’re used as bibliotherapy, and people who have used that have shown, and there’s lots of other studies, but it has been very well shown, that even people with significant depression, 75% of them can recover without medication, with just some decent cognitive coaching. Now, there is a small percentage that you add, about a 10% of people who are not responding to cognitive, behavioral, coaching, solution-focused – whatever you want to call it – if they’re not responding to coaching and cognitive behavioral methods, then you can add medication and then you’ll get about another 10%.
If you just use medication, you’ll get only about 50-60% will respond and most of those that respond when you stop the medication have a much higher relapse rate than those who have been coached out of their depression, so to my view, there’s no negative side effects to coaching, like there is to the medication. For depression, I really think people should try coaching or cognitive behavioral therapy or solution-focused therapy or whatever therapy you want to call it, getting talk therapy, cognitive therapy, and if that’s not working, then they can be referred to a psychiatrist and treated with anti-depressants and then I don’t think it shouldn’t just be thrown at them unnecessarily by GPs sometimes dispense it like they dispense valium and valium actually caused more problems than good and over prescribing antidepressants have caused more problems than good, but if people really are not responding, then they really should be examined by a competent psychiatrist, who can then prescribe the appropriate medication.
Reuben: Ok, so that makes sense. I was just wondering…
Ritchie: I do know that a lot of psychiatrists who prescribe medication be it for depression or be it for bipolar or schizophrenia or OCD or whatever, appreciate then sending their clients to coaches for ongoing coaching and CBT to help them learn the skills and to cope because the psychiatrist don’t want to spend the time. They don’t have the time, and they’re not usually focused or trained to so much – that’s not what they usually want to do. They want to diagnose and medicate.
Sara: May I just interject, Dr. Richie? It’s Sara again. I just want to say that a large proportion of clients, I work together with a psychotherapist and with a psychiatrist, and we refer to each other – that means if someone comes to me with obvious mental health issues, for which I’m not trained, they go there, but what happens is once they go on drugs for about six months and they’re slowly weaned off, they’re referred back to me because if they’re weaned off drugs with a coach, then, like you said, they’re better able to join their regular schedule, so I just think that it’s good for coaches, from my experience, to team up with other professionals and then I get referrals from them because they’re not interested in doing the slightly slower and more build up self-esteem type of work, and I don’t prescribe medication or diagnose people, so it’s like a two-way road.
Ritchie: Right, it’s complimentary.
Reuben: Thank you, I appreciate that. I think that very well answers my questions.
Woman 5: Hi Dr. Ritchie? Hi, this is Mickey from Mexico. I wanted to ask you whether this route of healing for depression also suffering from OCD would also work?
Ritchie: You’ve mixed two things already which often happens, but OCD does not usually go with depression although it is in the same cluster of problems. Bipolar have manic phases and depressed phases. There are people who are just depressed, there are people who are bipolar and there are people who have OCD.
Mickey: I’m talking about a client who has OCD but initially she was suffering from depression and then she was diagnosed with OCD and this may have been caused from depression.
Ritchie: Yeah, could be. Alright, so what about it?
Mickey: So would it also work for OCD patients?
Ritchie: Yes, so it does work, but clearly for OCDs, they benefit, it’s been shown nicely, they do benefit from medication but medication alone is not enough, they do also need cognitive behavioral therapy. The best approach is a combination of cognitive behavioral and medication, but to remember is OCD, bipolar, and the things that need medication is a small percentage of the population. Everyone can benefit from coaching. The percentage of people who are experiencing serious problems that need medication is less than 5% of the population, but there are people who need medication for sure, but they still can be coached with their medication or as they come off of their medication.
Mickey: They can or they should? Is it better for them to have a more permanent improvement to be coached doesn’t really have too much.
Ritchie: OCD is not well treated just by medication. Only about 50% respond to that. You get almost another 50% added to the medication. Between using medication and CBT, you’ll get about 75% recovery. So it’s a dramatic improvement over just medication alone, and that’s a recent advancement. Good CBTs and good medication combined have only been used for the past 10-15 years or so for OCD.
Woman 6: Yes, hello Dr. Ritchie. It’s Goldie from America, and I’d like to ask you if coaching and CBT is also good for traumatic past?
Ritchie: For post traumatic stress, is that what you’re saying?
Goldie: Basically post traumatic stress disorder but meaning from traumatic use.
Ritchie: From what?
Goldie: From traumatic use…
Ritchie: Ah, yeah, no, there are variations for how to work with that – that, again, you would need cognitive…NLP is very effective and the variations of Erik Sony and hypnotherapy and NLP are very effective for that and there are lots of variations for that. Some is called EFT, TAT, EMDR, there are various ways of using NLP or Erik Sony and trance states that help people with that, but you do need a good deal of training and experience to be good at that. We teach you some of the basics of that, but you do need, if somebody has those problems, it would be good to refer them to somebody who has good experience and good success with it.
In general, coaching if it’s done the way we teach it, you’ll never do any harm, but there are often might be people who are better capable to help somebody so we shouldn’t be bashful about suggesting people could get other help if they need more help than we can offer, and if somebody really has a very difficult problem, sometimes they need somebody who is more experienced with the particular problem that they have, or if they need medication, they can be evaluated and get treated.
On the other hand, coaching doesn’t do harm and should probably be the first thing people might try, and it often works very, very well. And again, coaching is not only for people who are in trouble, it’s also for people who want to be better performers. They’re already good performers, but now, they want to be great. They want to develop more and more of their ability to be even higher and higher quality, or normal problems with relationships and so on. Lots of normal people struggle with relationship problems in the family, in education, in organizations, so coaching is extremely helpful in helping people work through and be better communicators and better able to solve communication issues and problems, so normal people can have problems with relationships and communication and coaching is very good at helping develop people with more of those skills.
Woman 7: Hello? Professor Ritchie? Hi it’s Malkie Naydoff, how are you?
Ritchie: Oh hi, Malkie. How are you?
Naydoff: It’s so heart warming to hear everything. I love listening over and over your beautiful explanations. I’m a graduate for two months already, and I have quite a few clients, and I’m learning through my clients how effective coaching really is first hand. My biggest problem seems to be my turnover. I keep on graduating my clients – you don’t need me anymore.
Ritchie: You’re too good! You’re too good.
Naydoff: The most I kept a client is five sessions, and that’s long, and one of the nice effective things we do with the clients is we ask them questions at the end about how effective you feel the session was and did you feel I was addressing what you wanted to speak and so on and so forth? Some of the feedback you get back from the clients is “you know I really, really liked coming to you because it’s different than when I went to a therapist,” “I feel like you believe in me,” some of the quotes I have here are, “you don’t look at me like there’s something wrong with me,” “I leave with something concrete to work with that I chose to work on myself, you didn’t tell me what to do,” and it’s just amazingly effective for the person to move on wherever they needed to move on.
Ritchie: Right on – that’s so nice but I’m not surprised hearing it from you. Let me comment on the high turnover. I think that’s a very commendable achievement, and that’s what the good coaches do and that’s what the BRIEF coaching school in London talks about and that’s what the founders talked about – that’s what they call it solution-focused BRIEF therapy and BRIEF coaching – if you’re that good, you can charge higher fees, for one thing. Two, you can encourage your clients and let them know, as you say, you ask them if it has been helpful, and they say, it has been wonderful, and can you think of other people who could also use and benefit from being coached by me? Have them actually come up with names and have them tell you how they’re going to refer them. So get very specific on getting them to refer specific people to you, and if one client refers you two clients, then your practice will keep expanding exponentially even if you finish quickly.
Naydoff: Right, at first, I thought the clients would never refer anybody because of the privacy issue and they would feel uncomfortable saying they have gone to a life coach, but I realize the stigma is that it’s not like going to a therapist, and I’ve actually told them that if they get me clients, the first session for the new client will be free. Just to get them to be able to wet their seats to come in, and it has been effective, and they have referred their friends.
Ritchie: That’s part of the beauty of coaching is that it is respectful of the client, and we’re not treating them like they’re cripples or defective or they don’t have to be embarrassed that they’ve seen a psychiatrist or a therapist for years. Although, there are people who aren’t embarrassed by that, but in our circles, most people would be, but coaching shouldn’t have that same stigma because all successful people, literally all the big, successful people in the world have coaches. That’s just taken for granted. Just like they have an accountant and a lawyer and a financial advisor and so on, an interior decorator and so on. Anybody who’s rich and famous they also all have coaches, and they might have more than one coach – a coach for this, a coach for that – I mean, it’s not at all a stigma.
As a matter of fact, it’s a status symbol. How could you be without a coach? So successful people don’t look at it at all as a stigma – they look at it like a very normal thing. No businessman would be without an accountant or a lawyer, and no executive would be without an executive coach basically, and no corporate leader would be without a coach. Organizations have organizational coaches and have people coaching all of their staff.
Sara: Yeah, I just want to add – it’s Sara again – that clients come and barack hashem, we move them on, but what I have found, being a graduate for a number of years now, is that they call you back, that means life moves on and somebody gets married and needs coaching or somebody has a child and needs coaching or somebody’s spouse needs coaching, so you might not hear from them for like a year then they’ll come back because it worked so they keep coming back. So I find that I have a few clients that once every six months, once every year, they come back and makes more appointments, so I’m sure, it sounds like, I can’t remember her name, but I’m sure she’s very successful, I’m sure, but whoever she helps will come back as life reaches certain bumps on the road.
Ritchie: I think that’s the other part of the truth, and we can take pride that we’re not milking our clients, we’re not doing this just to get rich off of one client. If we’re good, we’ll have plenty of clients, and we’ll be very proud of the fact that we have empowered them and we have successfully, in a very economical fashion, help them. It’s not that they’re going to spend good old fashioned Freudian psychoanalysis two or three times a week for five years, spend a huge fortune of money, and they really weren’t any better off after five years than when they began. That’s not what we do with our coaching. As you say in four, five sessions, they’ve solved their problems, and they’ll refer others, and they’ll come back when they need help with another issue. That’s more satisfaction and that’s more honest integrity to help people in that way and not make them feel dependent and not make them feel come back and look forward to helping them be empowered and cope very capably on their own.
Woman 8: It’s Sayla – you’ve mentioned NLP a few times and I'm not sure what that refers to.
Ritchie – It’s called Neurolinguistic Programming – it’s somehow a bit related to cognitive therapy, and it’s developed by the work based on Milton Erickson who is this master hypnotherapist, Virginia Satir, who’s a sort of a social worker therapist and Fitz Pearls - they studied what worked. They looked at three superb therapists in the 70s and modeling on what they did, they developed some methodology that is very effective and a lot of that methodology comes from Milton Erickson, who is this wonderful MD hypnotherapist. That is integrated into cognitive work, solution-focused work, and into good coaching if you’re skillful at it. We teach it as part of the basics of how to more effectively influence and communicate with people and how to understand people, read people, and help understand people understand you.
Sayla: So what was the “P” for?
Ritchie: Neuro. Linguistic. Programming. Programming like computer programming.
Sayla: Oh ok, I got it, I just didn’t hear you.
Sara: Hello, Dr. Ritchie? This is Sara again – actually after Refuah, I trained in hypnosis and NLP, I’m happy to give a free session, you know, if you want to organize to get a little bit of hands-on things with what I do with my clients. If you want to do a free WebEx or whatever.
Ritchie: Ok, we’ll talk about that.
Sara: Because I realized when I learned NLP that you had showed us NLP, but I didn’t realize we were learning NLP. You know, when I learned it more formally, and we went through the Eriksonian stage and we went through all the different types of hypnotherapy and of visualization and imagery, I realized you did actually incorporate it, you didn’t point it out, now you’re learning NLP, so I think that I gained more from my course afterwards because I had already been at Refuah because the people in my course – that was the first course they had ever taken – they couldn’t grasp it as quickly because I realized a lot of the basics, we did cover. But anyway, my offer stands, if there are people who are interested – especially for post-graduates.
Ritchie: We’re talking about doing that for our post-graduates – a half-year program in those various techniques of NLP.
Sara: Yes the techniques. They’re very real techniques, and I use them all of the time with coaching. When I feel that somebody needs just a little bit more of a helping hand or someone comes to you with, you were talking about depression, they’re so down and they can’t really talk, so just doing a bit of visualization with them really helps them so that they’re able to express themselves better next time.
Woman 9: Professor? Professor?
Ritchie: By the way, Sara is in London. Yes, who’s speaking?
Woman 9: My name is Malkie. My question is that I saw that you spoke a lot of those telematics kind of stuff like people who are depressed or things like that, I’m just wondering there are a lot of callers that are on the line who have graduated, if there are clients that come with basic issues, they want to be productive, they want to be doing more business so they come to a coach for that or most of the clients are looking for help on problems that are more like mental or emotional kinds of issues.
Ritchie: It really depends on your interest. Coaching, as I said, comes from any age group, from children through the elderly, coaching can be used from top executives to athletes to people who have mental problems and everything in between, it’s up to you what type of client you want to work with and what’s in your community and who will respect you and want to come to you. What are you known for? Most of you that are inquiring or are interested, already have people coming to you for advice and guidance. What are the types of people that come to you? Those are the types of people that you will be able to help more effectively.
Through the course, some people do find new fields they want to work in – that’s certainly true, and people do expand their horizons because they do, in the course, apply coaching in many different ways, that’s part of what we do over the course of the year. You learn how its used with marriage, you learn how its used with children, you learn what its used in adolescents, you learn how its used in the elderly, you learn how its used in all sorts of different situations, so as you go through that, you will then be able to choose, and that’s part of one of the lectures, which is finding your specialty, your niche, your type of clientele and what type of market – so to speak. Who’s going to be your clients? We don’t call them patients, we call them clients, so what type of clients will you be attracting and what type of clients do you want to attract? It’s up to you. You could decide that you like this or you like that. Or you might be surprised who wants to come to you, and you have to decide whether you want to work with them or not.
Malkie: I was just wondering about the people who are good out there, like they are ok, and I can see there is a big demand for people who are having troubles and they want somebody to quickly fix them, so I was looking for more people who want to be greater and…
Ritchie: Usually, for instance, I’ll tell you on our faculty is Stewart Hirsch, who was a lawyer and is now a full time executive coach, and he works only with successful executives, and part of his access to them is they respect him because he has the status of being a lawyer. It depends on what people respect you for, so you’ll attract people – you don’t have to be an expert in the field to coach people, that’s another thing we’ll teach you in the course, but on the other hand, it is easier for you to communicate and understand people and people will be more impressed with you if you do know the field that they’re coming to you for consulting in.
So if you wanted to consult for organizations or executives or people in business or certain careers or fields, you’ll have a much greater chance of attracting those people, if you, yourself have been successful in that field. You’re an entrepreneur and people want coaching on how to be a more successful entrepreneur, you’ll be more likely if you bring other things to the table. If people want to be a better educator and you’ve been a successful educator, then people will more likely come to you for coaching on how to be a better educator, if you have already been an educator and now have coaching skills.
Malkie: And you have graduated several students like that?
Ritchie: Oh hundreds.
Malkie: Thank you very much.
Ritchie: Most of our students – everybody brings their talents and many are in entrepreneurial and business things – people come from all sorts of backgrounds. Some are lawyers etc. so it’s a broad diversity, so that’s what I’m very proud of also that people coming from all these diverse backgrounds learn to work together, learn from each other, and get what they need out of this course. We have also trained people who have been social workers, who have been PhD psychotherapists, people who have Masters in Education, heads of Kereb organizations, so the people that we have trained – one of the things that’s also interesting that in the last two decades – 20 years or so – the majority of psychotherapists have taken training on how to be coaches. The majority of social workers have trained to be coaches because coaching skills are powerful and effective and everybody is realizing that and the population appreciates it. Population likes it.
One of the things about coaching that it can be done and most coaches do it by phone – which saves the client traveling or saves the coach from having a fancy office and paying rent. You can do it from your own office at home. Stewart who does executive coaching does 90-95% of his work his office at home and charges very large fees for it – gets very big fees and does it from his phone at home. So it’s a skill that you can learn that many people who work helping people as educators, as keru, community rabbis, community leaders, heads of families, a lot of people are using these skills for their extended families. There are all sorts of people who can use help – helping with rashida, helping with their businesses, helping with their schooling – coaching is powerful for helping children in their development and schooling and marriages and early marriages. There are thousands of ways people will be using their coaching skills and their communication skills.
We’re going to need to finish in 5-10 minutes, so we do have another few minutes, but we will have to wrap up soon. You all know how to get in touch with us, you all have our email address. You have our phone numbers. If you want to speak to me, personally, you can ask for an appointment. If you call, you will hear in the Jerusalem office, you’ll get Dan Gruen or maybe Yashai Gordon. If you ask for an appointment, you can get an appointment with me. If you call in the hours that we’re not answering the phone in Jerusalem, our answering service in the states will pick it up and give us a message and give us time and place about how we can get together, and they could set up an appointment as well, if you tell them when you’re available and that you’d like an appointment with Dan Gruen, the Director of Admissions, or myself. We’ll be glad to talk with you and help you.