Stuck Point Help Sheet For cpt therapists

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Stuck Point Help Sheet For CPT Therapists
Stuck points are thoughts that keep us from recovering. Stuck points are concise statements that reflect a thought – not a feeling, behavior, or event. When patients provide what they think are stuck points, but are not in stuck point format, Socratic dialogue can be used to better identify the underlying stuck point. Read pages 7-11 of the Therapist Manual to review how Socratic Dialogue can be used to elicit stuck points.
Below are examples that are commonly misidentified as stuck points:
Not a stuck point: “Trust”

Why not? This is a concept, not a thought. It is not specific, and you need to identify what the person thinks about trust. In this example, you might ask him/her what about ‘trust’ is a problem.

Possible related stuck points: “I can’t trust anyone.” “If I let anyone get close to me, I will get hurt.” “I can never trust my judgment.”
Not a stuck point: “I am nervous whenever I go on a date”

Why not? This is describing a feeling, not a thought. In this example, you might ask what patients are telling themselves about the date to help them identify potential stuck points.

Possible related stuck points: “If I go on a date, I will get hurt.” “People always take advantage of me.”
Not a stuck point: “I fight with my daughter all the time”

Why not? This is describing a behavior, not a thought. In this example, you might ask more about the client’s thinking before, during, and after a recent fight with her daughter to identify possible stuck points.

Possible related stuck points: “I don’t mean anything to her.” “I must be in control to keep her safe”
Not a stuck point: “I witnessed people die”

Why not? This is describing a fact, not a thought. In this example, you might ask for the client to describe the impact of witnessing others die. What thoughts did he have at the time, what thoughts does he have now? Or after that statement asking - And, therefore?

Possible related stuck points: “It was my fault that people died.” “I should have done something to prevent it.”
Not a stuck point: “I don’t know what will happen to me” or (“What will happen to me?”)

Why not? This is a question about the future. In order to find the stuck point in this example, you might ask clients when they ask themselves that question, what is the answer they come up with? What is the meaning of that answer?

Possible related stuck points: “I will not have a future.” “I am not deserving of good things in my future”
Not a stuck point: “The military should take care of soldiers”

Why not? This is a moral statement/golden rule and you want to identify the thought behind it. In this example, to find the stuck point, you might ask what the moral statement means to them with respect to their own lives.

Possible related stuck points: “The military failed me” “I can’t trust the government”

A few reminders about good stuck point structure:

  • Make sure the stuck point is one concise thought, if the client provides multiple stuck points as one, make sure to break them apart and challenge them separately. For example, “It is my fault Joe died, I am a terrible person and I deserve to be punished,” can be broken down into 3 different stuck points, “It’s my fault Joe died,” “I am a terrible person,” and “I deserve to be punished,” which all would be challenged separately, starting with the assimilated thought, “It is my fault Joe died.”

  • If you are struggling, put a statement into the “If…., then…” format if possible and have the client fill in the blank. For example, “If I had seen the mine, then Joe would not have died”. On the impact statement, you can underline stuck points and put into “if/then” format on the Stuck Point Log.

  • Stuck points are typically black/ white statements, and use extreme language. Extreme language can sometimes be hidden, for example, sometimes when a patient says “It was my fault” they really mean “It was ALL my fault” – the second can be easier to get some movement on.

  • Stuck points are harder to challenge when they are too vague. Make it more specific by asking, “How did you come to this conclusion? For example, “I trust no one” can be refined to “If I trust others, then I’ll get hurt.”

  • Keep your eye out for words that can have multiple interpretations, stuck points are easier to challenge when they are specific and do not make assumptions about the meaning of words. For example, “If I was normal, then I wouldn’t have fallen apart.” Here you can make the statement more specific by asking “What do you mean by normal?” and “What do you mean by falling apart?”

Examples of Stuck Points

  1. If I had done my job better, then other people would have survived. (assimilated)

  2. Other people were killed because I messed up. (assimilated)

  3. Because I did not tell anyone, I am to blame for the abuse. (assimilated)

  4. Because I did not fight against my attacker, the abuse is my fault. (assimilated)

  5. I should have known he would hurt me. (assimilated)

  6. It is my fault the accident happened. (assimilated)

  7. If I had been paying attention, no one would have died. (assimilated)

  8. If I hadn’t been drinking, it would not have happened. (assimilated)

  9. I don't deserve to live when other people lost their lives. (over-accommodated)

  10. If I let other people get close to me, I'll get hurt again. (over-accommodated)

  11. Expressing any emotion means I will lose control of myself. (over-accommodated)

  12. I must be on guard at all times. (over-accommodated)

  13. I should be able to protect others. (over-accommodated)

  14. I must control everything that happens to me. (over-accommodated)

  15. Mistakes are intolerable and cause serious harm or death. (over-accommodated)

  16. No civilians can understand me. (over-accommodated)

  17. If I let myself think about what has happened, I will never get it out of my mind. (over-accommodated)

  18. I must respond to all threats with force. (over-accommodated)

  19. I will go to hell because of the things that I have done. (over-accommodated)

  20. I am unlovable. (over-accommodated)

  21. Other people should not be trusted. (over-accommodated)

  22. My hypervigilance is what keeps me safe. (over-accommodated)

  23. If I have a happy life, I will be dishonoring my friends. (over-accommodated)

  24. I have no control over my future. (over-accommodated)

  25. The government cannot be trusted. (over-accommodated)

  26. People in authority always abuse their power. (over-accommodated)

  27. I am damaged forever because of the rape. (over-accommodated)

  28. I am bad because I killed others. (over-accommodated)

  29. I am unlovable because of [the trauma]. (over-accommodated)

  30. I am worthless because I couldn’t control what happened. (over-accommodated)

  31. I deserve to have bad things happen to me. (over-accommodated).

Introducing stuck points

  • Stuck points are often more easily understood when they are first described in non-traumatic terms.

  • Since reminders of the trauma often bring up anxiety, people may have difficulty “hearing” the description of stuck points, so describing them using more routine examples can be more helpful.

Sample introduction of stuck points:

“In this therapy we focus on how your thinking or your thoughts can get in the way of your recovery from your trauma. We call these kinds of thoughts “stuck points” because they are thoughts that keep you “stuck” in your misery. They create barriers to your recovery. Examples of some stuck point thoughts are “It’s my fault; I should have done something differently, we should have gone left instead of right, etc.” Remember, they are thoughts, not feelings.

Let me give you an example of how thoughts can keep us stuck and be barriers: When you were getting ready to come to CPT today you probably had some thoughts about coming. What were your thoughts? [Write down these thoughts on a white board or paper. Usually these thoughts are: “I don’t know if I can do this; I don’t know if this will help; this isn’t for me; you’ll think I’m stupid.”]
“If this is what you were telling yourself, how did that make you feel? [Write down corresponding feelings on board or paper]. Wow, you can see how these thoughts made you feel and how they can get in the way of your coming here today and working towards recovery. But somehow you got yourself here. You told yourself something that got you here. What were those thoughts? [No need to write these down, have them answer]. Examples may include: “I need to do this; I am tired of living this way; I want to do this for my family or myself.”
See how the thoughts that got you here are different than the first ones that we wrote down. The thoughts that got you here move you forward while the other thoughts can hold you back and keep you stuck and so, we call those stuck points. In this therapy, we want to look at your stuck points and see how they are keeping you stuck in your recovery from your traumas.”

Important reminders about challenging stuck points:

  • First, challenge stuck points directly using Socratic dialogue and worksheets, but if a client is still stuck, examine the function of the stuck point. You can do this by asking “What does it mean to hold on to this belief; What does holding on to this belief do for you; What if you no longer held on to this belief, then what?” If there is still no movement, back off and come back later, don’t get into a power struggle challenging this. You can say, “I can see this is important. Let’s come back to this later.”

  • Challenge assimilated stuck points before over-accommodated ones.

    • Assimilated stuck points are thoughts that are looking back on the past (e.g., the should have, could have, if only, it’s my fault, etc).

    • Over-accommodated stuck points are present and future oriented.

  • Many over-accommodated stuck points will resolve quickly once the event, and erroneous conclusions they were based on, are resolved and changed.

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