The I-CBT Practitioner's Manual

Complete Clinical Protocols, Session-by-Session Guidance, and Practice Resources for Mental Health Professionals

Lazaro Leon Palomares

• Publisher: ReasonPath Clinical Press
• Year: 2025
• eBook ISBN: 9781923646469
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Stop Treating Only Anxiety. Start Treating the Reasoning Error.

Obsessive-compulsive disorder doesn't stem from anxiety alone. It emerges from a fundamental reasoning error: clients confuse imagination with reality. When imagined contamination feels as certain as observed cleanliness, compulsions become irresistible.

The I-CBT Practitioner's Manual teaches you to target this inferential confusion directly. Your clients will learn to distinguish sensory evidence from imagination, challenge reasoning patterns maintaining doubt, and experience natural compulsion reduction as conviction decreases.

This comprehensive clinical resource provides:

? Complete session-by-session protocols from initial assessment through successful termination

? Reality-sensing techniques that ground clients in observable evidence rather than imagined scenarios

? Detailed guidance for every OCD subtype: contamination fears, harm obsessions, relationship OCD, scrupulosity, just-right concerns, and existential obsessions

? Annotated session transcripts showing exactly what expert practitioners say and when they intervene

? Reproducible client materials including psychoeducation handouts, practice logs, monitoring forms, and worksheets

? Full-length case studies following clients from assessment to termination with realistic setbacks and solutions

? Troubleshooting strategies for reassurance-seeking, certainty demands, poor insight, and treatment resistance

? Integration protocols for combining I-CBT with ERP, ACT, medication management, and treatment of comorbid conditions

Six comprehensive appendices deliver quick-reference guides, decision trees, complete session transcripts with therapist annotations, ready-to-use client handouts, assessment measures, documentation templates, and clinical glossary.

For psychologists, therapists, counselors, social workers, psychiatrists, and graduate students seeking evidence-based alternatives to exposure-focused treatment.

Master the reasoning-focused approach transforming OCD treatment.

Table of contents

• The I-CBT Practitioner's Manual
• Table of Contents
• Preface
• Part I: Understanding I-CBT Fundamentals
• Chapter 1.0: Understanding Inference Based CBT
• 1.1 Traditional CBT Limitations
• 1.2 Reasoning Errors as Core
• 1.3 Comparison with ERP
• 1.4 Who Benefits Most
• 1.5 Unlearning Previous Assumptions
• 1.6 Treatment Comparison Framework
• 1.7 Clinical Implications
• 1.8 Key Takeaways
• Chapter 2.0: Understanding Inferential Confusion
• 2.1 Obsessional Doubt Defined
• 2.2 Real Versus Imaginary Possibility
• 2.3 OCD Reasoning Hijack
• 2.4 The 100% Certainty Requirement
• 2.5 Why What If Persists
• 2.6 Inferential Confusion Examples
• 2.7 Clinical Recognition
• 2.8 Summary
• Chapter 3.0: The Obsessional Story
• 3.1 Narrative Structure Elements
• 3.2 Six Story Themes
• 3.3 Story Construction Process
• 3.4 Identifying Narrative Devices
• 3.5 Story Patterns by Subtype
• 3.6 Clinical Identification Practice
• 3.7 Spotting Narrative Exercise
• 3.8 Clinical Synthesis
• Part II: The I-CBT Assessment Process
• Chapter 4.0: Your First I-CBT Session
• 4.1 Introducing the Approach
• 4.2 Initial Assessment Structure
• 4.3 Identifying Obsessional Doubt
• 4.4 Distinguishing Realistic Concerns
• 4.5 Clinical Listening Focus
• 4.6 Common Session Pitfalls
• 4.7 Integration and Application
• Chapter 5.0: Mapping the Obsessional Narrative
• 5.1 The Structured Interview
• 5.2 Questions That Reveal
• 5.3 Creating the Doubt Diagram
• 5.4 Identifying Reasoning Subtypes
• 5.5 Documentation for Busy Practices
• 5.6 Ready to Use Templates
• 5.7 Essential Points
• Chapter 6.0: I-CBT Case Conceptualization
• 6.1 Building the Formulation
• 6.2 Life History Connections
• 6.3 The Obsessional Story Worksheet
• 6.4 Sharing the Conceptualization
• 6.5 Matching Targets to Findings
• 6.6 Sample Conceptualizations Across Presentations
• 6.7 Clinical Implications
• Part III: Core I-CBT Interventions
• Chapter 7.0: Teaching Reality Sensing
• 7.1 Real Versus Imagined
• 7.2 Reconnecting With Senses
• 7.3 The Criterion Exercise
• 7.4 In Session Practice
• 7.5 Client Resistances
• 7.6 Reality Sensing Homework
• 7.7 Key Takeaways
• Chapter 8.0: Challenging Inferential Confusion
• 8.1 Socratic Method Application
• 8.2 Key Questioning Sequences
• 8.3 Seeing Imagination Override
• 8.4 Working With What If
• 8.5 Magical Thinking Patterns
• 8.6 Session Dialogue Examples
• 8.7 Essential Points
• Chapter 9.0: Dismantling the Obsessional Story
• 9.1 Identifying Narrative Devices
• 9.2 Story Comparison Technique
• 9.3 Reductio Ad Absurdum
• 9.4 Selective Attention and Confirmation Bias
• 9.5 Reality-Based Narratives
• 9.6 Between-Session Practice Worksheets
• Anxiety-Contradictory Evidence (what OCD ignores):
• 9.7 Synthesis
• Chapter 10.0: Working with Reasoning Subtypes
• 10.1 Category Confusion
• 10.2 Inverse Inference
• 10.3 Selective Attention Patterns
• 10.4 Imagined Possible Consequences
• 10.5 Distrust of Perception
• 10.6 Targeting Specific Errors
• 10.7 Chapter Conclusions
• Chapter 11.0: Session Structure and Planning
• 11.1 Treatment Timeline
• 11.2 Standard Session Format
• 11.3 Balancing Treatment Elements
• 11.4 Structuring Homework Practice
• 11.5 Progress Without Anxiety Ratings
• 11.6 Sequencing Interventions
• 11.7 Integration and Application
• Chapter 12.0: I-CBT Across OCD Subtypes
• 12.1 Contamination Presentations
• 12.2 Harm Obsessions
• 12.3 Relationship OCD
• 12.4 Sexual Orientation Concerns
• 12.5 Scrupulosity and Morality
• 12.6 Just Right Feelings
• 12.7 Existential and Philosophical
• 12.8 Adaptation Principles
• 12.9 Essential Points
• Chapter 13.0: Combining I-CBT with Approaches
• 13.1 Integrating ERP
• 13.2 Using ACT Strategies
• 13.3 Medication Management
• 13.4 Comorbid Depression
• 13.5 ADHD Considerations
• 13.6 Autism Spectrum Considerations
• 13.7 When Standalone Insufficient
• 13.8 Summary and Recommendations
• Chapter 14.0: Troubleshooting Common Challenges
• 14.1 Strong Conviction Management
• 14.2 Certainty Seeking Clients
• 14.3 Reassurance Seeking
• 14.4 Generating New Obsessions
• 14.5 Therapist Uncertainty
• 14.6 Progress Plateaus
• 14.7 Cultural Adaptation
• 14.8 Synthesis
• Chapter 15.0: Building Your I-CBT Skillset
• 15.1 Self-Supervision Strategies
• 15.2 Practicing Between Sessions
• 15.3 Common Therapist Errors
• 15.4 Therapeutic Stance Development
• 15.5 Training Resources
• 15.6 Continuing Education Pathways
• 15.7 Professional Growth
• APPENDIX A: Quick-Reference Guides
• Purpose and Clinical Utility
• A.1: I-CBT at a Glance (One-Page Overview)
• A.2: Key Questions for Each Phase of Treatment
• A.3: Decision Trees for Common Clinical Scenarios
• A.4: Troubleshooting Flowchart
• APPENDIX B: Client Handouts and Worksheets
• Purpose and Organization
• B.1: Psychoeducation - Understanding I-CBT (Client Version)
• B.2: The Obsessional Story Worksheet
• B.3: Reality-Sensing Practice Log
• B.4: Inferential Confusion Monitoring Form
• B.5: Reasoning Subtypes Self-Assessment
• B.6: Between-Session Practice Guides
• APPENDIX C: Session Transcripts
• Purpose and Format
• C.1: Complete First Session Example
• C.2: Mid-Treatment Session - Challenging the Doubt
• C.3: Working with Difficult Reasoning Pattern - Summary
• C.4: Annotated Dialogues with Therapist Thinking Process - Summary
• APPENDIX D: Case Examples in Full
• Purpose
• D.1: Contamination OCD - Complete Case Study
• APPENDIX E: Assessment and Outcome Measures
• E.1: Recommended Standardized Measures
• E.2: Progress Monitoring Strategies
• E.3: Clinical Documentation for I-CBT
• APPENDIX F: Glossary of I-CBT Terms
• Purpose
• References