Theory and Practice of Counseling and Psychotherapy

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Theory and Practice of Counseling and
Psychotherapy

• Psych422
• Chapter10 Cognitive Behavior Therapy

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Rational Emotive Behavioral Therapy (REBT)

• Stresses thinking, judging, deciding, analyzing,
  and doing
• Assumes that cognitions, emotions, and behaviors
  interact and have a reciprocal cause-and-effect
  relationship
• Is highly didactic, very directive, and concerned
  as much with thinking as with feeling
• Teaches that our emotions stem mainly from our
  beliefs, evaluations, interpretations, and
  reactions to life situations

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View of Human Nature

• We are born with a potential for both rational
  and irrational thinking
• We are self-talking, self-evaluating, and
  self-sustaining.
• We have an inborn tendency toward growth and
  actualization
• We learn and invent disturbing beliefs and keep
  ourselves disturbed through our self-talk
• We have the capacity to change our cognitive,
  emotive, and behavioral processes

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View of Emotional Disturbance

• We learn irrational belief from significant other
  during childhood
• Teach clients to feel undepressed even when they
  are unaccepted and unloved by significant others.
  
• Blame is at the core of most emotional
  disturbances
• Irrational idea (e.g., I must be loved by
  everyone)? internalize ? self-defeating
• We have a tendency to make ourselves emotionally
  disturbed by internalizing self-defeating beliefs

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The A-B-C theory of personality
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Case discussion 1

• Tom, a college sophomore, want to overcomes his
  shyness around women. He doe not date and even
  des his best to keep away from women because he
  is afraid they will reject him. But he want to
  change this pattern.
• Using A-B-C-D-E-F to analyze and help Tom

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Case discussion 2

• Mary would like to take a course in creative
  writing, but she fears that she has no talent.
  She is afraid of failing, afraid of being told
  that she is dumb, and afraid of follow through
  with taking the course.
• Using A-B-C-D-E-F to analyze and help Mary

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Case discussion 3

• Each week John comes to his sessions with a new
  excuse for why he has not succeeded in following
  through with his homework assignments. Either he
  forgets, gets too busy, gets scared. Or puts it
  offanything but actually doing something to
  change what he says he wants to change. Instead
  of really doing much of anything, he whines each
  week about how rotten he feels and how he so much
  would like to change but just doesnt know how.
• What are the possible irrational beliefs, which
  keep John from taking actions
• What homework assignment might you suggest?

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Case discussion 4

• Brent feels that he must win everyones approval.
  He has become a super nice guy who goes out of
  his way to please everyone. Rarely does he assert
  himself, for fear that he might displease someone
  who then would not like him.
• What are the possible irrational beliefs?
• How do you help Brent?
• If Brent is Asian American, what cultural
  components you might take into account?

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Irrational Ideas

• Irrational ideas lead to self-defeating behavior
• Some examples
• I must have love or approval from all the
  significant people in my life.
• I must perform important tasks competently and
  perfectly.
• If I dont get what I want, its terrible, and I
  cant stand it.

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The Therapeutic Process

• Therapy is seen as an educational process
• Clients learn
• To identify and dispute irrational beliefs
• To replace ineffective ways of thinking with
  effective and rational cognitions
• To stop absolutistic thinking, blaming, and
  repeating false beliefs

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Therapeutic Goals

• A basic goal is to teach clients how to change
  their dysfunctional emotions and behaviors into
  health ones.
• Two main goals of REBT are to assist clients to
  achieving unconditional self-acceptance and
  unconditional other acceptance.
• As clients become more able to accept themselves,
  they are more likely to unconditionally accept
  others.

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Therapists function and Role

• 1. Encouraging clients to discover their
  irrational beliefs and ideas
• 2. Making connection of how these irrational
  beliefs lead to emotional disturbances
• 3. Challenging clients to modify or abandon their
  irrational beliefs.
• 4. Dispute the irrational beliefs and substitute
  rational beliefs and behaviors.

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Clients Experience in Therapy

• A learner---learn how to apply logical thoughts,
  experiential exercises, and behavioral homework
  to problem solving and emotional change.
• Focus on here-and-now experiences
• Not spend much time to exploring clients early
  history and connecting present and past
• Expect to actively work outside the therapy
  sessions.

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Relationship Between Therapist and Client

• Intensive therapeutic relationship is not
  required. But, REBT unconditionally accept all
  clients and teach them to unconditionally accept
  others and themselves. (accept them as persons
  but confront their faulty thinking and
  self-destructive behaviors)
• Ellis believes that too much warmth and
  understanding can be counter-productive,
  fostering dependence for approval.
• Therapists shows great faith in their clients
  ability to change themselves.
• Open and direct in disclosing their own beliefs
  and values
• Transference is not encouraged, when it occur,
  the therapist is likely to confront it (e.g.,
  clients believe that they must be liked and loved
  by their therapists.)

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Therapeutic techniques and procedures

• Cognitive methods
• Disputing irrational beliefs
• If I dont get what I want, it is not at the end
  of the world
• Doing cognitive homework
• Applying ABC theory in daily lifes problems
• Put themselves in risk-taking situations to
  challenge their self-limiting beliefs.
• Replace negative self-statement to positive
  message
• Changing ones language
• It would be absolutely awful..?It would be
  inconvenient
• Using humor
• Humorous songs

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Therapeutic techniques and procedures

• Emotional Techniques
• Rational-emotional imagery
• Imagine the worst things that could happen to
  them
• Role playing
• Shame-attacking exercises
• Take a risk to do something that they are afraid
  to do because of what others might thinkuntil
  they realize that their feelings of shame are
  self-created.
• Use of force and vigor
• From intellectual to emotional insight
• Reverse role playing

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Therapeutic techniques and procedures

• Behavioral Techniques
• Use most of the standard behavioral therapy
  approaches.
• Research Efforts
• Most studies focus only on cognitive methods and
  do not consider emotive and behavioral methods.

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Applications of REBT

• REBT has been widely applied to several areas
  anxiety, depression, psychotic disorders,
  problems of sex, love, and marriage, crisis,
  couple and family therapy

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Aaron Becks Cognitive Therapy (CT)

• Insight-focused therapy
• Emphasizes changing negative thoughts and
  maladaptive beliefs
• Theoretical Assumptions
• Peoples internal communication is accessible to
  introspection
• Clients beliefs have highly personal meanings
• These meanings can be discovered by the client
  rather than being taught or interpreted by the
  therapist

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Theory, Goals Principles of CT

• Basic theory
• To understand the nature of an emotional episode
  or disturbance it is essential to focus on the
  cognitive content of an individuals reaction to
  the upsetting event or stream of thoughts
• Goals
• To change the way clients think by using their
  automatic thoughts to reach the core schemata and
  begin to introduce the idea of schema
  restructuring
• Principles
• Observe automatic thoughts, identify cognitive
  distortions, and ask for evidences for reality
  testing the cognitive distortions

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CTs Cognitive Distortions

• Arbitrary inferences
• Making conclusions without supporting and
  relevant evidence
• Selective abstraction
• Forming conclusions based on an isolated detail
  of an event
• Overgeneralization
• Based on one single incident and applying them to
  dissimilar events

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CTs Cognitive Distortions

• Magnification and minimization
• Perceiving a case or situation in a greater or
  lesser light than it truly deserves
• Personalization
• Relate external events to themselves even when
  there is no basis for the connection.
• Labeling and mislabeling
• Portraying ones identity on the basis of
  imperfections or mistakes made in the past
• Polarized thinking
• Thinking in all-or-nothing terms

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The Client-Therapist Relationship

• Therapeutic relationship is necessary, but not
  sufficient, to produce therapeutic effect.
• Encourage clients to take an active role in
  self-discovery.
• Aim to teach client how to be their own
  therapist, educate clients about the nature of
  their problem, about the process of cognitive
  therapy, and how thoughts influence their
  emotions and behaviors.\
• Use homework to test their beliefs in daily-life
  situations

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CTs Cognitive Triad

• Pattern that triggers depression
• 1. Client holds negative view of themselves and
  blames themselves
• 2. Selective abstraction Client has tendency to
  interpret experiences in a negative manner
• 3. Client has a gloomy vision and projections
  about the future

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Application of CT

• Treatment of depression and anxiety
• Managing stress, in parent training, and in
  treating various clinical disorders

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Donald Meichenbaums Cognitive Behavior
Modification (CBM)

• Focus
• Changing clients self-verbalizations or
  self-statements
• Premise
• As a prerequisite to behavior change, clients
  must notice how they think, feel, and behave, and
  what impact they have on others
• Basic assumption
• Distressing emotions are typically the result of
  maladaptive thoughts

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Meichenbaums CBM

• Self-instructional therapy focus
• Trains clients to modify the instructions they
  give to themselves so that they can cope
• Emphasis is on acquiring practical coping skills
• Cognitive structure
• The organizing aspect of thinking, which seems to
  monitor and direct the choice of thoughts
• The executive processor, which holds the
  blueprints of thinking that determine when to
  continue, interrupt, or change thinking

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How Behavior Changes?

• 3 Phases of Behavior Change
• 1. Self-observation
• Listen to themselves, realize they contribute to
  their depression through how they think, and
  develop new cognitive structures
• 2. Starting a new internal dialogue
• See adaptive behavioral alternatives
• 3. Learning new skills
• Teaching more effective coping skills

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Coping Skills Programs

• Coping skills programs Stress inoculation
  training (3 phase model)
• 1. The conceptual phase
• Creating a working relationship with clients
• 2. Skills acquisition and rehearsal phase
• Giving coping skills to apply to stressful
  situations
• 3. Application and follow-through phase
• Transfer change to real world

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From a multicultural perspective

• Contributions
• Diverse populations?appreciate the emphasis on
  cognition and actions
• Challenge rigid thinking (e.g., should) instead
  of questioning the values
• Stress the relationship of individuals to the
  family, community, and systems

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From a multicultural perspective

• Limitations
• Exploring core beliefs is important in CBT-?needs
  to sensitive to cultural background and context
• Value working hard?feel ashamed for not living
  up to the expectations divorce?bring shame to
  her family
• Diverse clients may be hesitant to question their
  basic cultural values
• Diverse clients may value interdependence and may
  feel difficult to be independent

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Summary and Evaluation

• Contributions
• REBT focus on how we interpret and react to the
  events put insight into action teach clients
  ways to carry out their own therapy without
  depending on therapists
• CT research support that CT is as empirically
  validated treatment focus on a detailed case
  conceptualization to understand clients is an
  eclectic psychotherapy

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Summary and Evaluation

• Limitations
• Ellis being too confrontational ignoring
  past power imbalance
• CT focusing too much on positive thinking, being
  too simplistic, denying past, being too
  technique-oriented, failing to use the
  therapeutic relationship, working only to reduce
  symptoms, failing to explore the underlying
  causes of difficulties, ignoring unconscious
  factors and emotions.