 |
| | | | | | |
Theory and Design in Counseling and Psychotherapy
Susan X Day , Iowa State University and University of Houston
| | | | | | | | | | | |
CHAPTER 9: Cognitive-Behavioral Therapies
Key Terms and Essential Concepts
Mediational position: Cognitive theory describes how external
influences are interpreted inside our minds. Thoughts add our own idiosyncratic
meaning to events and influence our emotional reactions. To change feelings,
thoughts can be reinterpreted, intervening (mediating) in the cycle of personal
reactions.
Rational-Emotive Behavior therapy: REBT is a counseling theory,
founded by Albert Ellis, that stresses the impact of negative thinking pattern
on emotions and behavior. How a person perceives a problem shapes the person’s
reaction and the outcome of the situation. According to Ellis, it is not negative
events that create emotional reactions but the thinking that occurs between
the event and the feelings. Change negative thinking and negative feelings will
dissipate.
A-B-C-D-E-F: Ellis’s simple method to illustrate the mediational
process, or the conversations in our heads. A indicates the activating event;
B is the belief in our minds related to the event; C stands for the consequence
or the reactions, either emotional or behavioral, that follow B. Since B happens
instantaneously and automatically, it can seem like the sequence occurs from
A, event, to C, consequent reaction, not recognizing that B, the thoughts in
between, have enormous influence. To change emotions and ineffective behaviors,
D can be used. D stands for disputing, questioning the automatic thought. E
is effecting a new philosophy or developing new automatic thoughts in reaction
to what happens. Over time, the disputing teaches new thinking that is more
reasonable and effective. F stands for the new feelings that are automatically
associated with new beliefs and that will replace old reaction to events.
Automaticity: Thinking reactions are spontaneous, occurring
quickly and without effort (automatically), making the thoughts seem inevitable.
However, habitual thoughts that happen involuntarily are subject to change when
the thoughts are drawn out and repeatedly challenged.
Personal constructs: Kelly explained that each individual develops
thought patterns that attribute idiosyncratic meanings to what happens in life.
The thinking structure creates the world view characteristic of the person.
Core schemas: Beck described the network of beliefs that become
a part of the individual’s personality and characteristic of the individual’s
reactions to some events. The beliefs are learned from experience, often during
childhood, and are embedded to the degree that the thoughts may never be completely
unlearned. The basic, core nature of the schema indicates that the thoughts
are built in to the cognitive structure even when a person establishes new thought
patterns. Such thoughts reoccur when events trigger associations to past events,
so cognitive therapists prepare clients for dealing with potential relapses.
Irrational beliefs: Ellis’s theory says people who are not
happy and/or have emotional difficulties share a common set of beliefs. Some
of the eleven beliefs involve assumptions about the self as someone who must
be loved and competent and can never overcome past experience. Other irrational
thoughts involve outside circumstances, perceiving that unwanted events are
terrible and require worry as well as implying that all externals are out of
the person’s control. Still other irrational beliefs consist of reactions to
others, suggesting that other’s approval and assistance is necessary; or that
others should be blamed as bad and in need of punishment; or that the problems
of others require one to become upset. Finally, beliefs about methods for dealing
with difficulties can be irrational, suggesting that problems have perfect solutions
or that avoiding problems and personal responsibility is wise.
Cognitive therapy: Cognitive therapists identify clients’ dysfunctional
thought patterns and lead clients to challenge negative constructs. Automatic
thoughts are tested through behavioral experiments and are logically assessed.
Clients learn to analyze their own thinking
so even difficult life events are seen in perspective and the positive aspects
of life are remembered.
Errors in information processing: Beck devised a list of common
mistakes people make in interpreting or perceiving what is happening. The next
six terms refer to such errors that are identified by cognitive therapists
to help clients change ineffective thinking patterns.
Arbitrary inference: Coming to a conclusion that is not supported
by the evidence. An example could be the lion in the Wizard of Oz who claims
to be a coward but demonstrates courage in protecting Dorothy against danger.
Selective abstraction: Ignoring some aspects of a situation
and characterizing the circumstances on the basis of some details but not others.
Blame is often the focus of some aspects of a person’s behavior, while other
behaviors that would contradict the negative assumptions are ignored.
Overgeneralization: Assumes that one or two facts tell the
whole story about a situation and presumes that the characterization is an accurate
prediction for what will happen in the future.
Magnification and Minimization: Assumes an event is either
more important than it is or less important than it is. Magnifying something
may unreasonably characterize the whole situation, and minimizing may lead
to ignoring something that has true significance.
Personalization: An individual makes personal assumptions about
external events, when in reality whatever happened may not be at all related
to the person. For example, an earthquake could be seen as "
my bad luck"
when
the event had nothing to do with the person or his luck.
Absolutistic: The person thinks in absolutes, that everything
is black or white without any shades of gray. The thinking is dichotomous in
that everything fits into clear distinct categories, and usually each division
is the direct opposite of the other. The person’s speech patterns suggest judgments
that place other people, or events, in good or bad, positive or negative groupings.
Cognitive triad: Beck’s empirical research showed that depressed
people demonstrated negative thoughts in three categories: the self, current
experience, and the future. The self is characterized as defective, inadequate,
unhealthy, or disadvantaged. Experience is interpreted as consistently negative,
showing a world view that life is overwhelming in its demands, with impossible
obstacles and unreasonable daily expectations. Finally, the future is predicted
to be more of the same, painting a picture of inevitable failure and unhappiness.
Learned helplessness: Term coined by Seligman describing a
pattern of reacting helplessly when negative consequences allow no escape and
are repeated consistently. For example, a victim of childhood abuse may accept
abuse even as an adult, given the assumption that she has no control over current
circumstances. The cognitive pattern presuming no personal control and accepting
negative circumstances often leads to depression.
Collaborative empiricism: In cognitive therapy, the client
is encouraged to identify thoughts and determine whether the thinking is accurate
or not. Logical analysis may show if thoughts are realistic; or experiments,
such as trying out a behavior or asking others for feedback, may reveal how
rational a thought may be. Stimulating an active problem solving approach to
evaluating experiences helps clients resist automatic conclusions that may not
work very well. The client learns to examine his own life in a manner similar
to a scientific researcher, evaluating evidence and trying things out, rather
than accepting suppositions without scrutiny.
Socratic dialogue: Cognitive therapists use a method of questioning
that leads the client to come to a conclusion or shows previous conclusions
to be inaccurate. This form of questioning was used by Socrates in teaching
his students critical thinking.
Guided discovery: Cognitive therapists may use Socratic questioning
or assign behavioral tasks that will lead a client to realize the usefulness
of particular ways of thinking or the truth of some conclusions. When clients
discover alternative thoughts or approaches, the learning has a more powerful
initial impact compared to simply being told something.
Choice theory: Glasser developed an approach for helping clients,
often juvenile delinquents, recognize the impact of realistic choices. Basic
needs are universal: survival, belonging, power and achievement, independence,
and fun. Within the context of such needs, individuals make choices to satisfy
both needs and wants. The quality of everyone’s life is based on the choices
they make and the effectiveness of their thinking and behavior to reach individual
goals. The theory suggests that negative, ineffective behavior often occurs
when the person does not take into account realistic considerations. Therapists
have clients name what they want and then to consider whether their behavior
leads them in a direction toward their goals or not. The impact of behavior
on the client’s satisfaction and the resulting effect on other people are evaluated.
Finally, the client is assisted in planning future behavior that may
realistically gain the goals. The counseling approach uses Wubbolding’s WDEP
acronym as a learning tool to help clients remember how to think clearly in
making realistic choices. The counseling system stemming from choice theory
is reality therapy.
Time projection: Reality therapists underscore long term negative
consequences by asking clients to vividly describe future life circumstances
if negative behaviors are continued. An example would be, "
Where will you and
your family be in one year, or five years, if you continue to act in this manner?"
Natural consequences: In Glasser’s choice theory and other
parenting systems, such as Adler’s, there is a concept of what naturally occurs
after a behavior. For example, if a person is rude to other people, the natural
expectation of what would happen is that others will respond negatively or not
at all. People learn to moderate their behavior to create the outcomes they
want to live with. So, therapists teach clients to predict what would likely
happen when certain actions are taken. Understanding natural consequences can
be an effective inducement for clients to behave in ways that will bring about
positive, not negative, effects.
Control theory: Also called cybernetics, control theory
describes how systems regulate themselves to maintain desirable conditions.
A heating system contains a thermostat to indicate when the furnace needs to
emit more heat and when the temperature signals the furnace to stop. The temperature
set on the thermostat would be defined in cybernetics as a reference point.
For our own self-regulation, we define what state we want and check our behavior
to see if the results conform to our desired reference point or not.
Dialectics: Linehan developed a sequence of multiple treatment
methods to assist clients diagnosed with borderline personality disorder. The
methods recognize that competing demands pull clients in divergent directions.
Clients need to change but also accept themselves as worthwhile just as they
are. Clients’ symptoms may be serving the clients’ needs in some ways, but they
also have to learn to give up symptoms to improve their lives. Clients also
have to feel as though their experiences are valid, but at the same time they
need to learn new interpretations of their experience.
Stress: A sense of anxiety a person feels when he perceives
that the situation is beyond his capacity to cope with the demands. Stressors
can be the intense reaction to an important life event; multiple strong emotional
reactions associated with trauma or negative experience; or ongoing pressure
induced by dealing with difficult situations over time. Even positive experiences
cause stress, such as hoping to live up to high expectations.
Stress inoculation: Meichenbaum conceptualized methods to help
individuals deal with stressful situations through healthy self talk. Clients
are encouraged to face and describe the fears they expect to experience for
future situations and are then taught skills and thinking patterns that will
make coping easier. Clients then use new skills in situations that are increasingly
more difficult until they gain a sense of efficacy in meeting situational demands.
Multimodal therapy: Lazarus developed a therapy approach that
recognizes that client issues may need a number of interventions to deal with
multiple effects. Rather than assuming client needs can be summarized by a diagnosis,
counselors assess seven dimensions of the client’s personality.
Basic ID: An acronym designed by Lazarus to indicate the client
dimensions requiring assessment. Behavior, affect, sensation, imagery, cognition,
interpersonal relationships, and drug/biological factors compose the assessment
protocol.
Modality profile: A compilation of symptoms arranged by the
Basic ID system.
Structural profile: The rating system used to designate the
strength of personality characteristics indicated in each category on the modality
profile. Clients rate their tendencies on a scale from 1 to 10.
Technical eclecticism: Most counselors utilize interventions
from multiple sources. Techniques are drawn from several theoretical bases,
as long as they work well together toward client goals. Multimodal therapy is
an example of technical eclecticism.
Tracking: In multimodal therapy, the sequence of introducing
treatment interventions is based on the ratings the client has given to dimensions
on the structural profile. As therapy progresses, the therapist keeps track
of changes made in each dimension. However, therapists from other approaches
use the term tracking to indicate following the client’s content or progress
in therapy.
Bridging: In multimodal therapy, the therapist notes which
modalities the client rated highest and the order of ratings for all the other
dimensions. The order of counseling interventions is based on utilizing the
strongest tendencies first and using the skills learned in these area to influence
change for other modalities. Bridging is the term that means creating client
change between modalities.
EMDR: Eye movement desensitization and reprocessing system
is termed by the letters for the previously listed treatment method. The technique
developed by Shapiro has the counselor move two fingers in front of the client’s
face while the client’s eyes follow the fingers’ movement. According to Shapiro,
traumatic memories held in the client’s consciousness during the eye movements
are neurologically reprocessed. Negative thoughts associated with memories are
identified, and more positive cognitions are developed. After a set of eye movement
sequences the client rates her reaction to the memory using a SUD (subjective
units of distress) scale( 0–10) to indicate the intensity of negative feelings.
Positive thoughts are also rated using a VOC (validity of cognition) scale (0–7).
The treatment is controversial, with some practitioners skeptical and with some
empirical evidence showing it works as well as other techniques, such as exposure
treatments.
Cognitive Interweave: If the client’s distress is not lessened
with eye movement treatments,
the counselor introduces adaptive thoughts during rest periods between eye movement
treatments.
Phenomenological: Many therapy approaches agree that the individual’s
perceptions are determined by the person’s unique way of viewing the world.
For cognitive therapies, the world view is contained within the person’s cognitive
structure and the thoughts the person uses to interpret events. Each person
adds subjective meanings to external occurrences.
Problem-solving: Cognitive counseling defines problems as
situations that cannot be resolved with the client’s naturally occurring automatic
reactions. Nonadaptive cognitions make it difficult for clients to develop
effective responses to stressful situations. In addition negative thought patterns
make dealing with everyday situations more stressful. Cognitive restructuring
can allow clients to see many problems as normal and can prepare clients for
dealing with difficult circumstances.
| | | | | | | |
|
|
|
