Adlerian Theory And The Cognitive Behavioral Theory
Theoretical Framework and Application 2
Samantha Erb
COUN5239
Theories of Psychotherapy
December 14, 2014
Dr. Damaris Conrad
Abstract
Within this paper there will be a description of the Cognitive Behavioral Theory, the theories basic philosophies, how the theory aligns with my own values and philosophy, evidence supporting this theory, appropriateness for diverse populations. Along with providing information on the Cognitive Behavioral Theory, this theory will be applied to the case of Margarita which will include: goals for Margarita, interventions and techniques, cultural considerations, and strengths and limitations of using this theory. This paper will also include similarities and differences between the Adlerian Theory and the Cognitive Behavioral Theory.
Theories Origin Cognitive Behavioral Therapy (CBT) is a form of “talk”; clients are able to talk to the counselor about themselves, problems, society, other people, etc. Within a counseling session, the clients are allowed to disclose information about how different things may affect them, how their problems/issues affect/affected their way of thinking, their emotions, perspectives, and the way they behave within and out of society. CBT also allows the client to reflect, realize, …show more content…
release, and understand their reality to change the way in which they think (cognitive element) and their behavior (behavioral element) (Corey, 2013).
This therapy approach is focused on the present time; here and now. It is a goal oriented psychotherapy that uses hands on problem solving approach. The main concept of this approach is to assist the client in coping and to improve their state of mind. CBT allows the counselor and the client to work as a collaborative team; both play an active role in each session. The counselor acts as the teacher and the client is the student. They set goals together where the progress is monitored throughout treatment. CBT also helps the clients re-educate themselves through a variety of techniques which then helps them change their habitual way of thinking, feeling, perceiving, and reacting towards events (Brewin, 1996).
CBT was brought into psychology in the late 1960’s by Aaron Beck and Albert Ellis. This therapy allowed “psychologists and psychiatrists to study how thinking (cognitions) affected emotions and behaviors.” (Suffolk Cognitive Therapy, 2006). “Beck used his personal problems as a basis for understanding others and for developing his cognitive theory.” (Corey, 2013 p. 288). He used his observations of depressed clients to reveal that they had a negative bias in their interpretation of certain life events, which then contributed to their cognitive distortions and beliefs (Corey, 2013). CBT exemplifies that our irrational thoughts and behaviors are dealt with in sections and when they are resolved they make our life more manageable.
Basic Philosophies The Cognitive Behavioral Theory has eight basic principles that it follows: (1) cognitions affect behavior and emotions, (2) cognitions may be made aware, monitored, and altered, (3) desired emotional and behavioral change can be achieved through cognitive change, (4) change mood status by using cognitive and behavioral strategies: identifying/modifying automatic thoughts and core beliefs, regulating routine, and minimizing avoidance, (5) emphasis on “here and now”, (6) preference on concrete examples, (7) reliance on socratic questioning, and (8) empirical approach to test beliefs (Corey, 2013 p. 303-305). This approach has the assumption that abnormality comes from faulty cognitions about other people, the world around us, and from ourselves. “This faulty thinking may be through cognitive deficiencies (lack of planning) or cognitive distortions (processing information inaccurately).” (McLeod, 2014). These cognitions that we experience cause distortions in the way we perceive things; Ellis suggested it is through irrational thinking, while Beck proposed the cognitive triad.
Another assumption is that “people with emotional difficulties tend to commit characteristic “logical errors” that distort objective reality.” (Corey, 2013 p. 303). Within the basic principles, Beck proposed that the systematic errors in reasoning that people experiences lead to faulty assumptions; these assumptions are now named cognitive distortions. There are seven distortions: (1) Arbitrary inferences which “refer to making conclusions without supporting and relevant evidence.”, (2) Selective abstraction which “consists of forming conclusions based on an isolated detail of an event.”, (3) Overgeneralization which “is a process of holding extreme beliefs on the basis of a single incident applying them inappropriately to dissimilar events of settings.”, (4) Magnification and minimization which “consist of perceiving a case or situation in a greater or lesser light than it truly deserves.”, (5) Personalization which “is a tendency for individuals to relate external events to themselves, even when there is no basis for making this connection.”, (6) Labeling and mislabeling which “involve portraying one’s identity on the basis of imperfections and mistakes made in the past and allowing them to define ones true identity.” , and (7) Dichotomous thinking which “involves categorizing experiences n either-or extremes.” (Corey, 2013 p. 303-304).
Beck believed that individuals have the potential for rational and irrational thinking where that thinking may result in the behavior that is identified as the problem/issue when in reality it is their faulty thinking. Rational thinking is self-preservation, happiness, thinking, verbalization, loving, communication, growth, and self-actualization. Irrational thinking is self-destructions, avoidance, procrastination, mistakes, superstition, intolerance, and self-blame (Day, 2008). Beck also believed that people live in a demanding manner, for example “I must do well, I must be liked.”, people teach themselves irrational thoughts, people think and behave simultaneously, and all of our emotional problems are directed from invalidated thinking (Day, 2008).
“The cognitive therapist operates on the assumption that an important way to produce lasting changing in dysfunctional emotions and behaviors is to modify inaccurate and dysfunctional thinking.” (Corey, 2013 p. 304). The role of the counselor is to listen, teach, and encourage the client. The counselor does not tell their client what to do or what to say, rather they assist the clients search for their strengths and then teach their clients how to utilize their strengths to achieve optimum health. The counselor assists the client in identifying their behaviors that are not productive or the behaviors that have an undesirable impact on the client’s life and assists the client in forming short and long term goals.
My Own Philosophy I believe that talking and expressing your own feelings is a form of healing and dealing with problems/issues within itself. Generally when something is/or went wrong, our friends and family would sit us down and ask us “what is wrong?”. They would want to find out how we feel and work with us to make the situation better. Sometimes they may have to correct our ideas or impressions of that given situation so we can feel better about the situation and ourselves. An aspect of this theory that aligns with my own values would be that our cognitions affect our behavior and emotions.
If we believe something about a situation or a person then it is going to affect our behavior. For example, I grew up within a city that had a high crime rate which made me believe that most cities were like this. This made me have a guarded behavior and always rely on myself. Another aspect that aligns with my own values would be that our cognitions can be made aware, monitored, and altered (Corey, 2013). From the previous example, since moving to the south my cognitions have changed about cities and people, thus my behavior changing and allowing myself to open up
more.
Evidence Supporting the Cognitive Behavioral Theory An organization named Britain 's Royal College of Psychiatrists (RCP) provides evidence that Cognitive Behavioral Therapy can help a client change the way in which they think and/or their actions. They also provided evidence that by making these changes, it will make the client “feel better”. Lastly, it provides that this therapy helps assist the client in finding ways to improve their state of mind. The impact of CBT can often be seen immediately or quicker than other therapies; CBT can be applied to a variety of problems/issues consisting of including anxiety, depression, panic, stress, bulimia, anorexia, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bipolar disorder, psychosis, low self-esteem, anger issues, etc (Corey, 2013 p.307). The Royal College of Psychiatrists (2014) illustrated a situation that showed how a persons corrective thinking is related to everyday situations within society. The situation that was provided was “You 've had a bad day, feel fed up, and so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you”. Within this example is describes the potential thoughts that were helpful and unhelpful: “Thoughts: He/she ignored me- they do not like me (unhelpful) and He/she looks like they are too into themselves- I wonder if there is something wrong? (helpful); Emotional Feeling: Low, sad and rejected (unhelpful), Concerned for the other person, positive (helpful); Physical Feeling: Stomach cramps, low energy, feel sick (unhelpful), None - feel comfortable (helpful); Action: Go home and avoid them (unhelpful), Get in touch to make sure they 're OK (helpful).” (Royal College of Psychiatrists, 2014). From the example, it exemplifies how a situation can affect and impact the self negatively more than the other.
Appropriateness for Diverse Populations “According to Hays (2009), there is an “almost perfect fit” between cognitive behavior therapy and multicultural therapy because these perspectives share common assumptions that make integration impossible.” (Corey, 2013 p. 316). Cognitive behavioral therapy can be appropriate for diverse populations because of the teacher-student role. This theory focuses on the client learning and taking an active role within the counseling session. “Some of the factors that Spiegler identifies that makes CBT diversity effect include individualized treatment, focusing on the external environment, active nature, emphasis on learning, reliance on empirical evidence, concern with present behavior, and brevity.” (Corey, 2013 p. 316). This theory also focuses on the strengths of the clients and specific skills that can be applied to the clients life with keeping in mind their values and beliefs,
The Case of Margarita
Margarita is a 26-year old Puerto Rican woman who is married to an African American man for five years; the couple has two children together. Margarita is seeking counseling for her anger problems and states that she has thought about physically harming her husband but has not put the thought into action; she and her husband do not communicate well. She is very intelligent where she is about to start law school in three months and is involved with her community. Margarita expresses that she is depressed and believes that she is socially judged without any friends. She has disclosed that she has thought of committing suicide. After the first three sessions, Margarita responded to the counseling interventions and improvement was noticed. She now discloses that she is still experiencing anger and feels hopeless about her life. Margarita has proposed specific goals that she would like to work towards and accomplish and has disclosed that she is confident in the cultural awareness aspect of counseling and if she were to have concerns she will say something.
Goals for Margarita Within the case of Margarita, there are many areas in which a counselor can implement goals that will help her achieve optimal health. There are five goals that can help Margarita: (1) changing her reinforces, (2) obtaining coping skills, (3) treat her anger outbursts, negative thinking, and anxiety, (4) understand where these outbursts are coming from (why, when and how), and (5) obtaining a new healthy relationship with her husband. Margarita does not understand where her anger issues and outbursts are coming from and chooses to isolate herself for that reason. By changing her reinforces it will help with reducing her habits that are associated with her anger issues which then can possibly lead to decreasing her anxiety. If she obtained coping skills it will allow her to control her thoughts of physically harming her husband and will also allow her to cope with her depression. There are many ways that Margarita can obtain coping skills: talk to someone she trusts, write her feelings down, have time for herself, walking away from situations, utilizing self-talk, etc. These goals are very important for Margarita to achieve optimum health but the major goal would be to obtain a new healthy relationship with her husband. By achieving the major goal, I believe that Margarita will be able to decrease her depression, anger outbursts, socialize more, and have someone to talk to when she starts to feel these feelings.
Interventions and Techniques Since Margarita has signed up for six sessions of counseling, the first three sessions allowed her to construct good rapport which allows her to respond and use open communication which signifies the applicability of CBT. For instance, she has been able to reflect on the reality of her husbands kindness towards her, his sense of responsibility, and she was able to manage her household. There are four interventions/techniques that can be used within the case of margarita: (1) socratic questioning, (2) homework, (3) self-monitoring, and (4) systemic desensitization.
Socratic questioning is allowing the therapist to focus on the clients problem by stimulating the clients self-awareness and exposing their belief system. By exposing their belief system it will challenge the irrational beliefs that the client is having. Homework is having the client participate in social activities, go over the previous counseling session, preparing themselves for the next session, etc. (Day, 2008). Self-monitoring is having the client write down and record their thoughts and behaviors which is will allow the counselor and the client to address and discuss the degree of seriousness for each situation and systemic desensitization is having the client pair something that is relaxing with the exposure to something stressful; the client is taught to relax within situations that provide anxiety (Day, 2008). Utilizing socratic questioning will allow Margarita to challenge the beliefs that she is having about her husbands plan to leave. She discloses that she has a fear that her husband will leave her due to her anger outbursts and her behavior (Case Study: The Case of Margarita, Part 2, 2014). An example that can be used would be by asking Margarita “Has something happened to lead you to this conclusion or have you felt this way for a long time?” If she is to answer that nothing has led her to that conclusion then in hopes she would understand that it was faulty thinking and irrational beliefs that lead her to his assumption.
Margarita discloses that she experiences social anxiety and avoids places where she thinking she is going to be judged. By having her do a homework assignment of going out to a social event (with or without her husband) will show her that people are not judging her and that it is okay to put herself out there. “The homework is not merely to teach clients new skills but also to enable them to test their beliefs and experience with different behaviors in daily-life situations.” (Corey, 2013 p. 307). With this intervention/technique there is hope that she will meet new friends which then will hopefully allow her to get out more. Along with homework the self-monitoring technique will allow Margarita to read over her behavior. By reading over what she has written down will allow her to understand if she is acting properly towards different situations.
Lastly, “Systemic desensitization is an empirically researched behavior therapy procedure that is time consuming, yet it is clearly effective and efficient in reducing maladaptive anxiety and treating anxiety-related disorders” (Corey, 2013 p.259). Systemic desensitization will allow Margarita to get over her fear of going out into society. Although she feels confident in her structured work projects, having her meet friends and have a social life will allow her to not have as much anger and outbursts. I would hope that she would find a hobby in which she can release her anger; such as working out. “Systemic desensitization is among the most empirically supported therapy methods available, especially for the treatment of anxiety.” (Corey, 2013 p. 260).
Cultural Considerations Although Margarita is influenced by American culture, she still abides by her native cultural values; she is from Puerto Rico. CBT emphasizes the need to adapt interventions to the needs and strengths of the client. One of the core values of CBT if using key questions to assess the clients belief system in order to develop culturally informed techniques (Hays, 2009). “If therapists understand the core values of their culturally diverse clients, they can help clients explore these values and gain a full awareness of their conflicting feelings.” (Corey, 2013 p. 315-316). Also CBT is known to be culturally sensitive; it utilizes the clients belief system as their method of self-exploration (Corey, 2013). This will be beneficial for the case of Margarita because she still believes in Puerto Rican beliefs.
Many people who are from Spanish decent are known to be very conservative and to keep their personal life to themselves; this could be a problem for this theory. The counselor may find it hard to have Margarita open up and disclose any personal experiences she has faced (Erb 2014).
Strengths and limitations Strengths for this theory would consists of it having a great application to/for clients because it focuses on the human cognitive abilities; Human cognitive abilities have been responsible for people accomplishment and problems Another strength would be CBT has been very effective for treating people with depression and moderately effective for people with anxiety; for this being very effective for depression (Beck, 1967), this approach would be good for Margarita and decreasing her depression. These strengths are good for the case of Margarita because Limitations for this theory would be the exact role of the cognitive process has yet to be determined. It is not known whether or not faulty cognitions are the cause of psychological problems. Another limitation would be how narrow the cognitive model is; it believes that thinking is the problem and is just one part of human functioning when in reality broader issues need to be addressed (Hollon & Beck, 1994). This would be a limitation for the case of Margarita because by only focusing on the way in which she thinks may not solve her anger outbursts; there may be some underlying factors that are contributing to her anger that need to be looked at. Also the counselor will have to look more into Margaritas home life to understand her faulty/irrational thoughts about her husband wanting to leave. If the counselor can figure out her home life and issues, I believe that some of her depression, anxiety and faulty thinking would diminish.
Compare and Contrast of CBT and Adlerian Theory Both the Adlerian theory and Cognitive Behavioral Theory believe that the roles of each the client and the counselor are beneficial within the counseling session. The role of the counselor within the Adlerian theory is to assist their clients in understanding, challenging, and changing their life story/goals just like the role of the CBT is to listen, teach, and encourage the client to achieve their goals (Corey, 2013). The difference between these two theories for the case of Margarita would be that with utilizing the Adlerian theory, the counselor focuses on early recollections and lifestyle assessments where within the CBT, the counselor focuses on the client’s behavior and their cognitions within their environment. Each theory is beneficial for the case of Margarita because it focuses on her life and the contributions that her life (past and present) have on her behaviors and thinking. I believe that by understanding her place in society and her relationship with her husband will allow her to broaden her thinking patterns towards herself and other people/situations. Both the Adlerian theory and CBT believe that having the client achieve precise goals will be beneficial within the counselling sessions (Dryden, 2006). The Adlerian goals are: 1) understanding equality and her place within society, (2) changing her lifestyle, (3) reducing her feeling of inferiority, (4) changing her mindset of thinking and motivation, (5) finding the trigger points to her anger, and (6) finding ways of dealing with her anger (Erb, 2014) and the goals for CBT are: (1) changing her reinforces, (2) obtaining coping skills, (3) treat her anger outbursts, negative thinking, and anxiety, (4) understand where these outbursts are coming from (why, when and how), and (5) obtaining a new healthy relationship with her husband. These goals are very similar and work together to achieve optimum health for Margarita. The difference between the two theories would be that the Adlerian theory is broken down into phases and Cognitive Behavioral Therapy is a form of “talk therapy”. For the Adlerian theory, Margarita is to finish each phase before she moves on to the next one to achieve optimum health; she can also work simultaneously to finish each phase. Margarita will allow the counselor to ask questions about her early recollections and then utilize those answers to help the counselor interpret their findings for Margaritas answers. CBT will have Margarita talk more about her problems and to put her learnings to society (such as a homework assignment). I believe that the Adlerian therapy will be most beneficial for the case of Margarita. I believe that this will be beneficial because of the three phases. The therapy is broken down which may be easier for Margarita to accomplish her goals. Also the therapy technique “encouragement”, I believe is a very important part of counseling. It seems as if Margarita doesn’t have a big support system and that she is isolating herself (which limits her support system even more) with utilizing encouragement I would believe that she will go out into society to make friends and to also speak to her husband about her irrational thoughts. I also believe that these two theories can integrated into the same counseling session.
References
Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press
Brewin, Chris R.; Annual Review of Psychology, Vol 47, 1996. pp.33-57. Publisher: Annual Reviews [Journal Article]
Case Study: The Case of Margarita, Part 2. (2014, November 30). Retrieved from https://courseroomc.capella.edu/bbcswebdav/institution/COUN/COUN5239/Version1014/Course_Files/cf_case_study_margarita2.html
Corey, G. (2013). Theory and practice of counseling and psychotherapy (9th ed.) [DVD included]. Pacific Grove, CA: Cengage-Brooks/Cole. ISBN: 9781133432623.
Day, S (2008). Theory and design in counseling and psychotherapy. New York: Houghton Mifflin
Erb, S. (2014). Theoretical Framework and Application.
Dryden, W. (2007). Rational Emotive Behaviour Therapy. In W. Dryden, & W. Dryden (Ed.), Dryden 's Handbook of Individual Therapy (5 ed., Vol. 1, pp. 353-371). London, England: SAGE Publications Ltd.
Hays, Pamela A. ; Professional Psychology: Research and Practice, Vol 40(4), Aug, 2009. Special Section: Evidence-Based Practice and Multicultural Populations. pp. 354-360. Publisher: American Psychological Association [Journal Article]
Hollon, S. D., & Beck, A. T. (1994). Cognitive and cognitive-behavioral therapies. In A. E. Bergin & S.L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 428—466). New York: Wiley.
McLeod, S. (2014, March). Cognitive Behavioral Therapy. Retrieved from SimplyPsychology: http://www.simplypsychology.org/cognitive-therapy.html
Royal College of Psychiatrists. (2014). Retrieved from RC PSYCH Royal College of Psychiatrists: http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/cbt/5areas.aspx
Suffolk Cognitive Therapy. (2006). BRIEF HISTORY OF COGNITIVE-BEHAVIOR THERAPY (CBT). Retrieved from Suffolk Cognitive Therapy: http://www.suffolkcognitivetherapy.com/cbt-history.htm
Samantha Erb
COUN5239
Theories of Psychotherapy
December 14, 2014
Dr. Damaris Conrad
Abstract
Within this paper there will be a description of the Cognitive Behavioral Theory, the theories basic philosophies, how the theory aligns with my own values and philosophy, evidence supporting this theory, appropriateness for diverse populations. Along with providing information on the Cognitive Behavioral Theory, this theory will be applied to the case of Margarita which will include: goals for Margarita, interventions and techniques, cultural considerations, and strengths and limitations of using this theory. This paper will also include similarities and differences between the Adlerian Theory and the Cognitive Behavioral Theory.
Theories Origin Cognitive Behavioral Therapy (CBT) is a form of “talk”; clients are able to talk to the counselor about themselves, problems, society, other people, etc. Within a counseling session, the clients are allowed to disclose information about how different things may affect them, how their problems/issues affect/affected their way of thinking, their emotions, perspectives, and the way they behave within and out of society. CBT also allows the client to reflect, realize, …show more content…
release, and understand their reality to change the way in which they think (cognitive element) and their behavior (behavioral element) (Corey, 2013).
This therapy approach is focused on the present time; here and now. It is a goal oriented psychotherapy that uses hands on problem solving approach. The main concept of this approach is to assist the client in coping and to improve their state of mind. CBT allows the counselor and the client to work as a collaborative team; both play an active role in each session. The counselor acts as the teacher and the client is the student. They set goals together where the progress is monitored throughout treatment. CBT also helps the clients re-educate themselves through a variety of techniques which then helps them change their habitual way of thinking, feeling, perceiving, and reacting towards events (Brewin, 1996).
CBT was brought into psychology in the late 1960’s by Aaron Beck and Albert Ellis. This therapy allowed “psychologists and psychiatrists to study how thinking (cognitions) affected emotions and behaviors.” (Suffolk Cognitive Therapy, 2006). “Beck used his personal problems as a basis for understanding others and for developing his cognitive theory.” (Corey, 2013 p. 288). He used his observations of depressed clients to reveal that they had a negative bias in their interpretation of certain life events, which then contributed to their cognitive distortions and beliefs (Corey, 2013). CBT exemplifies that our irrational thoughts and behaviors are dealt with in sections and when they are resolved they make our life more manageable.
Basic Philosophies The Cognitive Behavioral Theory has eight basic principles that it follows: (1) cognitions affect behavior and emotions, (2) cognitions may be made aware, monitored, and altered, (3) desired emotional and behavioral change can be achieved through cognitive change, (4) change mood status by using cognitive and behavioral strategies: identifying/modifying automatic thoughts and core beliefs, regulating routine, and minimizing avoidance, (5) emphasis on “here and now”, (6) preference on concrete examples, (7) reliance on socratic questioning, and (8) empirical approach to test beliefs (Corey, 2013 p. 303-305). This approach has the assumption that abnormality comes from faulty cognitions about other people, the world around us, and from ourselves. “This faulty thinking may be through cognitive deficiencies (lack of planning) or cognitive distortions (processing information inaccurately).” (McLeod, 2014). These cognitions that we experience cause distortions in the way we perceive things; Ellis suggested it is through irrational thinking, while Beck proposed the cognitive triad.
Another assumption is that “people with emotional difficulties tend to commit characteristic “logical errors” that distort objective reality.” (Corey, 2013 p. 303). Within the basic principles, Beck proposed that the systematic errors in reasoning that people experiences lead to faulty assumptions; these assumptions are now named cognitive distortions. There are seven distortions: (1) Arbitrary inferences which “refer to making conclusions without supporting and relevant evidence.”, (2) Selective abstraction which “consists of forming conclusions based on an isolated detail of an event.”, (3) Overgeneralization which “is a process of holding extreme beliefs on the basis of a single incident applying them inappropriately to dissimilar events of settings.”, (4) Magnification and minimization which “consist of perceiving a case or situation in a greater or lesser light than it truly deserves.”, (5) Personalization which “is a tendency for individuals to relate external events to themselves, even when there is no basis for making this connection.”, (6) Labeling and mislabeling which “involve portraying one’s identity on the basis of imperfections and mistakes made in the past and allowing them to define ones true identity.” , and (7) Dichotomous thinking which “involves categorizing experiences n either-or extremes.” (Corey, 2013 p. 303-304).
Beck believed that individuals have the potential for rational and irrational thinking where that thinking may result in the behavior that is identified as the problem/issue when in reality it is their faulty thinking. Rational thinking is self-preservation, happiness, thinking, verbalization, loving, communication, growth, and self-actualization. Irrational thinking is self-destructions, avoidance, procrastination, mistakes, superstition, intolerance, and self-blame (Day, 2008). Beck also believed that people live in a demanding manner, for example “I must do well, I must be liked.”, people teach themselves irrational thoughts, people think and behave simultaneously, and all of our emotional problems are directed from invalidated thinking (Day, 2008).
“The cognitive therapist operates on the assumption that an important way to produce lasting changing in dysfunctional emotions and behaviors is to modify inaccurate and dysfunctional thinking.” (Corey, 2013 p. 304). The role of the counselor is to listen, teach, and encourage the client. The counselor does not tell their client what to do or what to say, rather they assist the clients search for their strengths and then teach their clients how to utilize their strengths to achieve optimum health. The counselor assists the client in identifying their behaviors that are not productive or the behaviors that have an undesirable impact on the client’s life and assists the client in forming short and long term goals.
My Own Philosophy I believe that talking and expressing your own feelings is a form of healing and dealing with problems/issues within itself. Generally when something is/or went wrong, our friends and family would sit us down and ask us “what is wrong?”. They would want to find out how we feel and work with us to make the situation better. Sometimes they may have to correct our ideas or impressions of that given situation so we can feel better about the situation and ourselves. An aspect of this theory that aligns with my own values would be that our cognitions affect our behavior and emotions.
If we believe something about a situation or a person then it is going to affect our behavior. For example, I grew up within a city that had a high crime rate which made me believe that most cities were like this. This made me have a guarded behavior and always rely on myself. Another aspect that aligns with my own values would be that our cognitions can be made aware, monitored, and altered (Corey, 2013). From the previous example, since moving to the south my cognitions have changed about cities and people, thus my behavior changing and allowing myself to open up
more.
Evidence Supporting the Cognitive Behavioral Theory An organization named Britain 's Royal College of Psychiatrists (RCP) provides evidence that Cognitive Behavioral Therapy can help a client change the way in which they think and/or their actions. They also provided evidence that by making these changes, it will make the client “feel better”. Lastly, it provides that this therapy helps assist the client in finding ways to improve their state of mind. The impact of CBT can often be seen immediately or quicker than other therapies; CBT can be applied to a variety of problems/issues consisting of including anxiety, depression, panic, stress, bulimia, anorexia, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bipolar disorder, psychosis, low self-esteem, anger issues, etc (Corey, 2013 p.307). The Royal College of Psychiatrists (2014) illustrated a situation that showed how a persons corrective thinking is related to everyday situations within society. The situation that was provided was “You 've had a bad day, feel fed up, and so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you”. Within this example is describes the potential thoughts that were helpful and unhelpful: “Thoughts: He/she ignored me- they do not like me (unhelpful) and He/she looks like they are too into themselves- I wonder if there is something wrong? (helpful); Emotional Feeling: Low, sad and rejected (unhelpful), Concerned for the other person, positive (helpful); Physical Feeling: Stomach cramps, low energy, feel sick (unhelpful), None - feel comfortable (helpful); Action: Go home and avoid them (unhelpful), Get in touch to make sure they 're OK (helpful).” (Royal College of Psychiatrists, 2014). From the example, it exemplifies how a situation can affect and impact the self negatively more than the other.
Appropriateness for Diverse Populations “According to Hays (2009), there is an “almost perfect fit” between cognitive behavior therapy and multicultural therapy because these perspectives share common assumptions that make integration impossible.” (Corey, 2013 p. 316). Cognitive behavioral therapy can be appropriate for diverse populations because of the teacher-student role. This theory focuses on the client learning and taking an active role within the counseling session. “Some of the factors that Spiegler identifies that makes CBT diversity effect include individualized treatment, focusing on the external environment, active nature, emphasis on learning, reliance on empirical evidence, concern with present behavior, and brevity.” (Corey, 2013 p. 316). This theory also focuses on the strengths of the clients and specific skills that can be applied to the clients life with keeping in mind their values and beliefs,
The Case of Margarita
Margarita is a 26-year old Puerto Rican woman who is married to an African American man for five years; the couple has two children together. Margarita is seeking counseling for her anger problems and states that she has thought about physically harming her husband but has not put the thought into action; she and her husband do not communicate well. She is very intelligent where she is about to start law school in three months and is involved with her community. Margarita expresses that she is depressed and believes that she is socially judged without any friends. She has disclosed that she has thought of committing suicide. After the first three sessions, Margarita responded to the counseling interventions and improvement was noticed. She now discloses that she is still experiencing anger and feels hopeless about her life. Margarita has proposed specific goals that she would like to work towards and accomplish and has disclosed that she is confident in the cultural awareness aspect of counseling and if she were to have concerns she will say something.
Goals for Margarita Within the case of Margarita, there are many areas in which a counselor can implement goals that will help her achieve optimal health. There are five goals that can help Margarita: (1) changing her reinforces, (2) obtaining coping skills, (3) treat her anger outbursts, negative thinking, and anxiety, (4) understand where these outbursts are coming from (why, when and how), and (5) obtaining a new healthy relationship with her husband. Margarita does not understand where her anger issues and outbursts are coming from and chooses to isolate herself for that reason. By changing her reinforces it will help with reducing her habits that are associated with her anger issues which then can possibly lead to decreasing her anxiety. If she obtained coping skills it will allow her to control her thoughts of physically harming her husband and will also allow her to cope with her depression. There are many ways that Margarita can obtain coping skills: talk to someone she trusts, write her feelings down, have time for herself, walking away from situations, utilizing self-talk, etc. These goals are very important for Margarita to achieve optimum health but the major goal would be to obtain a new healthy relationship with her husband. By achieving the major goal, I believe that Margarita will be able to decrease her depression, anger outbursts, socialize more, and have someone to talk to when she starts to feel these feelings.
Interventions and Techniques Since Margarita has signed up for six sessions of counseling, the first three sessions allowed her to construct good rapport which allows her to respond and use open communication which signifies the applicability of CBT. For instance, she has been able to reflect on the reality of her husbands kindness towards her, his sense of responsibility, and she was able to manage her household. There are four interventions/techniques that can be used within the case of margarita: (1) socratic questioning, (2) homework, (3) self-monitoring, and (4) systemic desensitization.
Socratic questioning is allowing the therapist to focus on the clients problem by stimulating the clients self-awareness and exposing their belief system. By exposing their belief system it will challenge the irrational beliefs that the client is having. Homework is having the client participate in social activities, go over the previous counseling session, preparing themselves for the next session, etc. (Day, 2008). Self-monitoring is having the client write down and record their thoughts and behaviors which is will allow the counselor and the client to address and discuss the degree of seriousness for each situation and systemic desensitization is having the client pair something that is relaxing with the exposure to something stressful; the client is taught to relax within situations that provide anxiety (Day, 2008). Utilizing socratic questioning will allow Margarita to challenge the beliefs that she is having about her husbands plan to leave. She discloses that she has a fear that her husband will leave her due to her anger outbursts and her behavior (Case Study: The Case of Margarita, Part 2, 2014). An example that can be used would be by asking Margarita “Has something happened to lead you to this conclusion or have you felt this way for a long time?” If she is to answer that nothing has led her to that conclusion then in hopes she would understand that it was faulty thinking and irrational beliefs that lead her to his assumption.
Margarita discloses that she experiences social anxiety and avoids places where she thinking she is going to be judged. By having her do a homework assignment of going out to a social event (with or without her husband) will show her that people are not judging her and that it is okay to put herself out there. “The homework is not merely to teach clients new skills but also to enable them to test their beliefs and experience with different behaviors in daily-life situations.” (Corey, 2013 p. 307). With this intervention/technique there is hope that she will meet new friends which then will hopefully allow her to get out more. Along with homework the self-monitoring technique will allow Margarita to read over her behavior. By reading over what she has written down will allow her to understand if she is acting properly towards different situations.
Lastly, “Systemic desensitization is an empirically researched behavior therapy procedure that is time consuming, yet it is clearly effective and efficient in reducing maladaptive anxiety and treating anxiety-related disorders” (Corey, 2013 p.259). Systemic desensitization will allow Margarita to get over her fear of going out into society. Although she feels confident in her structured work projects, having her meet friends and have a social life will allow her to not have as much anger and outbursts. I would hope that she would find a hobby in which she can release her anger; such as working out. “Systemic desensitization is among the most empirically supported therapy methods available, especially for the treatment of anxiety.” (Corey, 2013 p. 260).
Cultural Considerations Although Margarita is influenced by American culture, she still abides by her native cultural values; she is from Puerto Rico. CBT emphasizes the need to adapt interventions to the needs and strengths of the client. One of the core values of CBT if using key questions to assess the clients belief system in order to develop culturally informed techniques (Hays, 2009). “If therapists understand the core values of their culturally diverse clients, they can help clients explore these values and gain a full awareness of their conflicting feelings.” (Corey, 2013 p. 315-316). Also CBT is known to be culturally sensitive; it utilizes the clients belief system as their method of self-exploration (Corey, 2013). This will be beneficial for the case of Margarita because she still believes in Puerto Rican beliefs.
Many people who are from Spanish decent are known to be very conservative and to keep their personal life to themselves; this could be a problem for this theory. The counselor may find it hard to have Margarita open up and disclose any personal experiences she has faced (Erb 2014).
Strengths and limitations Strengths for this theory would consists of it having a great application to/for clients because it focuses on the human cognitive abilities; Human cognitive abilities have been responsible for people accomplishment and problems Another strength would be CBT has been very effective for treating people with depression and moderately effective for people with anxiety; for this being very effective for depression (Beck, 1967), this approach would be good for Margarita and decreasing her depression. These strengths are good for the case of Margarita because Limitations for this theory would be the exact role of the cognitive process has yet to be determined. It is not known whether or not faulty cognitions are the cause of psychological problems. Another limitation would be how narrow the cognitive model is; it believes that thinking is the problem and is just one part of human functioning when in reality broader issues need to be addressed (Hollon & Beck, 1994). This would be a limitation for the case of Margarita because by only focusing on the way in which she thinks may not solve her anger outbursts; there may be some underlying factors that are contributing to her anger that need to be looked at. Also the counselor will have to look more into Margaritas home life to understand her faulty/irrational thoughts about her husband wanting to leave. If the counselor can figure out her home life and issues, I believe that some of her depression, anxiety and faulty thinking would diminish.
Compare and Contrast of CBT and Adlerian Theory Both the Adlerian theory and Cognitive Behavioral Theory believe that the roles of each the client and the counselor are beneficial within the counseling session. The role of the counselor within the Adlerian theory is to assist their clients in understanding, challenging, and changing their life story/goals just like the role of the CBT is to listen, teach, and encourage the client to achieve their goals (Corey, 2013). The difference between these two theories for the case of Margarita would be that with utilizing the Adlerian theory, the counselor focuses on early recollections and lifestyle assessments where within the CBT, the counselor focuses on the client’s behavior and their cognitions within their environment. Each theory is beneficial for the case of Margarita because it focuses on her life and the contributions that her life (past and present) have on her behaviors and thinking. I believe that by understanding her place in society and her relationship with her husband will allow her to broaden her thinking patterns towards herself and other people/situations. Both the Adlerian theory and CBT believe that having the client achieve precise goals will be beneficial within the counselling sessions (Dryden, 2006). The Adlerian goals are: 1) understanding equality and her place within society, (2) changing her lifestyle, (3) reducing her feeling of inferiority, (4) changing her mindset of thinking and motivation, (5) finding the trigger points to her anger, and (6) finding ways of dealing with her anger (Erb, 2014) and the goals for CBT are: (1) changing her reinforces, (2) obtaining coping skills, (3) treat her anger outbursts, negative thinking, and anxiety, (4) understand where these outbursts are coming from (why, when and how), and (5) obtaining a new healthy relationship with her husband. These goals are very similar and work together to achieve optimum health for Margarita. The difference between the two theories would be that the Adlerian theory is broken down into phases and Cognitive Behavioral Therapy is a form of “talk therapy”. For the Adlerian theory, Margarita is to finish each phase before she moves on to the next one to achieve optimum health; she can also work simultaneously to finish each phase. Margarita will allow the counselor to ask questions about her early recollections and then utilize those answers to help the counselor interpret their findings for Margaritas answers. CBT will have Margarita talk more about her problems and to put her learnings to society (such as a homework assignment). I believe that the Adlerian therapy will be most beneficial for the case of Margarita. I believe that this will be beneficial because of the three phases. The therapy is broken down which may be easier for Margarita to accomplish her goals. Also the therapy technique “encouragement”, I believe is a very important part of counseling. It seems as if Margarita doesn’t have a big support system and that she is isolating herself (which limits her support system even more) with utilizing encouragement I would believe that she will go out into society to make friends and to also speak to her husband about her irrational thoughts. I also believe that these two theories can integrated into the same counseling session.
References
Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press
Brewin, Chris R.; Annual Review of Psychology, Vol 47, 1996. pp.33-57. Publisher: Annual Reviews [Journal Article]
Case Study: The Case of Margarita, Part 2. (2014, November 30). Retrieved from https://courseroomc.capella.edu/bbcswebdav/institution/COUN/COUN5239/Version1014/Course_Files/cf_case_study_margarita2.html
Corey, G. (2013). Theory and practice of counseling and psychotherapy (9th ed.) [DVD included]. Pacific Grove, CA: Cengage-Brooks/Cole. ISBN: 9781133432623.
Day, S (2008). Theory and design in counseling and psychotherapy. New York: Houghton Mifflin
Erb, S. (2014). Theoretical Framework and Application.
Dryden, W. (2007). Rational Emotive Behaviour Therapy. In W. Dryden, & W. Dryden (Ed.), Dryden 's Handbook of Individual Therapy (5 ed., Vol. 1, pp. 353-371). London, England: SAGE Publications Ltd.
Hays, Pamela A. ; Professional Psychology: Research and Practice, Vol 40(4), Aug, 2009. Special Section: Evidence-Based Practice and Multicultural Populations. pp. 354-360. Publisher: American Psychological Association [Journal Article]
Hollon, S. D., & Beck, A. T. (1994). Cognitive and cognitive-behavioral therapies. In A. E. Bergin & S.L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 428—466). New York: Wiley.
McLeod, S. (2014, March). Cognitive Behavioral Therapy. Retrieved from SimplyPsychology: http://www.simplypsychology.org/cognitive-therapy.html
Royal College of Psychiatrists. (2014). Retrieved from RC PSYCH Royal College of Psychiatrists: http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/cbt/5areas.aspx
Suffolk Cognitive Therapy. (2006). BRIEF HISTORY OF COGNITIVE-BEHAVIOR THERAPY (CBT). Retrieved from Suffolk Cognitive Therapy: http://www.suffolkcognitivetherapy.com/cbt-history.htm