[Episode 14]In today's podcast, we're going to speak nigh the therapies that take away a cognitive-behavioral approach to working with people. I review the theoretical assumptions, therapeutic process, techniques, usage inward culturally competent practice, together with strengths together with limitations of CBT. This podcast is longer than most because I usage a lot of clinical examples together with dialogue to illustrate the concepts.
Influenza A virus subtype H5N1 partial listing of cognitive distortions tin strength out hold upward found at Wikipedia: http://en.wikipedia.org/wiki/Cognitive_distortion
This figure illustrates levels of thinking, from external to internal. The downward arrow technique moves the customer from external beliefs nigh the future, the basis together with others, to internal beliefs nigh themselves.
Transcript: Cognitive Behavioral Therapy
Hello together with welcome. You have got found the social piece of work podcast. My cry is Jonathan Singer together with I’ll hold upward your host every bit nosotros explore all things social work.
In today’s podcast, I’m going to hold upward talking nigh Cognitive-Behavioral Therapy, or every bit it is oft referred to every bit CBT. CBT is a relatively novel nipper on the psychotherapy block. If nosotros think nigh the neighborhood, nosotros tin strength out say that Freud lives inward the former together with somewhat creaky mansion on the hill; B.F. Skinner known to the folks inward the neighborhood merely every bit Burrhus, lives inward a real functional, if somewhat boxy condo. Down the route you’ll reveal Carl Rogers; although, non primarily known every bit a decorator. Rogers has an uncanny powerfulness to take away his vision of what his work solid should hold upward similar together with fit it with what his work solid really is. As a result, Rogers’ seat is a really cozy together with authentic house, together with although Freud, Skinner together with Rogers don’t ordinarily concur on much, they routinely acquire together together with complain to the neighborhood association nigh the ‘in your face’ appearance of Fritz Perls house. The existentialists Yalom together with May, they are to a greater extent than probable to rent than to own. After all, who knows what life volition bring, right? But because they are regularly consulted yesteryear others during renovations, their influence tin strength out hold upward felt inward almost every work solid on the block. This brings us to the novel kids on the block. The Cognitive-Behavioral therapists similar Albert Ellis, Aaron Beck, Donald Meichenbaum, together with Michael Mahoney. They grew upward inward this neighborhood. Ellis together with Beck followed Rogers’ footsteps together with moved out of Freud’s work solid when they were immature together with ready their ain places. Meichenbaum together with Mahoney, on the other hand, they were staying with Skinner. What nosotros know called, CBT, grew out of both the psychoanalytic together with the behavioral houses. In futurity podcasts, we’ll speak to a greater extent than nigh the other inhabitants of this psychotherapy neighborhood, including: William Glasser, Insoo Kim Berg together with others.
The Theoretical Neighborhood (click to enlarge)
This visual of the "theoretical neighborhood" I described inward the introduction to the podcast was created yesteryear MSW students inward Claudia Dewane's Clinical Practice I class at Temple University Harrisburg. Thank you!
Today, however, nosotros volition focus on CBT, the theoretical assumptions, the therapeutic processes, techniques, usage inward cultural competent exercise together with strengths together with limitations. Before nosotros start though, I want to acquire inward clear that CBT is non a unmarried therapeutic approach. CBT is a collection of therapies that seat differing amounts of emphasis on the roles of cognitions, emotions, behaviors together with the roles that they play inward our happiness. Some similar Albert Ellis’ rational emotive demeanour therapy or REBT assumes that in that location is an objective reality that tin strength out hold upward distorted. Others similar Mahoney’s cognitive constructivism assume that reality is socially constructed. The REBT therapists tin strength out safely debate that someone’s thoughts are rational because the supposition is that some thoughts are rational together with some are not, are all based on an objective reality. Now, although the constructivists would combat that mental processes are key to agreement the human condition, they would never say that what nosotros thought could hold upward objectively to a greater extent than rational than another. Yet these are 2 therapies that autumn nether the category of cognitive behavioral. So, if someone says, ‘Yeah, I do CBT’ inquire them for to a greater extent than specifics.
Theoretical Assumptions: The most basic supposition of CBT is if y'all want to modify the way y'all experience together with the way y'all behave, y'all have got to modify your thinking. As Vonk together with Early (2009) write inward their splendid summary of CBT inward the Social Workers’ Desk Reference: “Psychological distress is largely a component of disturbances inward cognitive processes.” CBT assumes that negative together with unrealistic thinking give ascent to emotional disorders. Altering our cognitive processes tin strength out trim down emotional disorders together with increase our functioning; however, question also supports the thought that our thoughts are influenced yesteryear our emotions together with behaviors. For example, the physical human activity of grin improves mood, that is, demeanour influences mood. Arthur Freeman together with his colleagues, inward their text, Clinical Application of Cognitive Therapy cite question that found that sadness facilitated the recall of sorry events, whereas happiness facilitated the recall of happy events. These are examples of mood affecting how nosotros access cognitions, together with of course, multiple times a 24-hour interval nosotros take away to bear for sure ways based on our thoughts.
So, some other supposition of CBT is that in that location is a reciprocal human relationship alongside cognitions, emotions, together with behaviors. Imagine you’re working with a adult woman whose miss died inward a machine accident. We’ll telephone yell upward her Isabella. What is the human relationship betwixt Isabella’s thoughts, feelings together with actions? Freeman together with his colleagues suggested that this reciprocal human relationship tin strength out plow into a self-perpetuating cycle. So, let’s say that Isabella had a biological predisposition to depression. The external event, her nipper dying inward a machine accident, triggered a depressive episode. Let’s say that Isabella also had a pith belief that she is unworthy of happiness. In this situation, her pith beliefs, mixed with the external events triggering automatic thoughts such as: ‘this was my fault’, ‘I should have got kept her at home’, together with ‘I don’t deserve to live’. These automatic thoughts influence her emotional response, sadness together with hopelessness. They also influence how she behaves around other people. For the sake of simplicity, let’s say that Isabella withdraws from social situations. Her demeanour together with thence influences the way others answer to her. They powerfulness halt calling, talking to her together with these responses together with thence influence her automatic thoughts. At the same time, these automatic thoughts triggered the feelings of sadness. As I mentioned before, sorry feelings facilitate the recall of unhappy events. So, her sadness makes it easier to recollect the unhappy experiences inward her life, providing her with farther evidence (however biased it may be) that back upward her thoughts together with feelings that things are hopeless. This instance illustrates the reciprocal influence of thoughts, feelings together with actions together with how psychopathology tin strength out hold upward perpetuated yesteryear this cycle.
The therapeutic procedure tin strength out intervene at whatever betoken inward this cycle, that’s why CBT has interventions that address behaviors together with emotions, every bit good every bit cognitive processes. Now, the therapeutic procedure inward CBT has to do with the goals of treatment, the human relationship betwixt the customer together with the therapist, every bit good every bit the particulars of assessment together with intervention. Regardless of the detail variant of CBT, the goals of handling part the next elements: identifying cognitive content, examining cognitions to determine their effects inward emotions together with behaviors together with developing interventions to aid clients utilize alternative together with to a greater extent than adaptive cognitions.
[7:20] Also mutual to all CBTs is that these elements tin strength out hold upward applied inward an individual, work solid unit of measurement or grouping setting. Albert Ellis states that 2 of the chief goals of rational emotive demeanour therapy are: to assist clines inward the procedure of achieving unconditional self-acceptance together with of others, together with to take in how the 2 are inter-related. The supposition is that every bit clients start to have got themselves, they volition hold upward amend able to have got others. Now, Ellis assumes that although people have got the potential for happiness, that nosotros are also fallible. Because nosotros are fallible, Ellis believes that a finish of therapy is to aid people have got themselves every bit they are, fallible creatures who volition brand mistakes, but at the same time, have got the potential to larn together with grow from those mistakes. Ellis illustrated this thought real clearly inward the at nowadays classic therapy session with Gloria. Gloria says she doesn’t want to hold upward an ordinary Jane Doe. Ellis challenges her to consider what would hold upward thence awful nigh beingness an ordinary Jane Doe. He is non proverb she should settle for mediocrity or have got no sense of achievement, rather he’s addressing a pith belief that ‘if my life isn’t special or unique, together with thence it’s awful’. In Beck’s cognitive therapy, schemata, also known every bit pith beliefs, are the targets of interventions. So, a basic finish of cognitive therapy is to modify the way clients think, using their automatic thoughts to make their pith beliefs or schemata together with get down to restructure how they empathise the world.
Depending on the variant of CBT, the role of the therapist together with the customer is to a greater extent than didactic, that is, teacher/student focused or to a greater extent than collaborative, for all CBT handling is seen every bit an educational process. The therapist is seen every bit an skilful inward cognitive behavioral methods, someone who actively teaches or coaches the customer nigh automatic thoughts, pith beliefs, together with ways to restructure thinking, every bit good every bit someone who gives homework. The CBT practitioner strives to hold upward every bit transparent every bit possible. What I hateful yesteryear transparent is that if the practitioner recognizes an automatic thought, she volition say to her client, “I exactly heard y'all limited what I telephone yell upward an automatic thought”. The practitioner would together with thence locomote on to define the term, give examples of what an automatic thought looks similar together with tell the customer how they tin strength out do exactly what the therapist did. In REBT, Gerry Corey (2005) notes that clients larn 3 things; the foremost is to seat together with dispute irrational beliefs that are maintained yesteryear self-indoctrination; Second, to supervene upon ineffective ways of thinking with effective together with rational thoughts; together with finally, to halt absolutist thinking, blaming, together with repeating mistaken beliefs. In contrast, Beck sees the client/therapist human relationship every bit beingness most successful when in that location is empathy, genuineness, together with unconditional positive regard. Now if these qualities sound familiar, it’s because they are associated with Carl Rogers, y'all know, the guy that lives downwards the block. Unlike Rogers, however, Beck believes that although these qualities are necessary for therapeutic exchange, they’re non sufficient to make optimum therapeutic effect.
In CBT, every bit with all other forms of treatment, the therapeutic procedure starts with an assessment. I review the basic components of assessments: bio, psycho, social spiritual, mental status exam, together with diagnostic statistical manual for social workers inward podcasts that tin strength out hold upward found on socialworkpodcast.com. The unique contribution of the CBT assessment is what Vonk together with Early telephone yell upward the cognitive analysis. Although the analysis tin strength out take away many forms, it essentially identifies the problems, thoughts, feelings together with actions that accompany those problems. Then a working hypothesis is developed to explicate the human relationship betwixt the specific work together with the client’s unique responses. In REBT, the cognitive analysis uses the ABC technique. In this approach, the therapist looks for an ABC designing where: Influenza A virus subtype H5N1 is the activating lawsuit (for example, a nipper is killed inward a machine accident), B is the belief (now that she’s dead everything volition hold upward awful) together with C is the resultant emotional together with behavioral consequences (such every bit sadness, fright together with isolating behaviors). Notice how the belief comes in-between or mediates the human relationship betwixt the lawsuit together with the feelings together with behaviors. That’s because CBT assumes that events do non crusade feelings together with behaviors, rather our views of those events, or interpretations of those events, are what causes our feelings together with behaviors. This assessment allows the therapist to seat consistent together with predictable patterns of demeanour that tin strength out together with thence locomote the target of intervention. The ABC assessment has a corresponding D, E together with F intervention together with outcome ingredient that we’ll speak nigh after on inward the podcast.
Before nosotros displace on to techniques together with interventions, I’d similar to speak briefly nigh the construction of a cognitive therapy session. Because CBT is a time-limited treatment, together with it addresses a few issues, CBT therapy sessions demand to hold upward focused together with productive. To that end, Freeman together with his colleagues depict 1 way to construction a CBT session. First, the session begins with agenda setting. This is a collaborative procedure wherein the customer together with the therapist tin strength out hold upward for sure to encompass topics that are relevant together with key to treatment. This does non forestall flexibility during the session, but it makes it easier for the CBT therapist to redirect together with avoid what is known every bit door knob comments. The door knob comment refers to a province of affairs where a customer brings upward a pregnant number on his way out of the door. Imagine your customer with his mitt on the door knob say, “Oh, yesteryear the way, my mom tried to kill herself finally nighttime together with I’m heading to the infirmary to take in her”. Why clients do this is upward for debate. One commonly suggested argue is that it is a run a peril to unload burdensome topics without having to address them. But regardless of the reason, setting an agenda helps to seat what issues are most of import at the starting fourth dimension of the session together with to create upward one's hear what topics volition hold upward focused on during the class of the session.
Number two, after the agenda has been set, y'all review your client’s electrical flow status, including what has transpired betwixt sessions. For example, if nosotros think of the mom whose miss was killed inward a machine accident, it would hold upward useful to know if in that location were whatever deaths of whatever unopen personal friends or related events to the expiry of her miss alongside other things, inward the yesteryear week. This quick banking company check also sets the tone for the session together with allows the customer the chance to focus on beingness introduce inward the session.
The side yesteryear side measuring is to inquire for feedback. Now feedback tin strength out either hold upward nigh the previous session, or if y'all inquire nigh feedback at the halt of the session, it tin strength out hold upward nigh the electrical flow session. Although Freeman together with his colleagues advise that this is an optional step, my experience has been that regular feedback is invaluable to addressing interpersonal issues that clients powerfulness hold upward unwilling or uncomfortable to part otherwise. For example, if during the starting fourth dimension of a session, I inquire my customer if he thought that what nosotros talked nigh during the previous session helped him during the calendar week together with he said no, together with thence I would have got the chance to explore what nosotros could do differently. It could hold upward that all he could recollect nigh the session was me beingness confrontational. And obviously, this data is crucial to addressing how I approach him, how I approach the therapy, thence that nosotros tin strength out have got a successful outcome.
The quaternary measuring is to review the previous week’s homework. Because CBT believes that most modify occurs exterior of the office, homework is an integral component of treatment; however, homework volition non hold upward successful if you’re non clear nigh the human relationship betwixt homework together with your client’s goals. It is the classic story of Albert Ellis together with the homework he assigned himself 1 summer. According to Gerry Corey (2005), Ellis was thinking of ways to overcome his shyness around women. He decided he would speak to 100 women over a catamenia of 1 month. Although the conversations did non resultant inward a date, the story goes that he did de-sensitize himself to the fright of rejection. This story clearly illustrates the value of making a similar a shot connecter betwixt the client’s goals together with the piece of work they do exterior the session. Imagine telling a customer with social phobia that they should speak with 100 strangers. Unless you’re real clear every bit to why this activity is the best for your customer to solve their problems, they’re probable to human face at y'all together with laugh, or to a greater extent than realistically, they are to a greater extent than probable to concur with y'all together with and thence exactly non do it. Freeman together with his colleagues (2004) advise a bright way of introducing the thought of homework to clients on page 29 of their text. They advise proverb something like, “One of the things I similar to do is to think inward damage of what the people I piece of work with tin strength out do betwixt sessions to acquire results to a greater extent than quickly. How does that sound to you? Do y'all have got whatever ideas what would hold upward useful to do betwixt at nowadays together with the side yesteryear side fourth dimension nosotros meet?”
Covering these foremost 4 items doesn’t demand to take away to a greater extent than than 10 minutes. The balance of the session tin strength out hold upward spent on addressing the finally sections of a therapy session, which include: the chief agenda items together with developing novel homework.
REVIEW
So, before I displace on to the really fun stuff, the intervention techniques, I want to chop-chop review what we’ve gone over thence far. CBT is an umbrella term that applies to the therapies that assume that behaviors together with emotions are influenced yesteryear our cognitions. The basic finish of CBT is to seat together with supervene upon dysfunctional thoughts with functional thoughts inward social club to improve mood together with develop good for y'all behaviors. This procedure is collaborative together with expects the customer to participate actively during treatment, within together with exterior the therapy session. Now we’re going to take away a brusque break, but when nosotros come upward dorsum we’re going to speak nigh some of the techniques used inward CBT, the usage of CBT inward culturally competent exercise together with the strengths together with limitations on the usage of CBT inward social piece of work practice.
[18:10] Music Interlude: QuinTango performing “Por una cabeza” http://www.amazon.com/Por-una-Cabeza/dp/B000SGU4M0
Welcome back. We are going to proceed our give-and-take of cognitive behavioral therapy yesteryear turning our attending at nowadays to the techniques together with interventions.
Techniques together with Interventions: Because cognitive-behavioral therapies believe inward a reciprocal human relationship betwixt cognitions, emotions together with behaviors, CBT uses techniques that address how nosotros think, feel, together with act. Today, nosotros are going to focus our attending on the cognitive, together with to a lesser extent, the emotive techniques. For a review of behavioral techniques, y'all tin strength out hear to the demeanour therapy podcast at /search?q=behavior-therapy. The cognitive techniques developed yesteryear Ellis, Beck, Meichenbaum together with others are widely used yesteryear therapist that do non consider themselves strict cognitive behavioral therapists. Corey notes that rational emotive demeanour therapy was really the foremost cognitive behavioral therapy. The cry rational emotive demeanour therapy tells y'all right off the bat that REBT distinguishes betwixt rational together with irrational thoughts, but also focuses on feelings together with actions. The supposition is that irrational ideas atomic number 82 to self-defeating behavior. Corey (2005) gives some examples of irrational ideas: ‘I must have got love or blessing from all of the pregnant people inward my life’, I must perform of import tasks competently together with perfectly’, ‘if I don’t acquire what I want, it’s terrible together with I can’t stand upward it’. Now, every bit a side comment, Ellis is known for using sense of humor to aid his clients recognize irrational thinking. In fact, usage of sense of humor is 1 of his techniques. For example, he called irrational thoughts “I must” mustabatory thinking together with he would caution his clients against musterbating. One technique Ellis uses inward intervening with irrational thinking is called disputation. The way it plant is that in 1 lawsuit an irrational thought has been identified, Ellis volition dispute that thought until clients no longer believe the idea, or at the real least, do non believe it thence strongly. For example, if your customer irrationally believes that whatever conflict is bad, Ellis powerfulness say, “Can y'all think of a circumstance when conflict is good”? If they tin strength out think of a unmarried instance, together with thence Ellis would say that the belief, every bit a full general rule, is clearly false. The customer would together with thence figure out a belief that was a rational one, such as, some conflict is counter-productive.
Remember before inward the podcast, I talked nigh the ABC model where Influenza A virus subtype H5N1 was the activating event, B was the mediating belief, together with C was the resultant emotional together with behavioral consequences? Well the finally 3 steps inward the model are cleverly called: D, E together with F. The D stands for a disputing intervention. Disputation targets the belief inward the way nosotros have got exactly talked about. The arguing has the effect or E. The E is that the to a greater extent than effective or functional philosophy is developed. For example, if nosotros think nigh our client, Isabella, whose miss died inward a machine accident, the arguing powerfulness aid her modify her belief from ‘everything is awful’ to ‘I wishing some things were different’. This E or effect, results inward a dissimilar feeling or F, similar hope. This is how y'all acquire ABCDEF every bit an intervention that tin strength out hold upward used to address cognitions, behaviors together with feelings. Another technique that Ellis uses to address irrational thinking is changing the linguistic communication that clients use. If your customer says, “I should do this” or “I should do that”, Ellis would say that they are shoulding on themselves. Don’t should I me, I won’t should on you. When nosotros believe nosotros should do something, nosotros confuse preference with needs. The statement: “I would prefer to flexure laundry before bed” is a real dissimilar message than “I should flexure laundry before bed”. Although subtle, the technique is congruent with CBT theory. As Lakoff together with Johnson illustrated inward their text, Metaphors We Live By, our words both reverberate together with create the basis nosotros alive in. If nosotros tin strength out modify our words, together with thence nosotros tin strength out modify the way nosotros think, feel, together with act. Aaron Beck believes that words are important, but he’s to a greater extent than interested inward listening to words to seat schemas, automatic thoughts together with cognitive distortions.
Beck conceptualizes problematic beliefs together with thoughts non inward damage of what is rational or irrational, because that’s upward for interpretation. But instead, beliefs are problematic when they are likewise rigid, likewise absolute, likewise broad or likewise extreme. In Beck’s version of CBT, people develop unconditional pith beliefs, also known every bit schemas, which influence feelings together with behaviors. Unconditional pith beliefs are beliefs that are likewise rigid, absolute, broad or extreme. For example, if I have got a pith belief that I am a fake, it agency that my pith belief is that I’m ever a fake, non that I’m sometimes, or inward some situations, or to some degree. Beck believes that these qualifiers do non apply to dysfunctional pith beliefs. The truth is that sometimes I am a fake, but that’s non what the pith belief says. No, the unconditional pith belief is that I am ever a fake. This is clearly non true, together with I tin strength out betoken to at to the lowest degree 3 times inward my life when I have got non been a fake. Sure, they were all dorsum inward the 1980’sm but nevertheless, they’re exceptions. If I had a express joy track, I’d hold upward playing it right now, but I don’t. Note to self, acquire a express joy track.
So, if nosotros are non aware of our pith beliefs, how do nosotros seat them? Beck suggests that nosotros tin strength out acquire to pith beliefs yesteryear identifying automatic thoughts. Freeman together with colleagues define automatic thoughts as: ‘spontaneous cognitions inward reaction to stimulus that leads to emotional responses”. For example, y'all acquire a seek dorsum together with y'all take in that y'all got an F. Your automatic thought powerfulness hold upward that I’m going to neglect the class. Now, y'all powerfulness non hold upward aware that y'all had the thought, but you’re likely going to hold upward aware of the feeling that follows. It could hold upward fear, sadness, or anger. Or it could hold upward relief together with happiness. Now, if it is relief together with happiness, this is exactly some other slice of supporting evidence that cognitive behavioral therapy has some validity. For example, your thought powerfulness hold upward ‘I loathe this class together with the alone excuse I would have got for dropping it is if I neglect the foremost test’. Then I would experience relief or happiness when I take in the failing grade. So, it’s non the grade that creates the feeling, but rather the intervening belief that informs how I volition experience nigh something. So, the way to acquire to pith beliefs is through automatic thoughts. It’s non plenty to modify my automatic thoughts though. In social club to really change, I have got to address my pith beliefs. Greenberg together with Padesky liken pith beliefs together with automatic thoughts to weeds inward a garden. The automatic thoughts are the weeds together with the pith beliefs are the roots. If y'all want to acquire rid of the weeds in 1 lawsuit together with for all, y'all have got to dig upward the roots. So, it’s non plenty to leave of absence the weed whacker together with locomote to town. If y'all cutting off the tops of the weeds, they’ll exactly grow dorsum again. Likewise, if y'all don’t bargain with the pith beliefs, your automatic thoughts volition exactly maintain coming back.
One technique that Beck uses to seat the pith beliefs is called the downward arrow technique. The way it plant is that your customer identifies a situation, doesn’t have got to hold upward a large bargain situation, it could hold upward anything where she had an emotional response. The goodness tidings nigh these pith beliefs is that they institute predictable patterns thence y'all are able to access pith beliefs using a multifariousness of situations. They don’t have got to hold upward intense, the most painful or the most pregnant ones. They could hold upward something modest similar ‘yeah, this guy yelled at me today’ or ‘I realize I showed upward for piece of work xv minutes late’. The downward arrow moves from the province of affairs you’re most aware of, which is the event, to regain the automatic thoughts, some of which y'all may hold upward aware of together with some y'all may non hold upward aware of, together with and thence ultimately regain the pith belief.
[27:30] The next dialogue is an instance of the downward arrow technique.
T: When Bob said he was likewise busy at piece of work to have got dinner with you, what went through your mind?
C: That he doesn’t want to hold upward with me.
(Ok, thence when he says ‘he doesn’t want to hold upward with me’, that’s an automatic thought. Notice that it is external, it’s nigh somebody else).
T: If that were true, that he doesn’t want to hold upward with you, what would that mean?
C: That he doesn’t attention enough.
(So, inward this 1 nosotros displace from his choice to argument nigh this person).
T: And what would that mean?
C: If he doesn’t love me, no 1 will.
(And at nowadays we’re moving deeper. He doesn’t really love me, nosotros displace deeper into his perception of his ain pith experience. We are getting closer to the pith belief).
T: And if it were true, that he didn’t attention enough, what would that mean?
C: That he doesn’t really love me.
(Ok, at nowadays he says, ‘if he doesn’t love me know 1 will’, this moves to the internal. This is nigh my client).
T: And what would that mean?
C: I’m unlovable.
(And finally nosotros acquire to the pith belief. This is my client’s pith belief nigh himself).
T: And what would that mean?
C: Just that, I’m unlovable. No 1 volition love me.
(Now if y'all noticed, he repeated that nobody else volition love me. When y'all acquire repetition, it agency y'all have got hitting bottom, that this is the client’s actual pith belief).
Using the phrase ‘what does that mean’ tin strength out acquire a piddling old. So, some variations include: ‘If that’s true, what’s thence bad about…’? Or, so, what’s the worst component about…’? Or, ‘so, what if…’ or ‘what does that hateful nigh you’? Beck recognizes that nosotros perceive situations correctly, but because of dysfunctional beliefs, nosotros tin strength out pull erroneous conclusions. The procedure that results inward right perceptions leading to erroneous conclusions is called cognitive distortion. Everyone has cognitive distortions, non exactly people with diagnosable mental illnesses. In his 1999 revised edition of “Feeling Good: The New Mood Therapy,” Burns identifies commonly observed cognitive distortions. One cognitive distortion is called dichotomous or ‘all or nothing’ thinking. In this cognitive distortion, things are seen inward mutually exclusive categories. All goodness or all bad. For example, I was seeing a span for couples counseling together with the beau was having problems with his girlfriend. Obviously, or they wouldn’t have got been inward span counseling. But nosotros were talking nigh a specific situation, together with my customer said that during the province of affairs his lady friend was mad at him. And because nosotros were inward a span counseling situation, I could plow to the lady friend together with inquire her, ‘Is it true? Were y'all mad at him?’ And she said yes. So, my customer correctly perceived that his lady friend was mad at him inward that situation. But, because he employed the cognitive distortion of ‘all or nothing’ thinking, he erroneously concluded that she was basically a hateful person. Once nosotros identified the cognitive distortion, together with thence nosotros were able to displace on from in that location together with intervene appropriately, recognizing where the customer had gone incorrect inward his thinking. Another type of cognitive distortion that Burns talks nigh is called mindreading. If your customer is employing the cognitive distortion of mindreading, they are thinking that they know what somebody else is thinking, without whatever supporting evidence.
I saw this cognitive distortion all the fourth dimension when I was working with kids inward schoolhouse settings. For example, I was working with this thirteen twelvemonth former called Manuel, who was suspended for fighting. When I asked him what happened, he said, “Raymond was looking at me disrespectfully”. When I asked him what made him think that the other nipper was disrespectful, my customer said, “Well, every fourth dimension I human face up, Raymond is looking at me”. So, this was an instance of mindreading because Manuel assumed that he knew what Raymond was thinking. And, inward fact, that Raymond was thinking disrespectful thoughts. The resultant of this cognitive distortion was a maladaptive emotional response. Manuel went from beingness annoyed to uncomfortable, irritated together with enraged. This faulty expectation nigh how Raymond should human activity resulted inward appropriate demeanour on the component of Manuel. Specifically, Manuel decided that he couldn’t represent this disrespect, thence he waited until after schoolhouse together with he jumped Raymond. It was really no surprise to Manuel, or to me, that he got suspended for jumping some other pupil after school. So, what do y'all do with this variety of situation? Well, cognitive-behavioral therapy supports the thought that y'all tin strength out intervene at the cognitive, affective or behavioral points inward this scenario. And they are all congruent with cognitive behavioral therapy. So, a cognitive intervention powerfulness start with a supportive argument like, ‘It sounds similar y'all think Raymond was dissing you’? If y'all are using rational emotive demeanour therapy perspective, y'all powerfulness create upward one's hear to challenge the irrational belief yesteryear saying, “I wonder what else powerfulness explicate him looking at you’? Or, ‘I wonder what Raymond thought when he saw y'all looking at him’?
If arguing doesn’t piece of work because of a lack of rapport or the customer gets angry or frustrated easily, y'all could take away Beck’s approach together with take in what thoughts, what pathways, to pith beliefs exist. You powerfulness usage the downward arrow technique together with ask, “So, what’s the worst affair that could occur if it were truthful that Raymond was dissing you? Or what does it say nigh y'all if someone is beingness disrespectful?” An intervention to aid emotions powerfulness hold upward to usage a feeling thermometer. The thought is to aid Manuel seat his feelings together with intervene before they escalate to the betoken of no return. And inward Manuel’s case, the betoken of no supply was rage. So, the way that it plant is that y'all would take away the feeling thermometer, which is essentially a slice of newspaper with a thermometer drawn on it together with say, ‘The bottom is when y'all experience cool. The top is when y'all experience hot. Just similar a existent thermometer.’ Then y'all would inquire Manuel to score on the thermometer where he would seat his feelings of beingness annoyed, escalating to beingness uncomfortable together with and thence to angry together with finally to beingness enraged. So together with thence y'all would speak nigh what things he could do to maintain the thermometer from rising. For example, when y'all experience annoyed, what sort of things would y'all hold upward able to do different?
Finally, y'all could usage the behavioral interventions to seat alternate to jumping Raymond, including: talking with a instructor or the schoolhouse social worker, mayhap waiting 24 hours before acting on his impulses, or having him play detective together with have got him maintain rails of the number of times Raymond is looking at him, when he looks at Raymond. You could also ready a mediated coming together betwixt Manuel together with Raymond to speak nigh the situation. In this way, y'all tin strength out address the emotional, the behavioral together with the cognitive yesteryear having Raymond answer to the accusation, ‘you’re beingness disrespectful’.
So, what do y'all do when these cognitive techniques don’t work? Michael Mahoney inward his 2003 text, “Constructive Psychotherapy: Influenza A virus subtype H5N1 Practical Guide” noted that cognitive methods worked best when people were willing together with able to hold upward aware of their self-talk. If cognitive therapy doesn’t seem to hold upward working, that is, the customer is unable to detach from the content together with the emotions associated with the province of affairs long plenty to seat or admit cognitive distortions, together with thence it is reasonable to measuring downwards to basic behavioral interventions. If Manuel together with I were talking shortly after the incident with Raymond, it powerfulness hold upward unreasonable to hold back an angry xiv years former to answer good to strictly cognitive interventions. The best choice powerfulness hold upward to start with the behavioral intervention with the intention of moving to a cognitive intervention after on.
Now, in that location are a number of other techniques used yesteryear cognitive behavioral therapists, including: problem-solving, assertion training, role-playing, together with imaginal techniques, such every bit having your customer imagine how she powerfulness think or experience inward the best or worst of situations. Cognitive behavioral therapists have got also developed a number of what I telephone yell upward newspaper together with pencil interventions. These are oft practiced in-sessions, but assigned every bit homework together with commonly take away the shape of a sail of newspaper where the customer fills inward data nigh events, beliefs, automatic thoughts, feelings, rational responses together with alternate choices. Freeman together with colleagues write nigh together with include many examples of these types on interventions inward their text, “Clinical Applications of Cognitive Therapy”. The interventions together with techniques mentioned inward this department are exactly the tip of the iceberg for what’s available through cognitive behavioral therapy.
If y'all are interested inward learning to a greater extent than nigh interventions together with techniques, I advise doing a Google search or Amazon.com search on books having to do with cognitive behavioral therapy. I’m partial to the Freeman text. I experience that it’s a real practical together with logical step-wise approach to working with folks. If y'all are working with folks that are suicidal, Rudd together with colleagues (1999) published a mass that deals with cognitive behavioral therapy together with handling together with management of suicidal behaviors. And beyond that, in that location are cognitive behavioral handling manuals for folks with obsessive compulsive disorder, panic attacks. David Barlow has an entire serial of practitioners’ guides to treating a multifariousness of dissimilar disorders. I think it’s from Guilford Press, but I could hold upward wrong. I haven’t double checked that. So, the betoken is in that location are a lot of resources out in that location that y'all tin strength out reveal to larn nigh specific interventions or techniques for specific populations.
[38:20] As nosotros displace into the finally component of this podcast, I’d similar to speak nigh the usage of CBT inward culturally competent. Then halt with some strengths together with limitations of CBT, specially with an oculus towards its usage inward social piece of work practice. Gerald Corey’s text, “Theory together with Practice of Counseling together with Psychotherapy” discusses some of the strengths together with limitations of CBT inward culturally competent practice. Corey notes that CBT has the wages of spending the fourth dimension to indentify a client’s pith beliefs, rather than making assumptions of what people believe based on how they human face or what neighborhoods they come upward from. The pregnant work concern nigh mental wellness handling is that multi-cultural populations tend to usage less services that the bulk White culture. And they tend to study lower rates of satisfaction with the services they do receive. CBT addresses these concerns somewhat yesteryear having handling that is fairly structured together with organized. This emphasizes practical solutions, increasing participation rates together with overall satisfaction with services. In my ain practice, I have got found that CBT is useful inward bridging cultural gaps because it’s connecting for my clients to know that irrational together with distorted thoughts are experienced yesteryear everyone, from the most privileged together with powerful to the most marginalized together with dis-empowered. I have got also found that it sometimes is easier for my culturally various clients to hold upward honest nigh beliefs having to do with mistrust of dominant civilization when using a CBT approach. As a White man, I want to know if my African-American teenage customer believes that White people are non to hold upward trusted. I also want to know if this belief is shared together with supported yesteryear his community or if this is born of personal experience, or mayhap both. Knowing the divergence would influence how I would proceed inward my treatment.
There are a number of limitations of CBT inward culturally competent practice. The foremost is in that location is an emphasis on challenging clients’ beliefs together with labeling thoughts every bit irrational together with this tin strength out hold upward perceived every bit an irresponsible usage of power. For example, if my customer came inward together with said that he didn’t trust White people together with I called that an over-generalization, I could real chop-chop lose whatever existing rapport together with likely pigment a bad film of what social workers are similar together with what therapy is. More importantly, however, I would hold upward ignoring the social context that informed those cultural beliefs. Influenza A virus subtype H5N1 2nd limitation is that some of the techniques, such every bit challenging beliefs, powerfulness hold upward inward conflict with clients that have got a grouping or work solid unit of measurement vs. private orientation. As a privileged White male, I am expected to hold upward an private who could challenge others together with hold upward competitive to my ain advantage. That powerfulness non hold upward the instance for many of my non-White clients. Influenza A virus subtype H5N1 finally limitation is that the didactic or teaching orientation of CBT tin strength out ready an expectation that the therapist volition solve the problems for the client, especially if the customer comes from a civilization where the opinions of professionals are held inward high regard.
Now, the finally component of this podcast is a human face at the strengths of CBT together with some of the limitations, specially every bit far every bit social piece of work is concerned. So, 1 of the strengths of CBT is the thought that events do non crusade us to hold upward happy or unhappy; Rather, it is our perception of the event. Clients locomote their ain teachers inward a CBT model. It’s an empirically validated handling for depression, anxiety, phobias, obsessive compulsive disorder, eating disorders, together with a number of other psychosocial disorders that nosotros address inward social piece of work practice. And because of the large amount of data available, CBT is an accessible model of intervention for both novice together with experienced practitioners. The emphasis tends to hold upward on measurable outcomes together with that makes it a lot easier to document together with to hold upward accountable, both to your clients together with to the 3rd political party payers. Because it targets specific problems, CBT is ordinarily short-term together with that’s a feature desired yesteryear both clients together with 3rd political party payers. Targeting specific problems enables handling to hold upward individualized. This is a pith value of social work. It tin strength out hold upward used with individuals, families together with groups, something that social workers do all of. It supports the social piece of work value of self-determination together with the client’s active involvement is consistent with social work’s empowerment approach. Finally, the techniques are portable. Because social workers are oft inward the acre with clients, nosotros tin strength out implement CBT techniques inward the hither together with now, regardless of the setting.
Some of the limitations include that: the focus is on problems rather than solutions. Another limitation is every bit nosotros mentioned inward damage of culturally competent practice, it tin strength out hold upward confrontational together with that tin strength out hold upward off-putting or seen every bit culturally insensitive. Therapists tin strength out acquire caught upward inward technique over rapport together with therapeutic alliance. Another limitation is the peril of imposing the therapist’s thought of what constitutes rational thinking. Another limitation is the critique or criticism that CBT is merely the powerfulness of positive thinking at work. Really, it’s non y'all environment, it’s non your neighborhood, it’s non policies that are causing y'all to hold upward unhappy, it’s exactly because you’re thinking you’re unhappy. Think positively together with y'all volition hold upward happy. Well, CBT is non that simplistic, but it tin strength out hold upward a limitation if the therapist is non adequately trained together with grounded inward the theory together with knowledge nigh how to contain the external with the internal. Another limitation is that CBT tin strength out minimize feelings, although doesn’t necessarily have got to. CBT assumes an objective reality together with nosotros sort of alluded to this before, where nosotros were talking nigh Mahoney’s constructivist theory, where the thought is that constructivists believe that nosotros build our ain realities. Folks similar Ellis state in that location is some variety of objective reality from which nosotros tin strength out create upward one's hear that something is rational or irrational. Now, to Ellis’ credit, he did say that essentially, I am a constructivist; although, I’m non really for sure how that fits with his model. But nevertheless, the finally limitation of cognitive behavioral therapy is that it assumes that the demeanour volition modify if clients larn to human activity rationally. And every bit nosotros all know, thinking rationally nigh something is no guarantee that behaviors are going to hold upward rational or that people volition fifty-fifty necessarily experience amend nigh themselves.
In sum, cognitive behavioral therapy is a collection of therapies, all of which assume that people’s behaviors together with their feelings are influenced yesteryear the way they think nigh events. Events don’t crusade us to believe or think or experience or human activity inward a for sure way. Rather, it’s the perception of those events. CBT is perhaps best known for its broad multifariousness of techniques together with interventions, some of which address cognitive, some of which address affective, together with yet others pull from behavioral therapy to address behaviors. Finally, cognitive behavioral therapy contributes a lot to culturally competent exercise together with although it has strengths together with limitations, it is currently the handling intervention (or serial of interventions) they have got that have got the most evidence base of operations to back upward their efficacy.
[47:11: END]
References
Bandura, A. (1977). Social learning theory. Englewood Cliffs, N.J.: Prentice-Hall.
Burke, J. F. (1989). Contemporary approaches to psychotherapy & counseling: The self-regulation together with maturity model. Belmont, CA: Wadsworth Press.
Burns, D. D. (1999). Feeling good: The novel mood therapy (Rev. ed). New York: Avon.
Corey, G. (2005). Theory together with exercise of counseling together with psychotherapy (7th ed). Belmont, CA: Wadsworth/Thomson.
Dattilio, F. M., & Goldfried, M. R. (1998). Case studies inward span together with work solid unit of measurement therapy: Systemic together with cognitive perspectives. New York: Guilford Press.
Freeman, A., Pretzer, J., Fleming, B., & Simon, K. M. (2004). Clinical applications of cognitive therapy (2nd ed. ed.). New York: Kluwer Academic/Plenum Publishers.
Rudd, M. D., Joiner, T. E., & Rajab, M. H. (2001). Treating suicidal behavior: An effective, time-limited approach. New York: Guilford Press.
Rychlak, J. F. (1981). Introduction to personality together with psychotherapy (2nd ed.). Boston: Houghton Mifflin Company.
Tomb, M., & Hunter, L. (2006). Effective interventions for students with obsessive-compulsive disorder. In C. Franklin, M. B. Harris & P. Allen-Meares (Eds.), The schoolhouse services sourcebook: Influenza A virus subtype H5N1 guide for school-based professionals (pp. 89-109). New York: Oxford University Press.
Vonk, M. E., & Early, T. J. (2002). Cognitive-behavioral therapy. In A. R. Roberts & G. J. Greene (Eds.), Social workers' desk reference (pp. 116-120). New York: Oxford University Press.
APA (6th ed) citation for this podcast:
Singer, J. B. (Host). (2008, March 19). Cognitive-behavioral therapy [Episode 14]. Social Work Podcast. Podcast retrieved Month Day, Year, from /search?q=behavior-therapy
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