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A Perspective on Cognitive Behavioral Therapy
By: Elizabeth Horwin, LPC
Cognitive-behavioral therapy (CBT) is a type of counseling aimed at teaching the client how to become healthier and experience a more satisfying, fulfilling lifestyle by modifying certain thought and behavior patterns. It is based on the theory that thought and behavior can affect a person's symptoms and be an obstacle to recovery. CBT can be helpful in treating a variety of problems, including depression, anxiety and panic disorders, dealing with life event such as: death, divorce, disability, unemployment, issues with children and mounting stress.
In CBT, the therapist and client work together to identify and change negative thinking and behavior patterns that may contribute to emotional and/or physical illness. The focus in therapy is to alter and change these thoughts or self-talks which express one’s beliefs and perceptions. Cognitive approaches focus on replacing one thought, belief, or form of self-talk with another (e.g. my life is miserable, to I have purpose in life). Therapy also focuses on teaching the client more positive ways of thinking about and coping with not only illness but also life events and relationships.
To Provide a Simple Definition: Cognitive Counseling focuses on Monitoring and Managing your thinking patterns. This counseling would focus on reducing negative thinking and changing the content of thoughts so that it results in more positive emotions. Behavioral Counseling focuses on what actions the client takes, what rewards are in place that encourages the client to act a certain way and what unpleasant consequences prevent the client from behaving in other ways.
The process of CBT helps the client identify and correct specific errors in what he or she is thinking that results in painful and negative feelings. These distorted thoughts influence the client on an emotional and behavioral level. In treating a person who is experiencing psychological difficulties, I find that the most effective point of intervention is at the level of the person's thoughts that are causing pain. If changes are made in thinking process, (e.g. assumptions, beliefs, values) changes in emotions and behavior will follow. I utilize various behavioral techniques and strategies as needed to enhance the treatment outcome (e.g., anger management, meditation, relaxation training, and assertiveness training).
Unlike many traditional counseling processes, CBT focus on outcomes and goals. Results include a briefer counseling process in which the client experiences relatively rapid relief and enduring progress. CBT is a simple model and has proven to be a powerful and successful type of psychological treatment in outcome studies conducted over the past several decades.
Currently enjoying widespread popularity, CBT is practiced by many qualified professionals throughout the United States and internationally. I believe this type of counseling is most effective in dealing with individuals who are bright, rational and desire to have passion and enjoyment in their life. It is my opinion that this counseling does not work with individuals who want to stay in a victim role or spend their time blaming others for what’s not going right in their life. It takes courage and a willingness to say, "Whatever happened to me before I couldn’t do anything about, it is as it is, but now I am responsible for how I react to what has happened to me, what is happening to me and how I want to continue living my life." The work, the effort, the fortitude of my clients continues to amaze and humble me---even after all of these years.
History:
CBT can be traced to early pioneers of psychology, but cognitive counseling, as it is practiced today was developed in the fifties and sixties. Throughout the seventies, the cognitive and behavioral schools were joined by thinkers and practitioners into cognitive-behavioral counseling. Beginning in the eighties and continuing through today, there has been a growing interest in cognitive-behavioral counseling because of its proven effectiveness and because this form of treatment can be administered in a briefer amount of time than traditional psychoanalysis or psychotherapy. For example, Dr. Phil is a cognitive behavioral therapist. Of course, he doesn’t provide treatment during his successful TV show, but only identifies the problem and sometimes presents therapy options (even offering to pay for them) to his guests.
Process:
CBT, the therapy process takes many forms. In fact, there are at least 60 variations depending on who you talk to. If you are doing TRADITIONAL cognitive-behavioral work, you do a lot of writing. The writing involves recording thoughts and counting behaviors, scaling emotions (e.g. on a scale of 1 to 100, where 1 is completely calm and 100 is out-of-control angry, where are you on this scale?), labeling categories of thoughts or behaviors, and writing alternative ways of thinking. I realize that cognitive-behavioral counseling is research proven; however, the rigidity of a strictly traditional method doesn’t work for me or my clients. Yes, my clients do a lot of writing, journaling, taking their thoughts from their mind and concretizing them on paper, setting clear goals and outcomes---they do that, but every client will resonate to their own method of working through the process and I must and will stay flexible to what works for them.
My focus in the counseling process includes:
• Assisting a client in recognizing, analyzing and managing their beliefs;
• Allowing the client to rely on his or her memory, and validate that memory;
• Placing a large emphasis on the client’s belief in who they are and what their purpose and place is in this world;
• Keeping the focus on increasing "satisfaction with life" rather than on decreasing negative emotions;
• Teach, Educate, Teach----giving them the opportunity to re-examine what they have been told (e.g., "you aren’t going to amount to much") to what in reality is true about themselves;
• Identifying and practicing skills (e.g., including goal-setting and problem-solving);
• Continuing to do this work on a long term basis after the counseling process is over.
Conclusion:
As I was pursuing my education in Psychology, I hit a road block because back in the 60’s the education system that I was involved in wanted me upon graduation to ascribe to a particular theory of counseling that I would practice once I graduated. I couldn’t find one that I could totally follow. I was someplace between Gestalt, Client-centered counseling, Jung and Cognitive Therapy. Since completing my education and working in corporate American for over thirty years, I have taken bits and pieces from different counseling theories, to provide services as a counselor, consultant, teacher and trainer.
In my private practice the core model that I ascribe to is cognitive behavioral therapy, but not in the traditional sense. I incorporate what I consider the best outcomes from various counseling theories and adapt them to the CBT model that best services the needs of the individual or family I am serving.
In order to assess whether the counseling service I offer is beneficial and will help the individual or family, I offer to potential clients an initial complimentary consultation to discuss the process and objectives of cognitive behavioral counseling, to determine if my services can help them and to discuss compensation for these services.
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