1. Theory and Practice of Counseling and Psychotherapy TENTH EDITION
Gerald Corey
Cengage Learning

2. Cognitive Behavior Therapy
Chapter 10
Cognitive Behavior Therapy

3. Cognitive Behavioral Approaches (slide 1 of 2)
The various cognitive behavioral approaches share the following attributes:
A collaborative relationship between client and therapist
The premise that psychological distress is often maintained by cognitive processes
A focus on changing cognitions to produce desired changes in affect and behavior
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (1)

4. Cognitive Behavioral Approaches (slide 2 of 2)
The various cognitive behavioral approaches share the following attributes:
A present-centered, time-limited focus
An active and directive stance by the therapist
An educational treatment focusing on specific and structured target problems
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (2)

5. Albert Ellis’s REBT Rational Emotive Behavior Therapy (REBT)
Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship
Is highly didactic and directive
Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (3)

6. REBT: An Educational Process
Clients learn to identify the interplay of their thoughts, feelings, and behaviors and to identify and dispute irrational beliefs maintained by self-indoctrination
Clients learn to stop absolutistic thinking, blaming, and repeating false beliefs and replace ineffective ways of thinking with effective and rational cognitions
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (4)

7. The A-B-C Theory of Personality
Activating
event B
Belief C
Consequence D
Disputing intervention E
Effective philosophy F
New feeling
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (5)

8. Irrational Beliefs
Three basics MUSTS we internalize that inevitably lead to self-defeat:
“I MUST do well and be loved and approved by others.”
“Other people MUST treat me fairly, kindly, and well.”
“The world and my living conditions MUST be comfortable, gratifying, and just, providing me with all that I want in life.”
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (6)

9. Therapeutic Goals
To help clients differentiate between realistic and unrealistic goals and between self-defeating and life-enhancing goals
To assist clients in the process of achieving:
Unconditional self-acceptance (USA)
Unconditional other-acceptance (UOA)
Unconditional life-acceptance (ULA)
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (7)

10. Therapeutic Techniques (slide 1 of 2)
Therapists practicing REBT use the following techniques:
Disputing irrational beliefs
Doing cognitive homework
Bibliotherapy
Changing one’s language
Psychoeducational methods
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (8)

11. Therapeutic Techniques (slide 2 of 2)
Therapists practicing REBT use the following techniques:
Rational emotive imagery
Using humor
Role playing
Shame-attacking exercises
Standard behavior therapy procedures
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (9)

12. Application of REBT to Group Counseling (slide 1 of 2)
Tailored for specific diagnoses such as anxiety, panic, eating disorders, and phobias
Treatments are standardized and based on empirical evidence
Use of homework allows lessons learned in group to generalize to the client’s daily environment
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (10)

13. Application of REBT to Group Counseling (slide 2 of 2)
Group REBT affords many opportunities to
Practice assertiveness skills
Take risks by practicing different behaviors
Challenge self-defeating thinking
Learn from the experiences of others
Interact therapeutically and socially with each other in after-group sessions
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (11)

14. Aaron Beck’s Cognitive Therapy (slide 1 of 2)
Insight-focused therapy with an emphasis on changing negative thoughts and maladaptive beliefs
Clients’ distorted beliefs are the result of cognitive errors
Psychological problems are an exaggeration of adaptive responses resulting from commonplace cognitive distortions
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (12)

15. Aaron Beck’s Cognitive Therapy (slide 2 of 2)
Through Socratic dialogue/reflective questioning, clients test the validity of their cognitions (collaborative empiricism)
Change results from reevaluating faulty beliefs based on contradictory evidence that clients have gathered
Hundreds of studies have confirmed the theoretical underpinnings of CT and established its efficacy for a wide range of psychiatric disorders
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (13)

16. Theoretical Assumptions
People’s internal communication is accessible to introspection
Clients’ beliefs have highly personal meanings
These meanings can be discovered by the client rather than being taught or interpreted by the therapist
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (14)

17. CT’s Cognitive Distortions
Personalization
Labeling and mislabeling
Dichotomous thinking
Arbitrary inferences
Selective abstraction
Overgeneralization
Magnification and minimization
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (15)

18. Negative Cognitive Triad
Pattern that triggers depression:
Clients hold negative views of themselves
“I am a lousy person”
Selective abstraction
Client interprets life events through a negative filter
“The world is a negative place where bad things are bound to happen to me”
Client holds a gloomy vision of the future
“The world is bleak and it isn’t going to improve”
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (16)

19. Applications of Cognitive Therapy
The length and course of CT varies greatly and is determined by the therapy protocols used for specific diagnoses
Examples:
CT for depression: lasts 16 to 20 sessions and begins with behavioral activation
CT for panic disorder: lasts 6 to 12 sessions and targets catastrophic beliefs about internal physical and mental sensations
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (17)

20. Strengths-Based Cognitive Behavioral Therapy
Developed by Christine Padesky and Kathleen Mooney,
S-B CBT is a variant of Aaron Beck’s cognitive therapy
Involves identifying and integrating client strengths at each phase of therapy
Active incorporation of client strengths encourages clients to engage more fully in therapy and often provides avenues for change that otherwise would be missed
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21. Applications for Strengths-Based CBT
An add-on for classic CBT
A four-step model to build resilience and other positive qualities
The NEW paradigm for chronic difficulties and personality disorders
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (19)

22. Donald Meichenbaum’s Cognitive Behavior Modification
Focus:
Client’s self-statements or self-talk
Premise:
As a prerequisite to behavior change, clients must notice how they think, feel, and behave, and what impact they have on others
Basic assumption:
Distressing emotions are typically the result of maladaptive thoughts
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23. Meichenbaum’s CBM Self-instructional therapy focus:
Trains clients to modify the instructions they give to themselves so that they can cope more effectively
Emphasis is on acquiring practical coping skills
Cognitive structure:
The organizing aspect of thinking, which seems to monitor and direct the choice of thoughts
The “executive processor”
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (21)

24. Behavior Change in CBM Three phases of behavior change
1. Self-observation
Starting a new internal dialogue
Learning new skills
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (22)

25. Meichenbaum’s Stress Inoculation training
SIT is a three-phase coping skills program
1. The conceptual-educational phase
2. Skills acquisition and skills consolidation phase
3. Application and follow-through phase
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26. Cognitive Narrative Approach to CBT
Focuses on the plots, characters, and themes in the stories people tell about themselves and others
Meichenbaum claims that we are all “story tellers”
In therapy, clients learn how they construct reality, examine the implications and conclusions they draw from their stories, and develop resilient-engendering behaviors
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27. Strengths from a Diversity Perspective
CBT uses the individual’s belief system, or worldview, as part of the method of self-exploration
Emphasis on cognition and action, and on relationship issues appeals to clients from diverse backgrounds
CBT and multicultural therapy share common assumptions that make integration possible
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28. Limitations from a Diversity Perspective (slide 1 of 2)
REBT’s negative view of dependency clashes with the view of interdependence as necessary to good mental health
The “rapid-fire active approach,” used by some clinicians may alienate those who value being reflective
Terms such as “irrational” or “maladaptive” may seem disrespectful and insensitive to clients who have felt marginalized in society
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29. Limitations from a Diversity Perspective (slide 2 of 2)
The emphasis on assertiveness, independence, verbal ability, rationality, cognition, and behavioral change may limit CBT’s use in cultures that hold different values
Inexperienced therapists may overemphasize cognitive restructuring to the neglect of environmental interventions
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30. Contributions of CBT (slide 1 of 2)
Both Ellis’s REBT and Beck’s CT represent the most systematic applications of CBT
The approaches are relatively brief and structured treatments that are cost effective
The cognitive behavioral theorists have demystified the therapy process
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31. Contributions of CBT (slide 2 of 2)
The credibility of this model grows out of the fact that many of its propositions have been empirically tested
All cognitive behavioral approaches place emphasis on practicing new skills both in therapy and in daily life, and homework is a key part of the learning process
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32. Limitations of CBT Extensive training is required to practice CBT
Therapists may misuse power by imposing their ideas of what constitutes “rational” thinking on a client
The strong confrontational style of Ellis’s REBT may overwhelm some clients
Some clinicians think CBT interventions overlook the value of exploring a client’s past experiences
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